Evidence for a Role of Gut Microbiota and Probiotics in Aneurysmal Pathogenesis and Possible Therapeutics: A Systematic Review of the Literature.

Introduction: Several studies investigated the implication of the gut microbiota (GM) in the formation and progression of aneurysms, suggesting a key role for GM metabolites in aneurysmal pathogenesis and prognosis.

Aim: This systematic review aims to collect key findings concerning the impact of gut bacterial compositions, GM-related metabolites, probiotics administration, and inflammatory markers in aneurysmal development and rupture.

Methods: A PubMed, Medline, Embase, and Web of Science database search was conducted in accordance with PRISMA guidelines for systematic reviews, targeting all studies assessing the GM's role in aneurysms till 2023.

Results: Data from 19 out of 292 non-duplicated studies were included. Based on the published literature, aneurysmal incidents in several locations were accompanied by an alteration in specific intestinal bacteria that may affect the prognosis of the aneurysm. The gut dysbiosis was also accompanied by modifications in the metabolic pathways. Hence, the administration of specific probiotics showed a significant implication in reversing the GM-related changes that were affecting the aneurysm, leading to a decrease in its severity, a better prognosis, and even serving as a prophylactic approach.

Conclusions: The outcomes of this review highlight the role of GM in the pathogenesis of aneurysms, assessing some involved mechanistic pathways such as gut dysbiosis, inflammation, and the alteration of gut-derived metabolites levels, which orient new research on developing therapeutic strategies.