Anna Pszonka

Background: The microbiota-gut-brain axis provides a biologically plausible framework for bidirectional communication between intestinal microorganisms and the central nervous system. Human studies have reported gut microbiota differences in autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and schizophrenia, but the reproducibility and clinical meaning of these observations remain uncertain. Objective: To critically summarize human evidence on gut microbiota composition in ASD, ADHD, and schizophrenia, and to assess clinical evidence for probiotic and synbiotic formulations and fecal microbiota transplantation (FMT) in these disorders. Methods: A focused narrative review was conducted using PubMed and supplementary Google Scholar searches. Publications from 1 January 2012 to 31 December 2024 were considered, and the final search update was completed on 28 February 2025. Forty-two publications were purposively selected and synthesized; original human studies were prioritized whenever available. Evidence was interpreted with attention to study design, sample size, medication exposure, diet, gastrointestinal symptoms, stool characteristics, sequencing and bioinformatics methods, outcome selection, safety reporting, and risk of reverse causality. Because this was a narrative rather than a systematic review, no PRISMA flow diagram, duplicate independent screening, formal study-level risk-of-bias instrument, or new quantitative pooling was used. Results: Across all three disorders, individual studies and meta-analyses report group-level microbiota differences, but no reproducible disorder-specific microbial signature has been established. In ASD, dietary selectivity, gastrointestinal symptoms, and stool consistency explain an important proportion of reported associations. ADHD studies are generally small and yield conflicting diversity and taxonomic findings. In schizophrenia, associations are influenced by antipsychotic exposure, metabolic status, smoking, diet, and illness chronicity. Controlled trials and meta-analyses have not shown consistent improvement in core symptoms with probiotic or synbiotic products. Early uncontrolled microbiota-transfer studies in ASD suggested possible benefits, but a 2024 randomized placebo-controlled FMT trial did not demonstrate improvement in its primary clinical outcome. Evidence for FMT in ADHD is limited to a case report, and no controlled human efficacy evidence was identified for schizophrenia. FMT carries infectious, procedural, and uncertain long-term risks. Conclusions: Gut microbiota differences in ASD, ADHD, and schizophrenia should currently be regarded as associated features rather than established causes, diagnostic biomarkers, or validated therapeutic targets. Routine microbiome testing, probiotics or synbiotics for core symptoms, and FMT cannot be recommended as standard treatments for these disorders. Future studies require longitudinal designs, careful control of diet and medication, standardized laboratory methods, preregistered clinical outcomes, adequate power, external validation, and systematic safety monitoring.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder traditionally linked to monoaminergic dysregulation within the brain’s reward circuitry. Recent evidence points to the potential role of the gut-brain axis (GBA), a bidirectional communication network linking the central nervous system with the enteric microbiota. This narrative review explores the proposed associations between intestinal dysbiosis and ADHD symptoms, as well as the potential for GBA-targeted therapeutic interventions. Research suggests that individuals with ADHD may exhibit distinct microbial profiles, characterized by an increased abundance of genera such as Bifidobacterium and Bacteroides , and a depletion of anti-inflammatory taxa like Faecalibacterium . These shifts are hypothesized to contribute to “leaky gut” syndrome, potentially triggering systemic inflammation and neuroinflammation that could disrupt neural circuits responsible for executive function. Furthermore, experimental models indicate that gut microbes may modulate the availability of dopamine precursors, indirectly influencing reward processing. Preliminary clinical data suggest that “psychobiotics,” synbiotics, and targeted micronutrient supplementation (e.g., iron, zinc, and magnesium in cases of confirmed deficiencies) might serve as supportive interventions and potentially improve quality of life. While standard pharmacotherapy remains the primary treatment, GBA-focused strategies are being investigated as adjunctive therapies, offering a promising yet preliminary avenue for personalized management. Integrating these interventions may help manage common comorbidities across the lifespan, though further robust clinical trials are required.

Background: Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy—a marriage of rotational atherectomy and intravascular lithotripsy—has recently been introduced to clinical practice as a novel therapeutic option. Methods: This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion. Results: The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified. Conclusions: Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.