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REVIEW ARTICLE

Microbiota–gut–brain axis: Modulation of gut microbiota in the management of Alzheimer’s disease

Hui Jiang1,2 ,  Manman Chen1,3 ,  Siew C. Ng1,3 ,  Zhilu Xu1,3* ,  Allen Ting Chun Lee2*
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1 Microbiota I-Center, Hong Kong SAR, China
2 Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
3 Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
MI, 025310069 https://doi.org/10.36922/MI025310069
Received: 31 July 2025 | Revised: 28 August 2025 | Accepted: 9 September 2025 | Published online: 22 October 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Insights into the role of the gut microbiota are advancing our understanding of Alzheimer’s disease (AD), which is the most common cause of dementia and a condition characterized by progressive cognitive decline and pathological hallmarks such as amyloid beta (Aβ) plaques and neurofibrillary tangles. The gut microbiota, composed of diverse microorganisms, influences brain health through the microbiota–gut–brain axis. This review outlines how alterations in gut microbial composition and metabolites occur across different stages of cognitive decline. The microbiota–gut–brain axis mediates interactions between the gut and brain, influencing neuroinflammation, Aβ accumulation, tau pathology, and oxidative stress. Therapeutic strategies targeting gut microbiota, including diet modulation, probiotics, prebiotics, synbiotics, microbial metabolites, and fecal microbiota transplantation, have shown potential in improving cognitive function in clinical and animal studies. Despite these advances, challenges remain in addressing individual variability, standardization, and long-term safety. Personalized microbiota-based interventions may provide promising tools for the diagnosis, prevention, and treatment of AD.

Keywords
Alzheimer’s disease
Gut microbiota
Microbiota–gut–brain axis
Therapeutic strategies
Funding
None.
Conflict of interest
Zhilu Xu is Scientist (Diagnostics) of GenieBiome Ltd. Siew C. Ng has served as an advisory board member for Pfizer, Ferring, Janssen and Abbvie and received honoraria as a speaker for Ferring, Tillotts, Menarini, Janssen, Abbvie and Takeda; has received research grants through her affiliated institutions from Olympus, Ferring and Abbvie; is a founder member, non-executive director, non-executive scientific advisor and shareholder of GenieBiome Ltd which is non-remunerative; is a shareholder of MicroSigX Diagnostic Holding Limited; is a founder member, non-executive Board Director, and non-executive scientific advisor of MicroSigX Biotech Diagnostic Limited, which is non-remunerative; and receives patent royalties through her affiliated institutions; is a named inventor of patent applications held by The Chinese University of Hong Kong and MagIC that cover the therapeutic and diagnostic use of the microbiome. All other authors declare that they have no conflicts of interest.
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Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing
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