Pressure injuries (PIs) are a leading cause of morbidity in spinal cord injury (SCI), yet the wound microbiome and its relationship to clinical outcomes remain poorly characterised. We profiled the 16S rRNA gene microbiome at three anatomical sites (PI lesion, periwound skin, and shoulder skin) in 57 SCI patients, integrating composition with blood cytokines and clinical evolution, and applied machine-learning and network-based analyses to identify outcome-relevant community signatures. PI lesions had higher Shannon diversity than periwound (p = 0.015) and shoulder skin (p = 0.003), were depleted in skin commensals, and enriched in wound-adapted anaerobes (q < 0.05). Major complications showed a dual-compartment signature: Proteus enrichment at the lesion (p = 0.030) with Blautia depletion in the periwound niche (p = 0.037). Staphylococcus abundance inversely correlated with circulating IL-1β (ρ = −0.46, p = 0.016). An aggregate wound-pathobiont burden score was twofold higher in poorly-healing wounds (p = 0.002) and achieved a cross-validated AUC of 0.70 ± 0.01 across 20 seeds, matching a flexible XGBoost classifier; SHAP analysis and SparCC network centrality independently identified the same anaerobic Gram-positive cocci as central hubs. Cross-site analyses confirmed outcome prediction is lesion-specific. These findings identify a parsimonious, deployable community-level biomarker of pressure-injury outcome.

Pressure injuries (PIs) are common in individuals with spinal cord injury (SCI) and increase the risk of infections, including urinary tract infections (UTIs), which may prolong hospitalisation. However, the role of PIs in the development of postoperative UTIs remains unclear. In this exploratory study, we investigated the relationship between the PI microbiome and urinary bacteria, and examined whether perioperative bacteriuria predicts prolonged hospital stay in patients undergoing reconstructive PI surgery. In this cohort study, 21 male patients with SCI and advanced-stage PIs undergoing reconstructive surgery were evaluated. Microbiome and urinary cytokine profiles were analysed at two postoperative time points: day 3 (early postoperative phase) and day 15 (after completion of antibiotic therapy). DNA from skin, PI tissue, and urine was analysed using 16S rRNA gene sequencing. Asymptomatic bacteriuria was present in 48% of patients on day 3 and 38% on day 15. Dominant urinary bacteria included Enterococcus, Klebsiella, Streptococcus, and Escherichia, which were associated with elevated urinary cytokine levels. High bacterial load (≥ 100,000 bacteria/mL) in urine on day 3 correlated with increased UTI incidence and frequency, although hospitalisation duration was unaffected. By day 15, urinary bacterial load was no longer associated with UTI incidence. The microbiota of PIs and adjacent skin were distinct from urinary microbiota, indicating minimal cross-contamination. Early perioperative high bacterial load is associated with increased urinary inflammation and a higher risk of postoperative UTIs in patients with SCI undergoing PI reconstruction. These findings support early infection monitoring and targeted preventive strategies to improve postoperative outcomes.

IntroductionPressure injuries (PIs) are a significant clinical problem, particularly in elderly, bedridden, and spinal cord injury patients. Bacterial infections are a primary complication that often delays or prevents wound healing. This systematic review analysed the current evidence on the role of the PI microbiome in wound healing outcomes.MethodsA systematic search was conducted in three online databases, namely Embase, Medline, and Web of Science (latest search October 2024). In total, 20 studies met the inclusion criteria, of which three were interventional (randomised controlled trials (RCTs), n=2; pre-post study, n=1), and 17 were observational study designs (retrospective, n=6; prospective, n=8; and case-control, n=3) comprising 1'015 study participants (with 1'034 PIs). These studies examined the PI microbiome, mostly at PI grades III and IV, using culture-based and next-generation sequencing (NGS) techniques. Data extraction focused on microbial diversity, predominant species, and their association with wound healing. The risk of bias was categorised as moderate, mostly due to the absence of sample size justification, as assessed by the NHLBI tool.ResultsThe findings confirmed that Staphylococcus aureus, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, Enterococcus spp., and Escherichia coli dominated the PI microbiomes. Microbiome composition varied according to PI severity and anatomical location. Molecular techniques have identified a more diverse microbiome than culture-based methods. Although no specific bacterial taxa have been found to be favourable for wound healing, many taxa were found to be detrimental to PI development, including Anaerococcus, Finegoldia, and Acinetobacter. Antibiotic resistance was common, particularly in S. aureus. Interventions targeting the microbiome, such as debridement and platelet-rich plasma therapy, have been shown to improve healing rates.DiscussionIn conclusion, evidence showed that the composition of the PI microbiome might negatively associate to wound healing, with the dominance of anaerobes associated with delayed healing. Therefore, future PI treatments should prioritise patient-centred approaches that integrate advanced microbial profiling with rigorous clinical evaluation to optimise chronic wound management.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024575143.

This pilot study examined longitudinal changes in psychological distress and biomarkers related to stress, inflammation, and biological aging during the first inpatient rehabilitation after Spinal Cord Injury (SCI). We analyzed data from 120 participants in the SwiSCI inception cohort at two timepoints: the beginning of the first post-injury rehabilitation and discharge. A subset of 50 participants representing four distress patterns (high chronic, low, transient, increasing distress) underwent biomarker analyses, including measurements of immune and inflammatory proteins and whole-blood transcriptomic profiling. The results showed that psychological distress, depression, and protein carbonyl content decreased significantly by discharge. In contrast, cortisol levels and telomere length showed no significant changes. Proteomic analyses revealed a broad downregulation of inflammatory proteins (e.g., IFN-γ, IL-10, LIF) at discharge, whereas transcriptomic profiles did not differ between timepoints. The high chronic distress group showed lower expression of six genes involved in adaptive immunity, neural development and apoptosis. Psychological distress was not linearly associated with global biomarker profiles. However, CXCL1 and IL-7 showed low-to-moderate correlations with depression and anxiety, respectively. This pilot study demonstrates the feasibility of integrating psychological and molecular data to investigate biological response following SCI. The findings are exploratory and need validation in larger studies with longer follow-up periods.

OBJECTIVES:To determine whether mupirocin-based decolonization, compared with placebo, no treatment, or alternative agents, reduces Staphylococcus aureus-related surgical site infection (SA-SSI), nasal S. aureus colonization, and overall SSIs incidence in elective surgery. METHODS:We searched EMBASE, Medline (Ovid), PubMed, CENTRAL, and Google Scholar to May 15, 2024, for randomized controlled trials (RCTs). Risk ratios (RRs) were pooled using a random-effects model with the restricted maximum likelihood estimator with the Hartung-Knapp adjustment. Prespecified subgroup analyses evaluated application strategy, surgical type, and chlorhexidine gluconate (CHG) co-administration. RESULTS:Seventeen RCTs (15,533 participants) were included. In trials with no-treatment or placebo controls, mupirocin-based decolonization reduced SA-SSI (RR 0.67, 95% confidence interval (CI) 0.49-0.91) and nasal colonization (RR 0.22, 95% CI 0.18-0.26). Effects were larger with targeted use in confirmed carriers and when combined with CHG. No reduction was observed for overall SSIs, except in orthopedic surgery (RR 0.80, 95% CI 0.65-0.99). Head-to-head data vs active alternatives were sparse and did not show a consistent advantage for mupirocin. CONCLUSION:Targeted preoperative mupirocin, especially when combined with CHG, reduces SA-SSI in elective surgery. The lack of significant impact on overall SSIs is interpreted as a reflection of polymicrobial etiologies in surgical infections. Given the emerging risk of mupirocin resistance, further adequately powered head-to-head trials with standardized outcomes and integrated resistance surveillance are warranted.

CONTEXT:Spinal cord injury (SCI) disrupts gut microbiota composition, resulting in dysbiosis that can worsen neuroinflammation and impede post-injury recovery. Short-chain fatty acids (SCFA), metabolites produced by the gut microbiome with anti-inflammatory properties, offer a promising avenue for improving recovery and rehabilitation outcomes. OBJECTIVE:We aimed to compile a summary of the human and animal evidence on the potential benefits of SCFA or SCFA  - producing bacteria in individuals with SCI. METHODS:Three databases (EMBASE, Medline (Ovid) and Web of Science) were searched from inception until 19 October 2023. No language restrictions were applied. Title and abstract screening, data extraction and risk of bias assessments were done independently by two reviewers. RESULTS:A total of 2492 studies were retrieved, 69 full-text studies were reviewed, and 13 studies were included (11 animal and 2 human). Human studies, which involved participants with chronic SCI, linked gut dysbiosis (a proxy for low SCFA production) and human metabolic profiles, suggesting a potential role for microbiome-targeted interventions even in later stages of injury. Evidence from animal studies, predominantly in acute and sub-acute models of SCI, consistently associated SCFA interventions with improved motor function, reduced tissue damage and favorable changes in inflammatory and oxidative stress markers. Fecal microbiota transplantation and probiotics improved motor function and reduced lesion size in animal models. Gut microbiome modulations through treatments such as melatonin, moxibustion, and intermittent fasting was correlated with improved motor outcomes and increased abundance of SCFA-producing bacteria. CONCLUSIONS:This review highlights the potential of targeting the gut microbiota and SCFAs as therapeutic strategies for SCI recovery. However, despite promising results in animal models, human evidence remains limited.

Objective: To systematically evaluate the application and utility of omics technologies, high-throughput methods measuring the complete or targeted set of molecules inside a biological system at a certain timepoint, in monitoring and optimizing rehabilitation interventions in traumatic spinal cord injury. Data sources: Embase, Medline/Ovid, and Web of Science were searched from inception to November 27, 2024. Study Selection: Eligible studies included adults (≥18 years) with spinal cord injury undergoing rehabilitation interventions assessed using omics technologies (genomics, epigenomics, transcriptomics, proteomics, metabolomics, or metagenomics). Data Extraction: Following PRISMA guidelines, independent screening, data extraction, and risk of bias (RoB) assessment (National Institutes of Health Quality Assessment Tools) were performed by 2 investigators. Based on RoB assessment, studies were classified from level 1 (most reliable) to level 4 (least reliable). Data synthesis: Twenty-three trials were included: 8 randomized controlled trials, 5 non-randomized controlled trials, and 10 pre-post trials. Twenty-two studies (96%) exhibit a moderate RoB due to small sample size and heterogeneity. Omics technologies were primarily applied to exercise and electrical muscle stimulation interventions (65%), followed by hormonal and cellular therapies (22%), and diet (13%). Transcriptomic analyses revealed consistent molecular adaptations, including increased mitochondrial biogenesis (proliferator-activated receptor gamma coactivator 1-alpha) and reduced muscle atrophy gene expression (myostatin), correlating with enhanced insulin sensitivity and improved aerobic capacity. Metagenomics consistently identified microbiome shifts, such as decreased inflammatory taxa and increased beneficial taxa, associated with improved metabolic profiles and bowel function. Proteomics and metabolomics highlighted systemic changes related to neurorecovery, immune modulation, and sperm motility, linking molecular signatures directly to clinical outcomes. Conclusions: Omics technologies enable early identification of molecular alterations. However, given small sample sizes and heterogeneity of the current studies, these findings should be interpreted with caution. Gradual integration of omics, particularly epigenomics which may capture long-term, injury-related changes holds promise for developing personalized rehabilitation protocols and monitoring clinical progression in spinal cord injury.

Background Accurate estimation of the microbial load is crucial for diagnosing infections and guiding treatment decisions. While traditional culture methods are informative, they are limited by their inability to grow all organisms. Next-generation sequencing offers a more comprehensive alternative for identifying and quantifying microbial communities. This study explored the application of full-length 16S rRNA gene sequencing for bacterial quantification by incorporating internal controls. Methods We optimized full-length16S rRNA gene sequencing using nanopore technology, on commercially available mock community standards. We varied DNA input, PCR cycles, and spike-in proportions. The method was then validated using human samples from the stool, saliva, nose, and skin, and a spike-in control for quantification. Community profiling was done with Emu. Results Emu performed well at providing genus and species-level resolution. The use of spike-in provided robust quantification across varying DNA inputs and sample origin. However, challenges remained in detecting low-abundance taxa and differentiating closely related species. Human samples with varying microbial loads showed high concordance between sequencing estimates and culture methods. Conclusion These findings demonstrate that full-length 16S rRNA gene sequencing, combined with spike-ins, offers a reliable and scalable approach for microbial quantification. The method's performance across diverse human microbiomes supports its potential use in clinical diagnostics where bacterial identification and load estimation are critical. However, further refinement is needed to address limitations in detecting low-abundance and closely related species.

Individuals with spinal cord injury/disease (SCI/D) have a high incidence of urinary tract infections (UTI). This randomized controlled pilot trial investigated the effect of an immunomodulator (Uro-Vaxom) versus a placebo on the urinary tract microbiome of individuals with SCI/D to inform the design of a larger trial. Twenty participants with SCI/D undergoing primary rehabilitation were randomized to receive either Uro-Vaxom or a placebo for three months (ClinicalTrials.gov NCT04049994 08/08/2019). Urine was collected at baseline, immediately post-treatment, and three months post-treatment. DNA was extracted and sequenced using full-length 16 S rRNA using Oxford Nanopore technology. Internal controls were added for absolute abundance estimation. There were 10 participants in Uro-Vaxom and 10 in placebo analyzed. The prevalence of Escherichia coli was lower in the Uro-Vaxom group (2/10) compared to the placebo group (5/10) post-treatment, although this difference was not statistically significant. Significant alpha and beta diversity differences were associated with the microbial load, sex, and voiding method. Uro-Vaxom showed potential in reducing E. coli prevalence during the treatment period, but this result requires validation in a larger trial. Future trials should consider the baseline microbial load and optimal timing of intervention to ensure that the observed effects are attributable to immunomodulation.

ObjectivesTo illustrate and explore associations between the gut microbiome and spinal cord injury (SCI) characteristics, physical training, dietary intake, body composition, and blood biomarkers of elite Swiss athletes.Design and settingBaseline data analysis of athletes with SCI who participated in a pilot trial (NCT04659408) in the Swiss Paraplegic Center, Nottwil, Switzerland.ParticipantsElite athletes, five males, and six females, with SCI who competed internationally.Outcome measuresWe conducted a differential abundance analysis and measured the alpha and beta diversity of the gut microbiome.ResultsThe athletes' median age was 34.5 years. Six had traumatic SCI and five had a spina bifida. The athletes competed in para-cycling (5), wheelchair athletics (3), and wheelchair tennis (3). A higher duration of training per week was positively associated with Akkermansia and Akkermansiaceae but negatively associated with Prevotellaceae. Muribaculaceae was negatively associated with the average number of trainings per week. Waist circumference is negatively associated with Butyricimonas. Significant differences in the alpha diversity were found with sex, gastrointestinal quality of life index (GIQLI) scores, total caloric intake, total fat intake, total carbohydrate intake, and high-sensitivity C-reactive protein (hs-CRP). Beta diversity differences were found with impairment of the sympathetic nervous system of the gut at the genus level and HbA1c at the family level.ConclusionsThis study provides insight into the gut microbiome of athletes with SCI. Our results were similar to those found in athletes without SCI. Further replication is needed to confirm the relationships of organisms observed in the gut of athletes with SCI.

OBJECTIVE:To evaluate the effect of lifestyle and behavioral interventions on anthropometric indices and body composition in individuals with spinal cord injury (SCI). DATA SOURCES:MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched from inception to January 22, 2024. STUDY SELECTION:Randomized controlled trials (RCTs), non-RCTs, and pre-post studies on the effectiveness of lifestyle and/or behavioral interventions in improving body composition (including body mass index, waist circumference, fat mass, and lean mass) were eligible. DATA EXTRACTION:Study design characteristics, number of participants, intervention/control characteristics, and outcomes were extracted. DATA SYNTHESIS:Sixty-one interventional studies were included in the systematic review, among which 5 RCTs contributed to meta-analysis. Exercise, alone or combined with functional electrical stimulation (FES), supplements, or educational sessions, was the most studied intervention across the identified studies, accounting for 75% of studies. Exercise regimen compared with the usual activities yielded a decrease in BMI (mean difference [MD], -0.38 kg/m2; 95% CI, -0.57 to -0.19; I2: 0%; Pq:.45]) and waist circumference (MD, -2.93 cm; 95% CI, -3.98 to -1.88; I2: 0%; Pq: 0.59). No significant differences were observed when comparing changes in total body fat percentage nor lean body mass between the 2 groups. Exercise with FES and testosterone, exercise and personalized diet, high-protein diet, and α-lipoic acid supplementation were mapped as other potentially beneficial interventions, whereas studies targeting behavioral changes were inconclusive. CONCLUSIONS:Exercise-based interventions alone or combined with FES or standardized/personalized dietary regimens show promise as effective strategies for improving anthropometric indices and body composition among individuals with SCI, emphasizing the potential benefit of the weight management program. The present findings may not be applicable to individuals with high SCI lesions. Further research to evaluate the effectiveness of a more complex lifestyle and/or behavioral interventions in individuals with SCI is warranted.

Abstract Disorders related to gut health are a significant cause of morbidity among athletes in wheelchair. This pilot feasibility trial aims to investigate whether probiotics compared to prebiotics can improve inflammatory status and gut microbiome composition in elite athletes in wheelchair. We conducted a 12-week, randomized, cross-over controlled trial involving 14 elite Swiss athletes in wheelchair. Participants were given a multispecies-multistrain probiotic or prebiotic (oat bran) daily for 4 weeks (Clinical trials.gov NCT04659408 09/12/2020). This was followed by a 4-week washout and then crossed over. Thirty inflammatory markers were assessed using bead-based multiplex immunoassays (LegendPlex) from serum samples. The gut microbiome was characterized via 16S rRNA sequencing of stool DNA samples. Statistical analyses were conducted using linear mixed-effect models (LMM). At baseline, most athletes (10/14) exhibited low levels of inflammation which associated with higher gut microbiome alpha diversity indices compared to those with high inflammation levels. The use of probiotic had higher decrease in 25 (83%) inflammatory markers measured compared to prebiotic use. Probiotic has the potential in lowering inflammation status and improving the gut microbiome diversity. The future trial should focus on having sufficient sample sizes, population with higher inflammation status, longer intervention exposure and use of differential abundance analysis.

Objectives To describe the concept, establishment and the operationalization of the biobank of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), the available biosamples, and demographic and clinical characteristics of study participants. Setting The SwiSCI biobank is a platform for research within SwiSCI. It collects and processes serum, plasma, PBMCs, RNA, DNA, and urine from three rehabilitation centers. Samples are collected at admission to first rehabilitation and at discharge. Additionly, the biobank provides services to projects nested in SwiSCI or otherclinical trials among Spinal Cord Injury population. Methods Descriptive statistics were used for an overview of available biosamples, study participant characteristics, and comparison of the participating centers. Results Between the SwiSCI biobank establishment on June 27th, 2016, and October 19th, 2023, the SwiSCI Study has obtained informed consent from 524 individuals. Of these, 315 (60.1%) have agreed to donate biospecimens to the biobank. The average age of the contributors was 54 years (range: 38–65), with the majority being male (80%). Most participants suffered from traumatic injuries (66%) and were classified as paraplegic (64%). Approximately 80% presented with motor and sensory-incomplete SCI. The median Spinal Cord Independence Measure (SCIM) score was 31 (Interquartile Range: 19–58). The proportion of individuals providing paired biosamples at two distinct time points ranged from 63% (for RNA) to 65% (for urine and urine sediment). Conclusions The SwiSCI biobank is a unique platform designed to serve as a basis for collaborative SCI research, including multi-omics approaches. The longitudinal collection of biospecimens and cryopreservation of multiple aliquots for each participant are fundamental for scrutinizing the temporal associations, ensuring research reproducibility, and achieving an adequate sample size for future investigations.

BACKGROUND:Accurate identification of bacterial communities is crucial for research applications, diagnostics, and clinical interventions. Although 16S ribosomal RNA (rRNA) gene sequencing is a widely employed technique for bacterial taxonomic classification, it often results in misclassified or unclassified bacterial taxa. This study sought to refine the full-length 16S rRNA gene sequencing protocol using the MinION sequencer, focusing on the V1-V9 regions. Our methodological enquiry examined several factors, including the number of PCR amplification cycles, choice of primers and Taq polymerase, and specific sequence databases and workflows employed. We used a microbial standard comprising eight bacterial strains (five gram-positive and three gram-negative) in known proportions as a validation control. RESULTS:Based on the MinION protocol, we employed the microbial standard as the DNA template for the 16S rRNA gene amplicon sequencing procedure. Our analysis showed that an elevated number of PCR amplification cycles introduced PCR bias, and the selection of Taq polymerase and primer sets significantly affected the subsequent analysis. Bacterial identification at genus level demonstrated Pearson correlation coefficients ranging from 0.73 to 0.79 when assessed using BugSeq, Kraken-Silva and EPI2ME-16S workflows. Notably, the EPI2ME-16S workflow exhibited the highest Pearson correlation with the microbial standard, minimised misclassification, and increased alignment accuracy. At the species taxonomic level, the BugSeq workflow was superior, with a Pearson correlation coefficient of 0.92. CONCLUSIONS:These findings emphasise the importance of careful selection of PCR settings and a well-structured analytical framework for 16S rRNA full-length gene sequencing. The results showed a robust correlation between the predicted and observed bacterial abundances at both the genus and species taxonomic levels, making these findings applicable across diverse research contexts and with clinical utility for reliable pathogen identification.

Pressure injuries (PI) are a common issue among individuals with spinal cord injury (SCI), especially in the sitting areas of the body. Considering the risk of infections occurring to PI during the wound healing process, the skin microbiome is likely to be a source of bacteria. We investigated the relationship between skin and PI microbiomes, and assessed any correlation with clinically relevant outcomes related to PI. Samples were isolated from SCI patients undergoing reconstructive surgery of PI, severity grades III and IV. DNA samples from skin and PI were analysed using 16S rRNA gene sequencing. Our results showed disparities in microbiome composition between skin and PI. The skin had lower diversity, while PI showed increased bacterial homogeneity as the severity grade progressed. The skin bacterial composition varied based on its location, influenced by Cutibacterium . Compositional differences were identified between PI grades III and IV, with clusters of bacteria colonizing PI, characterized by Pseudomonas , Proteus and Peptoniphilus . The skin and PI microbiomes were not affected by the level of the SCI. Our study highlights the differences in the microbiome of skin and PI in SCI patients. These findings could be used to target specific bacteria for PI treatment in clinical practice.

The high recurrence and complications associated with severe pressure injuries (PI) necessitate the exploration of advanced treatments, such as cell-based therapies, to facilitate wound healing. Such techniques harness the ability of different cell types to promote angiogenesis, re-epithelialization of the skin, and tissue regeneration. This systematic review explores the efficacy of cell-based therapies and tissue engineering in treating deep PI. We searched for interventional studies using cells in the treatment of PI in adults in four online libraries (PubMed, Embase, Ovid Medline, and Cochrane; latest search 10th June 2023). We found one randomized clinical trial (RCT), two non-RCT, and three pre-post studies, comprising 481 study participants with PI (253 intervention/228 controls). The risk of bias was categorized as moderate due to minimal bias in outcome measurements, or high owing to unclear patient randomization methods, as assessed by the ROBINS-I, NIH, and RoB-2 tools. Four cell types were identified in the context of cell-based therapies of PI: bone marrow mononuclear stem cells (BM-MNCs, n = 2); hematopoietic derived stem cells (HSC, n = 1); macrophages and activated macrophage suspensions (AMS, n = 2); and cryopreserved placental membrane containing viable cells (vCPM, n = 1). Wound healing outcomes were observed in patients undergoing cell-based therapies, including complete wound closure (AMS, vCPM; n = 142), faster healing rate (BM-MNCs, AMS; n = 146), improved granulation tissue formation (HSC, n = 3) and shorter hospitalization time (BM-MNCs; n = 108) compared to standard of care, with no adverse reactions. PI healing rate decreased only in one study with BM-MNC therapy, compared to control ( n = 86). Based on the available data, though with limited evidence, it seems that macrophage deployment showed the most favorable outcomes. The results indicate that cell-based therapies offer a potential avenue for enhancing wound healing and tissue repair in PI; however, more extensive research is needed in this domain.

STUDY DESIGN:Systematic review. OBJECTIVES:To investigate the changes in the microbiome among human and animal populations with spinal cord injury (SCI). METHODS:Four databases (EMBASE, Medline (Ovid), Web of Science, Cochrane Central Register of Trials (CENTRAL)) and Google Scholar were searched. No language restrictions were applied. Data extraction was done in parallel and independently by two reviewers. The search was last conducted on 07 April 2021. RESULTS:There were 6869 studies retrieved, 43 full-text studies reviewed, and 19 studies included. There were seven animal gut studies, six human gut studies, and six urinary tract studies identified. There were no publications found on other body sites. Among the included studies, we observed a consistent and significant difference in gut microbiome composition between populations with SCI and able-bodied populations. This is characterized by a decrease in beneficial butyrate-producing bacteria (Faecalbacterium, Megamonas, Roseburia) and an increase in inflammation-associated bacteria (Alistipes, Anaerotruncus, and Lachnoclostridium). On the other hand, the urine of individuals with SCI was polymicrobial and members of Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae) were frequently observed. Probiotics were shown to induce a significant but transient shift in the urinary tract microbiome. The studies had low to moderate risks of bias. CONCLUSIONS:There are limited studies on the changes in microbiome among SCI populations. The gut microbiome was characterized by bacterial profiles associated with chronic inflammation and metabolic disorder while the studies of the urinary tract microbiome show the dominance of bacterial genera associated with urinary tract infection.

Spinal cord injury (SCI) can lead to dramatic physiological changes which can be a factor in developing secondary health conditions and might be reflected in biomarker changes in this elevated risk group. We focused specifically on the endocrine and inflammation profile differences between SCI and able-bodied individuals (ABI). Our aim was to determine the differences in inflammatory markers and endocrine profiles between SCI and ABI. We systematically searched 4 electronic databases for relevant studies. Human observational (cross-sectional, cohort, case–control) studies that compared biomarkers of interest between SCI and ABI population were included. Weighted mean difference between SCI and ABI was calculated using random-effects models. Heterogeneity was computed using I 2 statistic and chi-squared test. Study quality was evaluated through the Newcastle–Ottawa Scale. The search strategy yielded a total of 2,603 studies from which 256 articles were selected for full-text assessment. Sixty-two studies were included in the meta-analysis. SCI individuals had higher levels of pro-inflammatory C-reactive protein and IL-6 than ABI. Creatinine and 25-hydroxyvitamin D 3 levels were lower in SCI than ABI. Total testosterone levels and IGF-1 were also found to be lower, while cortisol and leptin levels were higher in SCI when compared to ABI. Accordingly, meta-regression, subgroup analysis, and leave-one-out analysis were performed, however, they were only able to partially explain the high levels of heterogeneity. Individuals with SCI show higher levels of inflammatory markers and present significant endocrinological changes when compared to ABI. Moreover, higher incidence of obesity, diabetes, osteoporosis, and hypogonadism in SCI individuals, together with decreased creatinine levels reflect some of the readily measurable aspects of the phenotype changes in the SCI group. These findings need to be considered in anticipating medically related complications and personalizing SCI medical care.

Abstract Study design Systematic review and meta-analysis. Objective To determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI). Methods We searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162). Results We screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, −14.5 mmHg, 95% CI −19.2, −9.9; −7.0 mmHg 95% CI −9.2, −4.8, respectively), lower triglycerides (−10.9 mg/dL, 95% CI −19.7, −2.1), total cholesterol (−9.9 mg/dL, 95% CI −14.5, −5.4), high-density lipoprotein (−1.7 mg/dL, 95% CI −3.3, −0.2) and low-density lipoprotein (−5.8 mg/dL, 95% CI −9.0, −2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (−10.3 mmHg, 95% CI −13.4, −7.1; −5.3 mmHg 95% CI −7.5, −3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies. Conclusion In SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

Background Oats are a food source with multiple health benefits that could support beneficial bacterial groups and provide important bioactive compounds for the gut. Objectives This review explores the association between oat intake, gastrointestinal (GI) symptoms, and microbial community changes in individuals with celiac disease (CeD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) and without GI disease. Methods Four databases and Google Scholar were systematically searched from inception until April 29, 2021. Clinical trials, observational studies, and in vitro studies with human gut-derived samples were included. Results There were 84 articles [23 randomized controlled trials (RCTs), 21 nonrandomized trials, 8 observational studies, and 32 in vitro studies] included. Oat intake increased total bacterial count, Lactobacilli spp., and Bifidobacterium spp. in healthy individuals and those with CeD. There was an increased concentration of short-chain fatty acids and improved gut permeability with oat intake but with no significant quality-of-life difference. In some individuals with CeD, consumption of certain oat types was associated with worsening of GI symptoms. We found no studies reporting on IBS and only 3 for IBD. The quality of RCTs showed some concerns mostly in domains of randomization (73.9%), whereas the quality of evidence of non-RCTs, observational studies, and in vitro studies was satisfactory. Conclusions Oat intake was associated with the increase of beneficial bacterial groups in individuals without GI disease and those with CeD. Most studies showed no changes in GI symptoms with oat consumption. In vitro studies in CeD provide insight to oat-sensitive individuals and their GI mucosa, but the clinical studies remain limited, precluding our ability to draw firm conclusions. The prevalence of oat sensitivity in individuals with CeD should be further explored as this could improve clinical management and facilitate inclusion of oat in the diet for this population.