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Gut microbiota and sleep: Interaction mechanisms and therapeutic prospects

  • Zhonghui Lin , Tao Jiang , Miaoling Chen , Xudong Ji and Yunsu Wang EMAIL logo
Published/Copyright: July 18, 2024
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Open Life Sciences
From the journal Open Life Sciences Volume 19 Issue 1

Abstract

Sleep is crucial for wellness, and emerging research reveals a profound connection to gut microbiota. This review explores the bidirectional relationship between gut microbiota and sleep, exploring the mechanisms involved and the therapeutic opportunities it presents. The gut–brain axis serves as a conduit for the crosstalk between gut microbiota and the central nervous system, with dysbiosis in the microbiota impairing sleep quality and vice versa. Diet, circadian rhythms, and immune modulation all play a part. Specific gut bacteria, like Lactobacillus and Bifidobacterium, enhance sleep through serotonin and gamma-aminobutyric acid production, exemplifying direct microbiome influence. Conversely, sleep deprivation reduces beneficial bacteria, exacerbating dysbiosis. Probiotics, prebiotics, postbiotics, and fecal transplants show therapeutic potential, backed by animal and human research, yet require further study on safety and long-term effects. Unraveling this intricate link paves the way for tailored sleep therapies, utilizing microbiome manipulation to improve sleep and health. Accelerated research is essential to fully tap into this promising field for sleep disorder management.

Keywords: gut microbiota; sleep disorder; bidirectional relationship; mechanisms; therapeutic interventions; personalized medicine

1 Introduction

Sleep, an essential physiological process, is now recognized as a crucial regulator of our gut microbiome – the intricate ecosystem residing within us, demonstrating an unexpected yet profound interplay between microscopic inhabitants and our sleep. Disruptions in sleep patterns, such as insomnia or sleep deprivation, not only impair cognitive function and emotional wellbeing [1,2] but also trigger a cascade of biological perturbations that reverberate throughout the body [3,4], particularly affecting the delicate balance of the gut microbiota [5]. This intimate link poses intriguing questions about the potential of modulating gut microflora as a therapeutic avenue for mitigating sleep disorders.

The gut microbiota, a complex consortium dominated by bacteria from phyla Firmicutes, Bacteroidetes, and others, operates in a delicate harmony vital for maintaining homeostasis [6]. This equilibrium, however, is fragile and easily upset by lifestyle factors, including sleep habits, diet, and stress, among others [7–9]. The gut–brain axis, a bidirectional communication network, facilitates the microbiota’s influence on host physiology, including sleep regulation, underscoring the microbiome’s centrality in holistic health.

Recent scientific inquiries have uncovered a reciprocal relationship: while disrupted sleep patterns can disturb the gut microbiota, leading to dysbiosis and subsequent health implications, an imbalance in the microbiome can also exacerbate sleep issues, perpetuating a detrimental cycle [10–12]. This reciprocal symbiosis highlights the criticality of a balanced gut microbiome to overall health and underscores sleep as a pivotal modulator.

Given the established correlations and the potential for translational applications, exploring the precise mechanisms governing the gut microbiota-sleep axis becomes imperative. This review synthesizes the latest advancements in our understanding of the intricate dance between sleep disorders and the gut microbiome, aiming to distill the essence of this complex relationship. By illuminating these pathways, we strive to pave the way for targeted interventions in sleep medicine, emphasizing the potential of gut microbiota manipulation as a promising frontier in addressing sleep disturbances. Understanding these dynamics is not merely academic; it holds the key to transforming clinical practices, offering hope for novel, microbiome-centered therapies to restore sleep health and, consequently, enhance overall wellbeing.

2 The impact of sleep disorders on the gut microbiota

The composition of the gut microbiota is host-specific, shifting over an individual’s lifespan and readily susceptible to both environmental and intrinsic factors. The changes in gut microbiota exhibit clear circadian rhythms. Accumulating scientific evidence underscores a profound interconnection between the oscillations of human sleep-wake cycles and the gut’s microbial communities. Various sleep disorders have been shown to disrupt the circadian rhythms of gut microbiota, leading to ecological imbalances (Table 1), which, in turn, exacerbate sleep problems and contribute to the development of complications, including chronic inflammation, cardiovascular, and cerebrovascular diseases.

Table 1

An overview of studies examining gut microbiota changes in sleep disorders

Models Subjects Sample size Major findings of gut microbiota Reference
Disruption of circadian rhythms
Jet-lag C57Bl/6 mice (8–9 weeks old) 10 mice/group Increase in the Paraprevotella, Fusobacteria, and Fusobacteriales. Decrease of the Christensenellaceae, Dorea, Anaeroplasmatales, Anaeroplasmataceae, Anaeroplasma, Lactobacillus, Lactococcus, RF32, Alphaproteobacteria, Proteobacteria, Ruminococcus, and Ligilactobacillus ruminis. Promotes glucose intolerance and obesity [14]
Jet-lag C57BL/6J mice (8–10 weeks old) 6 mice/group Decreased in the microbial abundance, richness, and diversity [16]
Decreased in the Bacteroidetes phylum
Increased in the F/B ratio and Actinobacteria phylum
Decreased in the levels of tryptophan and its derivatives in fecal samples
Sleep–wake cycle shift Human beings (aged 20–35 years) 22 volunteers Increased in the F/B ratio [17]
Increased in the phyla Fusobacteria and Tenericutes and classes
Fusobacteriia and Mollicutes. Decreased in the order Pasteurellales and family Clostridiales, Peptostreptococcacea. Changed in the functional profile of gut microbiota Changed in the microbial networks
OSAS
OSAS C57BL/6 mice (6 weeks old) 8 mice/group Increased in the α-diversity and β-diversity [20]
Enrichment in the Firmicutes
Decreased in the Bacteroidetes and Proteobacteria phyla
OSAS Human beings (aged 2–12 years) 16 children (7 OSASs and 8 controls) Decreased in the gut microbial diversity [21]
Increased in the Bacteroides fragilis
Pro-inflammatory strains (including Proteobacteria, Clostridiaceae, Oscillospiraceae, and Klebsiella) are increased
OSAS, hypertension (HTN) Human beings (adults) 52 (9 controls, 17 OSAS only, 5 HTN only, and 21 OSAS + HTN) Increased in the F/B ratio [22]
OSAS had higher Ruminococcus_1, Lachnoclostridium, Lachnospira, Ruminococcus_torques_group, and unidentified Lachnospiraceae levels than those without OSA
In OSA patients, hypertensive patients had lower Faecalibacterium and Lachnospiraceae_NK4A136_group levels
OSAS Human beings (adults) 113 volunteers (93 OSASs and 20 controls) Decreased in SCFA-producing bacteria and increased in pathogens [23]
Decreased in Megamonas, Ruminococcaceae, Alistipes, Dialister
Oscillibacter
Elevated levels of IL-6
OSAS Human beings (adults) 48 (37 OSAS and 11 control) Enriched Fusobacterium, Megamonas, and Lachnospiraceae UCG_006 and reduced Anaerostipes in patients with severe OSA [24]
Sleep fragmentation
Sleep fragmentation C57BL/6J mice (8 weeks old) 60 (30 mice/group) Increased of food intake [25]
Enrichment of highly fermentative members of Lachnospiraceae and Ruminococcaceae
Decreased in Lactobacillaceae families
Acute sleep deprivation C57BL/6J mice (age: 7 weeks) 20 (10 mice/group) Increased in food intake, yet decreased in the body weight [26]
Decreased in the αand β-diversity of gut microbiota
Increased of the Candidatus_Arthromitus and Enterobacter
Decreased in the Lactobacillus
Muribaculum, Monoglobus, Parasutterella
Sleep fragmentation Sprague-Dawley rats (4 weeks old) 9–12 mice/group Significant perturbations in alpha- and beta-diversity [27]
Acute SF: decrease in the Lactobacillaceae, Lachnospiraceae, F16, and Alcaligenaceae families; increase in S24-7 and Porphyromonadaceae families in the distal ileum
Chronic SF: decrease in Enterobacteriaceae and Lactobacillaceae Families; increase in Turicibacteraceae and Clostridiaceae families
Sleep deprivation C57BL/6J mice (age: 8 weeks) 30 (10 mice/group) Increased of Tannerellaceae, Rhodospirillales, Alistipes, and Parabacteroides in SD mice [28]
Sleep deprivation Humans 25 volunteers Decreased in the a-diversity of gut microbiota [29]
Decreased of g_Prevotella, g_Sutterella, g_Parasutterella, g_Alloprevotella, g_Anaeroplasma, and g_Elusimicrobium
Decreased of the concentration of the SCFAs (including acetate, propionate, and butyrate) in fecal samples
Narcolepsy
Narcolepsy type 1 (NT1) Humans 35 patients and 41 controls No between-group differences for alpha diversity [30]
Decreased in Bacteroidetes, Bacteroides, and increased of Flavonifractor
NT1 Humans 20 NT1 patients and 16 controls No differences in alpha and beta diversity were observed between the two groups [31]
Enrichment of the Klebsiella
Decreased in the Blautia, Barnesiellaceae, Barnesiella, Phocea, Lactococcus, Coriobacteriia, Coriobacteriales, Ruminiclostridium_5, and Bilophila
Insomnia
Acute and chronic insomnia Humans 20 acute insomnia (AID), 38 chronic insomnia (CID), and 38 healthy controls (HC) Insomnia patients vs HC: lower microbial richness and diversity, depletion of anaerobes, and SCFA-producing bacteria, and an expansion of potential pathobionts. [32]
AID vs HC: decreased abundance in Faecalibacterium, Prevotella 9, and Roseburia, and increased abundance in Blautia and Eubacterium hallii.
CID vs HC: increased abundance in Bacteroides and decreased abundance in Lachnospira.

2.1 Disruption of circadian rhythms

Maintaining a normal circadian rhythm is vital to individual physical and mental well-being, and circadian rhythm disruption is a significant risk factor for diseases such as obesity and type 2 diabetes [13]. Observations in the normal human body have revealed that over 60% of gut microbiota composition adheres to oscillatory rhythms, with approximately 20% of mouse gut commensals and 10% of human gut commensals demonstrating clear circadian variability [14]. Species in the human gut microbiota that exhibit robust rhythmicity primarily include Parabacteroides, Lachnospira, Bulleida, Roseburia, Veillonella, Haemophilus, Adlercreutzia, Eggerthella, Anaerotruncus, Oscillospira, Ruminococcus, Holdemania, Desulfovibrio, Escherichia, unspecified genera of families S24-7, and Enterobacteriaceae [14,15].

Circadian rhythm perturbations trigger compositional shifts in the gut microbiome, marked by an increased Firmicute/Bacteroidetes ratio, depletion of Christensenellaceae, Dorea, Anaeroplasmatales, Anaeroplasmataceae, Anaeroplasma, Lactobacillus, Lactococcus, RF32, Alphaproteobacteria, Proteobacteria, Ruminococcus, and Ligilactobacillus ruminis, alongside enrichment of Paraprevotella, Fusobacteria, and Fusobacteriales [14,16,17]. Mouse models undergoing transplantation experiments have shown that circadian rhythm disruption alters gut microbiota profiles, causing weight gain and impaired glucose tolerance in mice [14], thereby implicating gut microbiota imbalance as a pivotal contributor to obesity development. These findings indicate that circadian rhythm disruption on gut microbiota dynamics and its implications for metabolic health.

2.2 Obstructive sleep apnea syndrome (OSAS)

Sleep apnea, a condition characterized by interrupted or shallow breathing during sleep, results in excessive daytime sleepiness and fatigue and poses a substantial risk for cardiovascular diseases, notably hypertension and stroke [18,19]. Studies in mice have shown that sleep apnea leads to a reduction in gut microbiota diversity and a shift towards a high Firmicutes/Bacteroidetes ratio [20]. In a pediatric cohort focusing on OSAS, Valentini et al. documented an enrichment of pro-inflammatory bacteria – Proteobacteria, Clostridiaceae, Oscillospiraceae, and Klebsiella, which impairs intestinal barrier integrity [21], further highlighting the detrimental effects on gut health. Hypertension, a frequent comorbidity with sleep apnea has also been linked to gut microbiota alterations. A cohort study involving 52 individuals, including 9 controls, 17 OSAS only, 5 hypertension only, and 21 suffering from both OSAS and hypertension, uncovered a distinctive increase in Ruminococcaceae and Lachnospiraceae genera among OSAS patients [22]. Collectively, these findings emphasize the alterations in gut microbiota composition in sleep apnea patients, which likely contributes significantly to the pathology of the condition.

2.3 Sleep fragmentation

Sleep fragmentation not only undermines health, cognitive performance, and physical prowess but also emerges as a significant risk factor in the development of neurodegenerative illnesses, such as Alzheimer’s disease [33]. Mouse models have shown that sleep fragmentation increases appetite and enhances the abundance of bacteria such as Lachnospiraceae and Ruminococcaceae, concurrently diminishing populations of Lactobacillaceae and Bifidobacteriaceae [25]. Studies spanning human and murine models highlight the anti-obesity and anti-inflammatory capacities of various Bifidobacterium strains [34,35]. In a study employing sleep-deprived C57BL/6 mice, subjects exhibited increased appetite alongside unexpectedly reduced body mass, coupled with profound disruptions to gut microbiota diversity, typified by an overrepresentation of Candidatus_Arthromitus and Enterobacter, and a depletion of Lactobacillus, Muribaculum, Monoglobus, Parasutterella, and other species [26]. Human studies parallel these findings, documenting declines in genera such as Prevotella, Sutterella, Parasutterella, Alloprevotella, Anaeroplasma, and Elusimicrobium, alongside reduced levels of acetate, propionate, and butyrate [29]. Collectively, these observations underscore the profound impact of sleep disturbances on the delicate microbial ecosystem equilibrium in both mice and humans, highlighting a crucial axis for future therapeutic interventions.

2.4 Narcolepsy

Narcolepsy, affecting roughly 0.02% of the global adult population, manifests through symptoms including excessive daytime sleepiness, cataplexy (sudden muscle weakness), sleep onset hallucinations, sleep paralysis, and disrupted nocturnal rest. This condition is further complicated by associations with psychiatric, cardiovascular, autonomic, and metabolic disorders [36,37]. In examining Type 1 Narcolepsy, two studies did not find differences in gut microbiota diversity measures (alpha and beta diversity) between the affected and healthy groups. However, they reported a conspicuous overabundance of Klebsiella genus and a marked decrease in the abundance of Blautia, Barnesiellaceae, Barnesiella, Phocea, Lactococcus, Coriobacteriia, and Coriobacteriales [30,31]. Mendelian randomization analysis have suggested that heightened levels of genus Alloprevotella and Ruminiclostridium 6 could potentially elevate the risk of NT1 [38]. These shifts in gut microbiota composition emphasize the substantial environmental influence in the development and pathophysiology of Type 1 Narcolepsy, pointing to potential environmental targets for further investigation and intervention strategies.

2.5 Insomnia

Insomnia, a condition marked by persistent sleep difficulties, has been found to be intricately connected to shifts in gut microbiota composition and heightened inflammatory responses, potentially unraveling new dimensions in our understanding and treatment of sleep disorders. A case–control study recruited 20 acute, 38 chronic insomnia, and 38 healthy controls and investigated gut microbiota and inflammatory cytokine changes in acute and chronic insomnia patients, revealing distinct microbial signatures correlated with sleep quality and elevated IL-1β [32]. Particularly, there is a conspicuous reduction in the populations of short-chain fatty acid (SCFA)-producing bacterial genera, notably Roseburia and Faecalibacterium, among individuals with insomnia [32]. These genera are recognized for their anti-inflammatory properties and positive contributions to health [39]. In rats, it has been demonstrated that chronic sleep restriction can increase pro-inflammatory cytokines, including IL-1β and TNF-α [40], whereas enhancing the variety of gut microbiota may inversely decrease circulating inflammatory cytokines, potentially leading to better sleep quality [41]. The results imply a complex interplay between insomnia, gut microbiome alterations, and inflammation, highlighting the microbiota’s potential as a diagnostic aid and therapeutic focus for sleep disorders.

3 Potential bidirectional interaction mechanisms between gut microbiota and sleep

The intricate and reciprocal interplay between gut microbiota and sleep, with its potential for bidirectional influence, constitutes a complex yet rapidly evolving frontier of research in contemporary science. Growing evidence suggests that the microbiota–gut–brain axis plays a pivotal role in governing sleep behaviors through both direct and indirect mechanisms, with implications for the underlying causes and development of sleep disorders. Specifically, it has been documented that insufficient sleep induces disruptions in gut microbiota function, while the presence of sleep disorders coincides with marked shifts in the composition of the gut microbiota. Three pivotal aspects underpin the interactions between gut microbiota and sleep: first, microbial metabolites exert direct effects on sleep patterns through the gut–brain axis. Second, the microbiota modulates immune responses, indirectly impacting sleep regulation. Lastly, sleep and gene expression dynamics shape the composition of the gut microbiota (Figure 1).

Figure 1 Schematic representation of potential bidirectional interaction mechanisms between gut microbiota and sleep. The bidirectional interaction between gut microbiota and sleep centered around the gut–brain axis encompasses three fundamental pathways: [1] Direct neurotransmitter influence: Gut microbiota-derived neurotransmitters like 5-HT and histamine directly affect the brain via the HPA axis, regulating the host’s sleep status. [2] Immune modulation: Gut microbiota and their metabolites stimulate immune cells such as dendritic cells, T cells, and B cells, modulating the immune state, which subsequently influences the host’s sleep patterns. Conversely, sleep disorders can lead to changes in immune status, resulting in gut microbiota dysbiosis [3]. Circadian rhythm and intestinal barrier integrity: Sleep disturbances induce alterations in the expression of circadian rhythm-related genes, disrupting the integrity of the intestinal epithelial barrier, ultimately leading to gut microbiota dysbiosis.
Figure 1

Schematic representation of potential bidirectional interaction mechanisms between gut microbiota and sleep. The bidirectional interaction between gut microbiota and sleep centered around the gut–brain axis encompasses three fundamental pathways: [1] Direct neurotransmitter influence: Gut microbiota-derived neurotransmitters like 5-HT and histamine directly affect the brain via the HPA axis, regulating the host’s sleep status. [2] Immune modulation: Gut microbiota and their metabolites stimulate immune cells such as dendritic cells, T cells, and B cells, modulating the immune state, which subsequently influences the host’s sleep patterns. Conversely, sleep disorders can lead to changes in immune status, resulting in gut microbiota dysbiosis [3]. Circadian rhythm and intestinal barrier integrity: Sleep disturbances induce alterations in the expression of circadian rhythm-related genes, disrupting the integrity of the intestinal epithelial barrier, ultimately leading to gut microbiota dysbiosis.

3.1 The impact of gut microbiota metabolites on sleep

3.1.1 Serotonin

Serotonin (5-hydroxytryptamine [5-HT]) is a monoamine neurotransmitter synthesized from the essential amino acid tryptophan has emerged as a key player in the microbiota–gut–brain axis, crucial in regulating emotions, hunger, pain processing, and sleep, alongside its role in gut motility and secretion [42]. Over 90% of bodily 5-HT is synthesized and released by gut enterochromaffin cells [43]. Studies in rats have shown that supplementing Lacticaseibacillus rhamnosus in rats significantly boosts 5-HT levels [44]. Key players in this gut–brain axis are bacteria from families such as Clostridiaceae and Turicibacteraceae, capable of producing and releasing 5-HT [45], reinforcing the gut microbiota’s integral role in 5-HT biosynthesis. The vagus nerve serves as a vital conduit connecting the gut’s activities to the central nervous system, facilitating communication via 5-HT receptors along its pathway. This neural link enables 5-HT to transmit signals to the brain, thereby regulating various physiological processes, including mood, with serotonin reuptake inhibitors’ antidepressant efficacy hinging on intact vagus nerve functionality [46]. Furthermore, chronic vagus nerve stimulation in cats leads to increased rapid eye movement (REM) sleep [47], underscoring the nerve’s impact on sleep patterns. Supplementation with Ganoderma lucidum in mice not only increased hypothalamic 5-HT concentrations but also ameliorated sleep quality [48], pointing to the potential of 5-HT modulation as a therapeutic target. Collectively, these findings suggest that manipulating gut microbiota to influence 5-HT levels presents a promising avenue for improving sleep quality, warranting deeper investigation in future research.

3.1.2 Histamine

Histamine, functioning dually as a neurotransmitter and a signaling molecule, plays a pivotal role in regulating intestinal physiological functions, local immune responses, inflammation, and sleep–week cycle [49]. Of note, specific bacterial species, including Escherichia coli, Limosilactobacillus vaginalis, and Morganella morganii strains, possess the capability to both synthesize and release histamine [50]. The therapeutic arena witnesses the exploration of histamine H1 receptor antagonists, such as LY2624803, in ongoing clinical trials targeting insomnia [51], highlighting the clinical relevance of histamine modulation in sleep disorder management. This pharmacological intervention underscores the potential of gut-derived histamine as a key mediator in the gut–brain axis, influencing sleep quality. Unraveling the exact mechanisms by which microbial-origin histamine shapes sleep patterns necessitates rigorous, multidisciplinary research, aimed at clarifying the complex interplay between microbial activity, neural signaling, and circadian regulation.

3.1.3 SCFA

Dietary fiber undergoes microbial metabolism in the gut, prominently including lactic acid bacteria (LAB) alongside genera such as Ruminococcus, Lachnospira, Lachnospiraceae, and Ruminococcus [52]. This metabolic process yields SCFAs, which are vital to maintaining intestinal homeostasis [53]. LAB contribute significantly to this process, fostering the production of SCFAs that reinforce the intestinal barrier, suppress oxidative stress, dampen inflammation, and preserve a stable gut ecosystem [52,53].

Sleep disturbances, however, disrupt this delicate balance by depleting populations of beneficial bacteria like LAB, thereby reducing SCFA levels. This decline in SCFAs is implicated in triggering neuroinflammation, a key factor affecting sleep quality [29]. Investigations into infant populations have revealed a positive correlation between a higher fecal content of propionic acid – a prominent SCFA – and prolonged periods of uninterrupted sleep in infants [54], implying a contributory role of SCFAs in determining sleep duration. The intricate relationship between sleep and inflammation is further illuminated by butyrate, a gut microbiota-derived metabolite known for its potent anti-inflammatory effects. Butyrate mitigates chronic inflammation, a frequent comorbidity with sleep disorders, by suppressing pro-inflammatory cytokine synthesis and inhibiting NF-κB activation [55,56]. This dual mechanism not only alleviates intestinal mucosal injury triggered by sleep deprivation but also fosters improved sleep quality. Additionally, studies have demonstrated that 72-h REM sleep deprivation can disrupt colonic circadian rhythms, accompanied by a decrease in SCFAs (propionic acid), intestinal inflammation, and enhanced intestinal permeability, resulting in disrupted circadian rhythms and gut microbiota dysbiosis [26], underscoring the delicate interdependence between sleep, gut health, and circadian homeostasis. In conclusion, these findings accentuate the critical role of LAB and their metabolites, especially SCFAs, in regulating sleep quality. They underscore the need for deeper mechanistic explorations to fully comprehend how these bacterial elements interact with sleep physiology, thereby informing potential therapeutic interventions for sleep disorders and gut health management.

3.1.4 Lipopolysaccharide (LPS)

LPS, a key constituent of the Gram-negative bacterial outer membrane, typically exists at trace concentrations in the bloodstream in health status. However, heightened intestinal permeability can permit the translocation of LPS and other gut microbiota products into the circulation. Rodent studies have indicated that LPS administration prolongs non-REM sleep, with the process potentially mediated by IL-6 [57]. Microglia play a pivotal role in maintaining brain homeostasis and immune function. They have been shown to govern the sleep-wake cycle by modulating the anterior thalamic reticular nucleus neuron dynamics through ceramide-mediated signaling [58]. When LPS breaches the blood-brain barrier, it interacts with Toll-like receptor 4 (TLR4) on microglia, triggering a cascade of pro-inflammatory cytokine production. This inflammatory response can impose adverse hippocampal neurons [26,59,60], and alterations in microglial cell activity induced by LPS may contribute to the onset of neurological and sleep problems [60]. These findings collectively propose that LPS primarily modulates sleep status through its inflammatory response induction. Thus, restricting the overgrowth of LPS-producing bacteria emerges as a prospective strategy for managing sleep disturbances by mitigating inflammation and preserving the integrity of the gut–blood–brain axis.

3.1.5 Other gut microbiota-associated metabolites

Studies have illuminated the pivotal role of neuroregulatory elements, including γ-aminobutyric acid (GABA), melatonin, and dopamine, as mediators through which the gut microbiome engages in sleep modulation. Melatonin, for instance, has demonstrated efficacy in reversing cognitive impairments and rectifying gut microflora imbalances precipitated by sleep loss. This restoration occurs via fine-tuning specific microbial populations and their metabolic byproducts, thereby attenuating hippocampal inflammation and neuronal apoptosis via intricate crosstalk between the TLR4/NF-κB and MCT1/HDAC3 signaling cascades, as reported in references [61,62]. In a rhesus monkey model, sleep deficiency has been linked to heightened stress hormone levels, systemic inflammation, and disruptions to the gut microbiota, implicating perturbations in GABA metabolism. Intervention with GABA-producing probiotics, notably Lactobacillus species, has proven efficacious in rehabilitating gut integrity and countering these adverse outcomes [63], implying that diminished GABA production in the gut could be central to the stress and gastrointestinal disturbances accompanying sleep deprivation.

3.2 The impact of gut microbiota on sleep through immunomodulation

The gastrointestinal tract, recognized as the largest immunological organ in humans, plays a crucial role in maintaining overall health [64]. Its dual function is paramount: first, maintaining the integrity of the intestinal barrier prevents deleterious microorganisms and their metabolites in the gut from entering the bloodstream, thereby preventing infections or systemic inflammation responses. Second, as a reservoir for a myriad of immune cells, including dendritic cells, macrophages, natural killer cells, and others. The gut fosters an environment where microbiota interact intimately with these cells. This interaction stimulates immune cell maturation and differentiation, preserving immune homeostasis and stabilizing the gut’s microbial ecosystem [64]. In a reciprocal dance, sleep and immune function are inextricably intertwined; immune activity exerts a regulatory influence on sleep patterns, while conversely, sleep quality impacts the immune system’s functionality and responsiveness [65]. This intricate balance highlights the interconnectedness of sleep, gut health, and immune competence in maintaining overall health and resilience.

Sleep disorder-induced immune dysfunction is a pivotal factor implicated in the pathogenesis of various diseases. Animal studies demonstrate that LPS, omnipresent in the gut, can induce inflammatory responses and damage the intestinal barrier by regulating the expression of TLR4 and NF-κB, thereby contributing to immune-related diseases induced by sleep deprivation [29]. Sleep deprivation results in a 1-4 fold decrease in anti-inflammatory cytokines, such as IL-4 and IL-10, concomitant with a surge (1- to 8-fold increase) in pro-inflammatory factors including IL-6, IL-1β, and TNF-α, disrupting the delicate balance. This also disrupts secondary bile acid metabolism, impairing colonization resistance mediated by gut microbiota [66]. Cohort analyses in humans reveal that insomnia can significantly elevate IL-6 levels compared to healthy individuals, with gut microbiota diversity positively correlated with both IL-6 levels and sleep duration [67,68]. In vitro supplementation of IL-6 in rats extends non-REM sleep duration [69]. Furthermore, reports underscore the intimate link between sleep quality and immune factors such as IL-1, IL-10, and TNF-β, emphasizing their regulatory roles [70,71]. Collectively, these observations underscore a bidirectional interplay between the gut microbiome and sleep, mediated through intricate immune regulatory mechanisms, highlighting the gut–sleep–health axis’s significance.

3.3 Potential interactions between gut microbiota and the expression of circadian genes

Sleep disruptions trigger multifaceted changes in the gut microbiota, affecting not only its structure but also functional capacity, which in turn feeds back to influence sleep quality. These alterations arise from the modulation of the host’s circadian rhythm genes, involving the downregulation of genes like brain and muscle ARNT-like 1 (BMAL1), cryptochrome circadian regulator 1 (CRY1), and occludin (OCLN). This disruption impairs the intestinal barrier’s integrity, diminishes the abundance of beneficial bacteria like lactobacilli and rumen ciliates, and fosters a state of gut microbiota dysbiosis, which consequently impacts sleep quality [26]. Notably, the central clock gene BMAL1’s dysfunction, as seen in knockout models, leads to compromised gut epithelial function, microbial imbalance, increased gut infection risk, and perturbed lipid metabolism [72], emphasizing the intricate link between circadian control and gut health.

Moreover, overexpression of the circadian rhythm gene CRY1 has demonstrated an ability to mitigate inflammation triggered by sleep deprivation [73], suggesting a direct role in sleep regulation. Conversely, sleep disorders can provoke intestinal mucosal damage alongside down-regulation of CRY1. Meanwhile, OCLN has been shown to mitigate inflammation and insulin resistance associated with insomnia [74], highlighting the therapeutic prospects of intervening in these molecular pathways. The findings from these studies imply that disturbances in host sleep can alter the expression of circadian rhythm-related genes, which then disrupt intestinal barrier integrity and impact the balance of gut microbiota. Conversely, disruptions in gut microbiota can impact sleep quality. A more profound comprehension of the interplay between these factors will contribute to the prevention and treatment of sleep disorders.

In addition to these genetic interactions, it is crucial to acknowledge the role of gut microbiota-derived metabolites, such as indoles, bile acids, and neurotransmitter precursors, in modulating circadian rhythms and sleep patterns. These metabolites act as signaling molecules interacting with host receptors, influencing the expression of circadian genes and thereby impacting sleep regulation.

Understanding the complex interplay among gut microbiota composition, circadian gene expression, and metabolite profiles provides a fertile ground for developing novel therapeutic strategies. Targeted interventions, including precision probiotics, dietary modifications designed to enhance beneficial metabolite production, and pharmacological agents that modulate specific circadian pathways, hold promise in restoring sleep-wake cycles and improving overall health in individuals with sleep disorders.

4 Gut microbiota interventions for sleep enhancement: Applications and challenges

The gut microbiota, through its integral role in the gut–brain axis, is a key player in preserving both physical and mental well-being. An increasing body of research on gut microbiota interventions, including the use of probiotics, prebiotics, postbiotics, and fecal microbiota transplantation (FMT), has illuminated the potential of modulating the gut microbiome as a novel therapeutic strategy for managing sleep disorders and enhancing overall sleep quality. This evolving understanding paves the way for innovative, microbial-based approaches to promote healthier sleep patterns.

4.1 Probiotics for sleep improvement

Probiotics, defined as live microorganisms conferring health benefits when administered in adequate amounts, have emerged as potential therapeutics for sleep enhancement. A double-blinded, placebo-controlled, crossover-designed trial showed that daily use of Lactobacillus gasseri CP2305 for 4 weeks showed significant improvements in anxiety, depression, sleep quality, and reduced cortisol levels, alongside alterations in gut microbiota composition [75], suggesting its potential benefits for managing stress-related behaviors. In another intervention by Lee et al., a probiotic mixture composed of Limosilactobacillus reuteri NK33 and Bifidobacterium adolescentis NK98 on 156 individuals with symptoms of anxiety and insomnia. The results demonstrated that this probiotic combination significantly enhanced sleep quality and notably reduced the abundance of Enterobacteriaceae in the gut [76], further supporting probiotics’ sleep-enhancing potential. A separate 17-week double-blind trial in rugby players found that the supplementation of Saccharomyces boulardii effectively enhances the sleep quality [77]. Another placebo-controlled, double-blind trial by Takada et al., demonstrated that the supplementation of Lacticaseibacillus casei Shirota ameliorated the sleep quality of individuals under stressful conditions [78]. These benefits microorganisms from their ability to modulate gut microbiota composition, increase bacterial diversity, and reduce pathogenic bacteria, thereby impacting the gut–brain axis positively.

While probiotics show promise in enhancing sleep, they encounter several pivotal challenges demanding attention. Chief among these is the issue of strain specificity, which underscores the need for meticulous research to discern the most efficacious strains for sleep therapy [79]. Individual variations in response, rooted in unique gut microbiomes and genetic backgrounds, introduce another layer of complexity, emphasizing the necessity for personalized strategies and complicating universal application. Lastly, the field is in want of extended longitudinal studies to ascertain the longevity of benefits and any potential adverse reactions over time, thereby filling a critical gap in our understanding of probiotics’ long-term implications for sleep health. Addressing these challenges is paramount to refine probiotic interventions, transforming them into a reliably effective and safely integrated part of sleep disorder management (Table 2).

Table 2

The studies summary of gut microbiota interventions for sleep enhancement

Category Type of intervention Proposed mechanism Principal findings Reference
Probiotics Lactobacillus gasseri CP2305 on a double-blinded, placebo-controlled, crossover-designed trial Inhibit the growth of harmful bacteria Suppressed the growth of Enterobacteriaceae and effectively alleviated stress while improving sleep quality [75]
Limosilactobacillus reuteri NK33 and Bifidobacterium adolescentis NK98 on 156 individuals with symptoms of anxiety and insomnia Regulate intestinal microecological balance and inhibit inflammatory responses Significantly enhanced sleep quality and notably reduced the abundance of Enterobacteriaceae in the gut; decreased serum interleukin-6 levels; increased Bifidobacteriaceae and Lactobacillacea [76]
Saccharomyces boulardii on a 17-week double-blind trial on rugby players Not reported Effectively enhance the sleep quality of rugby players [77]
Lacticaseibacillus casei Shirota on a placebo-controlled double-blind trial Not reported improve the sleep quality of individuals under stressful conditions [78]
Prebiotics scGOS and lcFOS on sleep-deprived mice Potentially by modulating inflammation levels and synchronizing circadian rhythms to foster optimal health Increase in fecal SCFA levels. Reduction in sleep deprivation-induced inflammation and anxiety-like symptoms [80]
Lactoferrin and milk fat globule membrane in rat models. Regulate intestinal microecological balance. Enhanced gut microbiota diversity, potentially linked to improvements in sleep quality [81]
Polydextrose and galactooligosaccharides, a double-blind randomized trial in infants Regulate intestinal microecological balance Increase in nap duration [82]
Postbiotics 5-HTP supplementation on sleep quality in 30 older adults over 12 weeks Regulate intestinal microecological balance Notably enhanced certain aspects of sleep, and led to increased gut microbiota diversity and SCFA-producing bacteria [83]
Heat-inactivated L. gasseri CP2305 on 60 Japanese medical students Not reported Reduced anxiety and sleep disturbance relative to placebo, attenuated the stress-induced decline of Bifidobacterium spp. and the stress-induced elevation of Streptococcus spp. [84]
FMT FMT in adults with chronic insomnia Restore intestinal microecological balance. Increase in genera like Lactobacillus, Bifidobacterium, and Turicibacter and a reduction in Eggerthella [85]

4.2 Prebiotics and sleep regulation

Prebiotics, characterized by their resistance to human digestive enzymes while serving as nutrients for gut microorganisms, hold promise in enhancing sleep quality through their ability to shape microbial populations and metabolic outputs [86]. The study by Chung et al. demonstrated the positive effects of a prebiotic mixture of short-chain galactooligosaccharides and long-chain fructooligosaccharides (lcFOS) (9:1 ratio) on sleep-deprived mice. This regimen led to elevated fecal SCFA levels, which were concurrently associated with reduced inflammation and anxiety-like behaviors induced by sleep loss. These findings hint at a potential mechanism for the observed improvements in sleep [80]. Similarly, interventions involving lactoferrin and milk fat globule membrane in rat models exhibited enhanced gut microbiota diversity, potentially linked to improvements in sleep quality [81]. This augmentation in gut microbial diversity is increasingly recognized as a factor contributing to overall health, including aspects of sleep regulation. Moreover, a double-blind randomized trial in infants who received polydextrose and galactooligosaccharides supplementation reported an increase in nap duration [87]. This observation not only supports the role of prebiotics in influencing sleep patterns but also highlights their potential applicability across different age groups, indicating a versatile strategy for sleep health promotion.

Prebiotic use for sleep regulation encounters challenges including the need for individualized dosing strategies, given varying responses tied to unique microbiome compositions. Long-term efficacy and safety profiles require further investigation to ensure sustainable benefits without adverse effects. Standardization issues persist due to a lack of consensus on defining and classifying prebiotics, complicating research comparability. Personalized approaches, accounting for individual gut microbiota variations, are imperative for maximizing benefits (Figure 2).

Figure 2 Proposed gut microbiota interventions to improve sleep quality. Four microbiota-targeted intervention approaches, including probiotics, prebiotics, postbiotics, and FMT, are depicted in the graph. These interventions have the potential to enhance sleep quality by modulating the microbiota–gut–brain axis, offering promising avenues for the treatment of sleep disorders.
Figure 2

Proposed gut microbiota interventions to improve sleep quality. Four microbiota-targeted intervention approaches, including probiotics, prebiotics, postbiotics, and FMT, are depicted in the graph. These interventions have the potential to enhance sleep quality by modulating the microbiota–gut–brain axis, offering promising avenues for the treatment of sleep disorders.

4.3 Postbiotics: a novel avenue for sleep enhancement

Postbiotics are metabolic products of bacteria or fragments of their cell bodies that can provide physiological benefits to the host while avoiding the risks associated with live microorganisms, such as infections. A single-blinded, randomized controlled trial examined the effects of 5-HTP supplementation on sleep quality and gut microbiota in older adults over 12 weeks, revealing that 5-HTP notably enhanced certain aspects of sleep, particularly in individuals with initially poor sleep quality, and led to increased gut microbiota diversity and SCFA-producing bacteria [83], suggesting a potential role in sleep improvement and gut health modulation. Moreover, long-term supplementation with heat-inactivated L. gasseri CP2305 in healthy adults reduced anxiety, improved sleep quality, and positively modulated gut microbiota, indicating potential benefits for mental health and sleep under stress.

The exploration of postbiotics for sleep enhancement faces a scarcity of studies, demanding expanded research to bolster evidence. Elucidating the exact mechanisms and identifying specific bioactive compounds are imperative. Standardized approaches for postbiotic characterization and quantification remain underdeveloped, posing obstacles to consistency and comparison across investigations.

4.4 FMT in sleep health

FMT is a therapeutic approach in which the entire microbiota from a donor is transplanted into a recipient to restore the recipient’s gut microbiota balance, which is primarily used to treat recurrent Clostridium difficile infections. However, recent exploratory studies have ventured into uncharted territories, assessing its potential in managing conditions beyond gastrointestinal disorders, including sleep health [88]. A study assessed the efficacy and safety of FMT in adults with chronic insomnia, comparing outcomes to a non-insomnia group. Results showed significant improvements in insomnia symptoms, anxiety, depression, and quality of life for insomnia patients post-FMT, with 76.47% achieving primary endpoints. The gut microbiota changes, specifically an increase in genera like Lactobacillus, Bifidobacterium, Turicibacter, and a reduction in Eggerthella, correlated with FMT effectiveness [85], suggesting FMT as a potential novel treatment for chronic insomnia with implications for sleep quality improvement.

Implementing FMT for sleep health faces numerous challenges, including ethical concerns around donor screening, standardization of procedures, and ensuring long-term safety and efficacy. Future research is expected to delve deeper into the mechanistic understanding of how FMT influences sleep, focusing on the specific microbial species and metabolites involved. Personalized FMT strategies, based on an individual’s microbiome profile, may emerge as a future direction.

Sleep disorder treatments conventionally involve drugs, psychotherapy, and traditional Chinese medicine, overlooking microbiota interventions. However, advances in understanding the gut microbiota-sleep link have sparked exploration into microbiota-targeted therapies for sleep enhancement. Personalized sleep therapy via gut microbiota modulation, using probiotics, prebiotics, and tailored interventions based on individual microbiota profiles, emerges as a promising frontier, prioritizing metabolite research for systemic effects.

5 Conclusions and perspectives

Emerging research highlights the intricate relationship between the gut microbiota and sleep, primarily orchestrated through the gut–brain axis that connects these two vital components of our physiology. While sleep disturbances can markedly alter the gut microbiota’s composition and function, the heterogeneity observed in these effects across studies underscores the need for further exploration of individual variability, species-specific responses, and the myriad environmental and intrinsic factors influencing gut microbial homeostasis. Promisingly, targeted interventions, including specific prebiotics such as polydextrose and galactooligosaccharides, probiotics like Bifidobacterium and Lactobacillus strains, and postbiotics like butyrate, have demonstrated potential in ameliorating gut dysbiosis and enhancing sleep quality. Mechanistically, these interventions may influence sleep by modulating neurotransmitter production, reducing inflammation, and stabilizing circadian rhythms.

Despite these advancements, it is imperative to recognize the existing limitations in our understanding, which include the lack of large-scale, longitudinal studies elucidating causality, and the complexity in deciphering the direct versus indirect effects of gut microbiota on sleep regulation. Future research should aim to clarify the precise mechanisms underlying the gut microbiota’s impact on sleep, identify biomarkers predictive of sleep disturbances, and evaluate the long-term efficacy and safety of microbiota-targeted interventions in diverse populations.

In conclusion, the reciprocal relationship between sleep and the gut microbiota opens new vistas for preventive and therapeutic strategies targeting sleep disorders. However, whether gut microbiota dysbiosis acts as a causative agent in sleep disorders or serves as an indirect contributor remains a subject demanding further in-depth investigation. The complex interplay between sleep and the gut microbiota warrants continued research efforts to fully decipher its far-reaching implications on human health and overall wellness.

  1. Funding information: This research was funded by the Xiamen Municipal Health Guidance Project (3502Z20214ZD1156).

  2. Author contributions: All authors contributed to the study conception and design. Data collection and curation, Z.L., T.J., M.C., and X.J.; writing – original draft, Z.L. and Y.W.; and writing – review and editing, Z.L. All authors have read and agreed to the published version of the manuscript.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Received: 2024-03-21
Revised: 2024-06-10
Accepted: 2024-06-11
Published Online: 2024-07-18

© 2024 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  207. Erratum to “Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation”
  208. Retraction
  209. Retraction to “MiR-223-3p regulates cell viability, migration, invasion, and apoptosis of non-small cell lung cancer cells by targeting RHOB”
  210. Retraction to “A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis”
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https://doi.org/10.1515/biol-2022-0910
Keywords for this article
gut microbiota; sleep disorder; bidirectional relationship; mechanisms; therapeutic interventions; personalized medicine
Creative Commons
BY 4.0

Articles in the same Issue

  1. Biomedical Sciences
  2. Constitutive and evoked release of ATP in adult mouse olfactory epithelium
  3. LARP1 knockdown inhibits cultured gastric carcinoma cell cycle progression and metastatic behavior
  4. PEGylated porcine–human recombinant uricase: A novel fusion protein with improved efficacy and safety for the treatment of hyperuricemia and renal complications
  5. Research progress on ocular complications caused by type 2 diabetes mellitus and the function of tears and blepharons
  6. The role and mechanism of esketamine in preventing and treating remifentanil-induced hyperalgesia based on the NMDA receptor–CaMKII pathway
  7. Brucella infection combined with Nocardia infection: A case report and literature review
  8. Detection of serum interleukin-18 level and neutrophil/lymphocyte ratio in patients with antineutrophil cytoplasmic antibody-associated vasculitis and its clinical significance
  9. Ang-1, Ang-2, and Tie2 are diagnostic biomarkers for Henoch-Schönlein purpura and pediatric-onset systemic lupus erythematous
  10. PTTG1 induces pancreatic cancer cell proliferation and promotes aerobic glycolysis by regulating c-myc
  11. Role of serum B-cell-activating factor and interleukin-17 as biomarkers in the classification of interstitial pneumonia with autoimmune features
  12. Effectiveness and safety of a mumps containing vaccine in preventing laboratory-confirmed mumps cases from 2002 to 2017: A meta-analysis
  13. Low levels of sex hormone-binding globulin predict an increased breast cancer risk and its underlying molecular mechanisms
  14. A case of Trousseau syndrome: Screening, detection and complication
  15. Application of the integrated airway humidification device enhances the humidification effect of the rabbit tracheotomy model
  16. Preparation of Cu2+/TA/HAP composite coating with anti-bacterial and osteogenic potential on 3D-printed porous Ti alloy scaffolds for orthopedic applications
  17. Aquaporin-8 promotes human dermal fibroblasts to counteract hydrogen peroxide-induced oxidative damage: A novel target for management of skin aging
  18. Current research and evidence gaps on placental development in iron deficiency anemia
  19. Single-nucleotide polymorphism rs2910829 in PDE4D is related to stroke susceptibility in Chinese populations: The results of a meta-analysis
  20. Pheochromocytoma-induced myocardial infarction: A case report
  21. Kaempferol regulates apoptosis and migration of neural stem cells to attenuate cerebral infarction by O‐GlcNAcylation of β-catenin
  22. Sirtuin 5 regulates acute myeloid leukemia cell viability and apoptosis by succinylation modification of glycine decarboxylase
  23. Apigenin 7-glucoside impedes hypoxia-induced malignant phenotypes of cervical cancer cells in a p16-dependent manner
  24. KAT2A changes the function of endometrial stromal cells via regulating the succinylation of ENO1
  25. Current state of research on copper complexes in the treatment of breast cancer
  26. Exploring antioxidant strategies in the pathogenesis of ALS
  27. Helicobacter pylori causes gastric dysbacteriosis in chronic gastritis patients
  28. IL-33/soluble ST2 axis is associated with radiation-induced cardiac injury
  29. The predictive value of serum NLR, SII, and OPNI for lymph node metastasis in breast cancer patients with internal mammary lymph nodes after thoracoscopic surgery
  30. Carrying SNP rs17506395 (T > G) in TP63 gene and CCR5Δ32 mutation associated with the occurrence of breast cancer in Burkina Faso
  31. P2X7 receptor: A receptor closely linked with sepsis-associated encephalopathy
  32. Probiotics for inflammatory bowel disease: Is there sufficient evidence?
  33. Identification of KDM4C as a gene conferring drug resistance in multiple myeloma
  34. Microbial perspective on the skin–gut axis and atopic dermatitis
  35. Thymosin α1 combined with XELOX improves immune function and reduces serum tumor markers in colorectal cancer patients after radical surgery
  36. Highly specific vaginal microbiome signature for gynecological cancers
  37. Sample size estimation for AQP4-IgG seropositive optic neuritis: Retinal damage detection by optical coherence tomography
  38. The effects of SDF-1 combined application with VEGF on femoral distraction osteogenesis in rats
  39. Fabrication and characterization of gold nanoparticles using alginate: In vitro and in vivo assessment of its administration effects with swimming exercise on diabetic rats
  40. Mitigating digestive disorders: Action mechanisms of Mediterranean herbal active compounds
  41. Distribution of CYP2D6 and CYP2C19 gene polymorphisms in Han and Uygur populations with breast cancer in Xinjiang, China
  42. VSP-2 attenuates secretion of inflammatory cytokines induced by LPS in BV2 cells by mediating the PPARγ/NF-κB signaling pathway
  43. Factors influencing spontaneous hypothermia after emergency trauma and the construction of a predictive model
  44. Long-term administration of morphine specifically alters the level of protein expression in different brain regions and affects the redox state
  45. Application of metagenomic next-generation sequencing technology in the etiological diagnosis of peritoneal dialysis-associated peritonitis
  46. Clinical diagnosis, prevention, and treatment of neurodyspepsia syndrome using intelligent medicine
  47. Case report: Successful bronchoscopic interventional treatment of endobronchial leiomyomas
  48. Preliminary investigation into the genetic etiology of short stature in children through whole exon sequencing of the core family
  49. Cystic adenomyoma of the uterus: Case report and literature review
  50. Mesoporous silica nanoparticles as a drug delivery mechanism
  51. Dynamic changes in autophagy activity in different degrees of pulmonary fibrosis in mice
  52. Vitamin D deficiency and inflammatory markers in type 2 diabetes: Big data insights
  53. Lactate-induced IGF1R protein lactylation promotes proliferation and metabolic reprogramming of lung cancer cells
  54. Meta-analysis on the efficacy of allogeneic hematopoietic stem cell transplantation to treat malignant lymphoma
  55. Mitochondrial DNA drives neuroinflammation through the cGAS-IFN signaling pathway in the spinal cord of neuropathic pain mice
  56. Application value of artificial intelligence algorithm-based magnetic resonance multi-sequence imaging in staging diagnosis of cervical cancer
  57. Embedded monitoring system and teaching of artificial intelligence online drug component recognition
  58. Investigation into the association of FNDC1 and ADAMTS12 gene expression with plumage coloration in Muscovy ducks
  59. Yak meat content in feed and its impact on the growth of rats
  60. A rare case of Richter transformation with breast involvement: A case report and literature review
  61. First report of Nocardia wallacei infection in an immunocompetent patient in Zhejiang province
  62. Rhodococcus equi and Brucella pulmonary mass in immunocompetent: A case report and literature review
  63. Downregulation of RIP3 ameliorates the left ventricular mechanics and function after myocardial infarction via modulating NF-κB/NLRP3 pathway
  64. Evaluation of the role of some non-enzymatic antioxidants among Iraqi patients with non-alcoholic fatty liver disease
  65. The role of Phafin proteins in cell signaling pathways and diseases
  66. Ten-year anemia as initial manifestation of Castleman disease in the abdominal cavity: A case report
  67. Coexistence of hereditary spherocytosis with SPTB P.Trp1150 gene variant and Gilbert syndrome: A case report and literature review
  68. Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells
  69. Exploratory evaluation supported by experimental and modeling approaches of Inula viscosa root extract as a potent corrosion inhibitor for mild steel in a 1 M HCl solution
  70. Imaging manifestations of ductal adenoma of the breast: A case report
  71. Gut microbiota and sleep: Interaction mechanisms and therapeutic prospects
  72. Isomangiferin promotes the migration and osteogenic differentiation of rat bone marrow mesenchymal stem cells
  73. Prognostic value and microenvironmental crosstalk of exosome-related signatures in human epidermal growth factor receptor 2 positive breast cancer
  74. Circular RNAs as potential biomarkers for male severe sepsis
  75. Knockdown of Stanniocalcin-1 inhibits growth and glycolysis in oral squamous cell carcinoma cells
  76. The expression and biological role of complement C1s in esophageal squamous cell carcinoma
  77. A novel GNAS mutation in pseudohypoparathyroidism type 1a with articular flexion deformity: A case report
  78. Predictive value of serum magnesium levels for prognosis in patients with non-small cell lung cancer undergoing EGFR-TKI therapy
  79. HSPB1 alleviates acute-on-chronic liver failure via the P53/Bax pathway
  80. IgG4-related disease complicated by PLA2R-associated membranous nephropathy: A case report
  81. Baculovirus-mediated endostatin and angiostatin activation of autophagy through the AMPK/AKT/mTOR pathway inhibits angiogenesis in hepatocellular carcinoma
  82. Metformin mitigates osteoarthritis progression by modulating the PI3K/AKT/mTOR signaling pathway and enhancing chondrocyte autophagy
  83. Evaluation of the activity of antimicrobial peptides against bacterial vaginosis
  84. Atypical presentation of γ/δ mycosis fungoides with an unusual phenotype and SOCS1 mutation
  85. Analysis of the microecological mechanism of diabetic kidney disease based on the theory of “gut–kidney axis”: A systematic review
  86. Omega-3 fatty acids prevent gestational diabetes mellitus via modulation of lipid metabolism
  87. Refractory hypertension complicated with Turner syndrome: A case report
  88. Interaction of ncRNAs and the PI3K/AKT/mTOR pathway: Implications for osteosarcoma
  89. Association of low attenuation area scores with pulmonary function and clinical prognosis in patients with chronic obstructive pulmonary disease
  90. Long non-coding RNAs in bone formation: Key regulators and therapeutic prospects
  91. The deubiquitinating enzyme USP35 regulates the stability of NRF2 protein
  92. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as potential diagnostic markers for rebleeding in patients with esophagogastric variceal bleeding
  93. G protein-coupled receptor 1 participating in the mechanism of mediating gestational diabetes mellitus by phosphorylating the AKT pathway
  94. LL37-mtDNA regulates viability, apoptosis, inflammation, and autophagy in lipopolysaccharide-treated RLE-6TN cells by targeting Hsp90aa1
  95. The analgesic effect of paeoniflorin: A focused review
  96. Chemical composition’s effect on Solanum nigrum Linn.’s antioxidant capacity and erythrocyte protection: Bioactive components and molecular docking analysis
  97. Knockdown of HCK promotes HREC cell viability and inner blood–retinal barrier integrity by regulating the AMPK signaling pathway
  98. The role of rapamycin in the PINK1/Parkin signaling pathway in mitophagy in podocytes
  99. Laryngeal non-Hodgkin lymphoma: Report of four cases and review of the literature
  100. Clinical value of macrogenome next-generation sequencing on infections
  101. Overview of dendritic cells and related pathways in autoimmune uveitis
  102. TAK-242 alleviates diabetic cardiomyopathy via inhibiting pyroptosis and TLR4/CaMKII/NLRP3 pathway
  103. Hypomethylation in promoters of PGC-1α involved in exercise-driven skeletal muscular alterations in old age
  104. Profile and antimicrobial susceptibility patterns of bacteria isolated from effluents of Kolladiba and Debark hospitals
  105. The expression and clinical significance of syncytin-1 in serum exosomes of hepatocellular carcinoma patients
  106. A histomorphometric study to evaluate the therapeutic effects of biosynthesized silver nanoparticles on the kidneys infected with Plasmodium chabaudi
  107. PGRMC1 and PAQR4 are promising molecular targets for a rare subtype of ovarian cancer
  108. Analysis of MDA, SOD, TAOC, MNCV, SNCV, and TSS scores in patients with diabetes peripheral neuropathy
  109. SLIT3 deficiency promotes non-small cell lung cancer progression by modulating UBE2C/WNT signaling
  110. The relationship between TMCO1 and CALR in the pathological characteristics of prostate cancer and its effect on the metastasis of prostate cancer cells
  111. Heterogeneous nuclear ribonucleoprotein K is a potential target for enhancing the chemosensitivity of nasopharyngeal carcinoma
  112. PHB2 alleviates retinal pigment epithelium cell fibrosis by suppressing the AGE–RAGE pathway
  113. Anti-γ-aminobutyric acid-B receptor autoimmune encephalitis with syncope as the initial symptom: Case report and literature review
  114. Comparative analysis of chloroplast genome of Lonicera japonica cv. Damaohua
  115. Human umbilical cord mesenchymal stem cells regulate glutathione metabolism depending on the ERK–Nrf2–HO-1 signal pathway to repair phosphoramide mustard-induced ovarian cancer cells
  116. Electroacupuncture on GB acupoints improves osteoporosis via the estradiol–PI3K–Akt signaling pathway
  117. Renalase protects against podocyte injury by inhibiting oxidative stress and apoptosis in diabetic nephropathy
  118. Review: Dicranostigma leptopodum: A peculiar plant of Papaveraceae
  119. Combination effect of flavonoids attenuates lung cancer cell proliferation by inhibiting the STAT3 and FAK signaling pathway
  120. Renal microangiopathy and immune complex glomerulonephritis induced by anti-tumour agents: A case report
  121. Correlation analysis of AVPR1a and AVPR2 with abnormal water and sodium and potassium metabolism in rats
  122. Gastrointestinal health anti-diarrheal mixture relieves spleen deficiency-induced diarrhea through regulating gut microbiota
  123. Myriad factors and pathways influencing tumor radiotherapy resistance
  124. Exploring the effects of culture conditions on Yapsin (YPS) gene expression in Nakaseomyces glabratus
  125. Screening of prognostic core genes based on cell–cell interaction in the peripheral blood of patients with sepsis
  126. Coagulation factor II thrombin receptor as a promising biomarker in breast cancer management
  127. Ileocecal mucinous carcinoma misdiagnosed as incarcerated hernia: A case report
  128. Methyltransferase like 13 promotes malignant behaviors of bladder cancer cells through targeting PI3K/ATK signaling pathway
  129. The debate between electricity and heat, efficacy and safety of irreversible electroporation and radiofrequency ablation in the treatment of liver cancer: A meta-analysis
  130. ZAG promotes colorectal cancer cell proliferation and epithelial–mesenchymal transition by promoting lipid synthesis
  131. Baicalein inhibits NLRP3 inflammasome activation and mitigates placental inflammation and oxidative stress in gestational diabetes mellitus
  132. Impact of SWCNT-conjugated senna leaf extract on breast cancer cells: A potential apoptotic therapeutic strategy
  133. MFAP5 inhibits the malignant progression of endometrial cancer cells in vitro
  134. Major ozonated autohemotherapy promoted functional recovery following spinal cord injury in adult rats via the inhibition of oxidative stress and inflammation
  135. Axodendritic targeting of TAU and MAP2 and microtubule polarization in iPSC-derived versus SH-SY5Y-derived human neurons
  136. Differential expression of phosphoinositide 3-kinase/protein kinase B and Toll-like receptor/nuclear factor kappa B signaling pathways in experimental obesity Wistar rat model
  137. The therapeutic potential of targeting Oncostatin M and the interleukin-6 family in retinal diseases: A comprehensive review
  138. BA inhibits LPS-stimulated inflammatory response and apoptosis in human middle ear epithelial cells by regulating the Nf-Kb/Iκbα axis
  139. Role of circRMRP and circRPL27 in chronic obstructive pulmonary disease
  140. Investigating the role of hyperexpressed HCN1 in inducing myocardial infarction through activation of the NF-κB signaling pathway
  141. Characterization of phenolic compounds and evaluation of anti-diabetic potential in Cannabis sativa L. seeds: In vivo, in vitro, and in silico studies
  142. Quantitative immunohistochemistry analysis of breast Ki67 based on artificial intelligence
  143. Ecology and Environmental Science
  144. Screening of different growth conditions of Bacillus subtilis isolated from membrane-less microbial fuel cell toward antimicrobial activity profiling
  145. Degradation of a mixture of 13 polycyclic aromatic hydrocarbons by commercial effective microorganisms
  146. Evaluation of the impact of two citrus plants on the variation of Panonychus citri (Acari: Tetranychidae) and beneficial phytoseiid mites
  147. Prediction of present and future distribution areas of Juniperus drupacea Labill and determination of ethnobotany properties in Antalya Province, Türkiye
  148. Population genetics of Todarodes pacificus (Cephalopoda: Ommastrephidae) in the northwest Pacific Ocean via GBS sequencing
  149. A comparative analysis of dendrometric, macromorphological, and micromorphological characteristics of Pistacia atlantica subsp. atlantica and Pistacia terebinthus in the middle Atlas region of Morocco
  150. Macrofungal sporocarp community in the lichen Scots pine forests
  151. Assessing the proximate compositions of indigenous forage species in Yemen’s pastoral rangelands
  152. Food Science
  153. Gut microbiota changes associated with low-carbohydrate diet intervention for obesity
  154. Reexamination of Aspergillus cristatus phylogeny in dark tea: Characteristics of the mitochondrial genome
  155. Differences in the flavonoid composition of the leaves, fruits, and branches of mulberry are distinguished based on a plant metabolomics approach
  156. Investigating the impact of wet rendering (solventless method) on PUFA-rich oil from catfish (Clarias magur) viscera
  157. Non-linear associations between cardiovascular metabolic indices and metabolic-associated fatty liver disease: A cross-sectional study in the US population (2017–2020)
  158. Knockdown of USP7 alleviates atherosclerosis in ApoE-deficient mice by regulating EZH2 expression
  159. Utility of dairy microbiome as a tool for authentication and traceability
  160. Agriculture
  161. Enhancing faba bean (Vicia faba L.) productivity through establishing the area-specific fertilizer rate recommendation in southwest Ethiopia
  162. Impact of novel herbicide based on synthetic auxins and ALS inhibitor on weed control
  163. Perspectives of pteridophytes microbiome for bioremediation in agricultural applications
  164. Fertilizer application parameters for drip-irrigated peanut based on the fertilizer effect function established from a “3414” field trial
  165. Improving the productivity and profitability of maize (Zea mays L.) using optimum blended inorganic fertilization
  166. Application of leaf multispectral analyzer in comparison to hyperspectral device to assess the diversity of spectral reflectance indices in wheat genotypes
  167. Animal Sciences
  168. Knockdown of ANP32E inhibits colorectal cancer cell growth and glycolysis by regulating the AKT/mTOR pathway
  169. Development of a detection chip for major pathogenic drug-resistant genes and drug targets in bovine respiratory system diseases
  170. Exploration of the genetic influence of MYOT and MB genes on the plumage coloration of Muscovy ducks
  171. Transcriptome analysis of adipose tissue in grazing cattle: Identifying key regulators of fat metabolism
  172. Comparison of nutritional value of the wild and cultivated spiny loaches at three growth stages
  173. Transcriptomic analysis of liver immune response in Chinese spiny frog (Quasipaa spinosa) infected with Proteus mirabilis
  174. Disruption of BCAA degradation is a critical characteristic of diabetic cardiomyopathy revealed by integrated transcriptome and metabolome analysis
  175. Plant Sciences
  176. Effect of long-term in-row branch covering on soil microorganisms in pear orchards
  177. Photosynthetic physiological characteristics, growth performance, and element concentrations reveal the calcicole–calcifuge behaviors of three Camellia species
  178. Transcriptome analysis reveals the mechanism of NaHCO3 promoting tobacco leaf maturation
  179. Bioinformatics, expression analysis, and functional verification of allene oxide synthase gene HvnAOS1 and HvnAOS2 in qingke
  180. Water, nitrogen, and phosphorus coupling improves gray jujube fruit quality and yield
  181. Improving grape fruit quality through soil conditioner: Insights from RNA-seq analysis of Cabernet Sauvignon roots
  182. Role of Embinin in the reabsorption of nucleus pulposus in lumbar disc herniation: Promotion of nucleus pulposus neovascularization and apoptosis of nucleus pulposus cells
  183. Revealing the effects of amino acid, organic acid, and phytohormones on the germination of tomato seeds under salinity stress
  184. Combined effects of nitrogen fertilizer and biochar on the growth, yield, and quality of pepper
  185. Comprehensive phytochemical and toxicological analysis of Chenopodium ambrosioides (L.) fractions
  186. Impact of “3414” fertilization on the yield and quality of greenhouse tomatoes
  187. Exploring the coupling mode of water and fertilizer for improving growth, fruit quality, and yield of the pear in the arid region
  188. Metagenomic analysis of endophytic bacteria in seed potato (Solanum tuberosum)
  189. Antibacterial, antifungal, and phytochemical properties of Salsola kali ethanolic extract
  190. Exploring the hepatoprotective properties of citronellol: In vitro and in silico studies on ethanol-induced damage in HepG2 cells
  191. Enhanced osmotic dehydration of watermelon rind using honey–sucrose solutions: A study on pre-treatment efficacy and mass transfer kinetics
  192. Effects of exogenous 2,4-epibrassinolide on photosynthetic traits of 53 cowpea varieties under NaCl stress
  193. Comparative transcriptome analysis of maize (Zea mays L.) seedlings in response to copper stress
  194. An optimization method for measuring the stomata in cassava (Manihot esculenta Crantz) under multiple abiotic stresses
  195. Fosinopril inhibits Ang II-induced VSMC proliferation, phenotype transformation, migration, and oxidative stress through the TGF-β1/Smad signaling pathway
  196. Antioxidant and antimicrobial activities of Salsola imbricata methanolic extract and its phytochemical characterization
  197. Bioengineering and Biotechnology
  198. Absorbable calcium and phosphorus bioactive membranes promote bone marrow mesenchymal stem cells osteogenic differentiation for bone regeneration
  199. New advances in protein engineering for industrial applications: Key takeaways
  200. An overview of the production and use of Bacillus thuringiensis toxin
  201. Research progress of nanoparticles in diagnosis and treatment of hepatocellular carcinoma
  202. Bioelectrochemical biosensors for water quality assessment and wastewater monitoring
  203. PEI/MMNs@LNA-542 nanoparticles alleviate ICU-acquired weakness through targeted autophagy inhibition and mitochondrial protection
  204. Unleashing of cytotoxic effects of thymoquinone-bovine serum albumin nanoparticles on A549 lung cancer cells
  205. Erratum
  206. Erratum to “Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM”
  207. Erratum to “Activation of hypermethylated P2RY1 mitigates gastric cancer by promoting apoptosis and inhibiting proliferation”
  208. Retraction
  209. Retraction to “MiR-223-3p regulates cell viability, migration, invasion, and apoptosis of non-small cell lung cancer cells by targeting RHOB”
  210. Retraction to “A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis”
  211. Special Issue on Advances in Neurodegenerative Disease Research and Treatment
  212. Transplantation of human neural stem cell prevents symptomatic motor behavior disability in a rat model of Parkinson’s disease
  213. Special Issue on Multi-omics
  214. Inflammasome complex genes with clinical relevance suggest potential as therapeutic targets for anti-tumor drugs in clear cell renal cell carcinoma
  215. Gastroesophageal varices in primary biliary cholangitis with anti-centromere antibody positivity: Early onset?
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