Emilio Moreno-González

Over time, our understanding of the central nervous system (CNS) as an immunologically privileged site where immune-cell infiltration takes place has changed; research has transformed the dominant view, showing that the CNS is an immunologically specialized tissue featuring complex interactions between the immune system and CNS processes, where the choroid plexus (CP) has an essential role in regulating neuronal tissue homeostasis and immune-cell trafficking. Although immune-cell entry into the CNS is tightly controlled, small numbers of antigen-experienced lymphocytes can access cerebrospinal fluid (CSF) compartments for immune surveillance under normal conditions. During an injury, such as cerebral ischemia or spinal cord damage, dendritic cell precursors infiltrate the CNS, suggesting their involvement in modulating lymphocyte activity. However, the immunoregulatory function of the CP alone is insufficient to prevent damage. Injury can trigger a cascade of events including activation of microglia toward a pro-inflammatory M1 phenotype, infiltration of peripheral immune cells across the blood–brain barrier (BBB), and uncontrolled neuroinflammation. T cells play a critical role in this process. Th1 cells exacerbate inflammation upon recognizing neural antigens, whereas Th2 cells promote recovery by releasing neurotrophic factors. This highlights the dual role of inflammation in CNS injury and repair.

Aim: To assess the effect of a synbiotic supplement composed of Enterococcus faecium and agave inulin on cognitive function in older adults with mild cognitive impairment (MCI). Methods: In a triple-blind randomized crossover trial, nineteen adults aged 64–85 years with MCI received either the synbiotic or an isocaloric vehicle for eight weeks, followed by a three-week washout and treatment crossover. Cognitive outcomes were assessed at baseline, after the first intervention, and after crossover using the Modified Mini-Mental State Examination (MMSE), Rey-Osterrieth Complex Figure Test (RCFT; copy and memory), and Abbreviated Instrument for Expectations of Self-Efficacy for Daily Activities in Older Adults (AERAC) self-efficacy scale. Paired and unpaired Student’s t-tests were used for statistical comparisons (p < 0.05). Results: The synbiotic group showed significant improvement relative to baseline across all domains: MMSE (p = 0.05), AERAC (p = 0.005), RCFT-copy (p = 0.03), and RCFT-memory (p = 0.03). Post-treatment comparisons between groups also favored the synbiotic, with significant differences in MMSE (p = 0.001), AERAC (p = 0.001), RCFT-copy (p = 0.0095), and RCFT-memory (p = 0.001). After crossover, cognitive gains were sustained and reproduced. MMSE scores reached 17.89 ± 1.45 in the synbiotic-first group versus 18.20 ± 0.63 in the control-first group (p < 0.001). RCFT-copy remained high (29.83 ± 4.18 vs. 29.52 ± 5.60, p = 0.0157), while RCFT-memory scores differed (17.56 ± 6.73 vs. 17.20 ± 3.29, p = 0.0005). AERAC scores continued to improve during crossover (82.60 ± 10.49 vs. 85.46 ± 8.28, p < 0.001). No adverse effects occurred. Conclusions: Synbiotic supplementation significantly improved global cognition, visuoconstructive ability, memory, and functional self-efficacy in older adults with MCI. Benefits persisted beyond the initial intervention and were replicated when the control group received the synbiotic, supporting its potential as a safe and effective strategy to mitigate age-related cognitive decline.

The glymphatic system (GS) consists of a paravascular fluid-exchange network that regulates cerebrospinal and interstitial fluid dynamics, clears metabolic waste, and modulates neuroinflammation. Aquaporin-4 (AQP-4), expressed in astrocytic end-feet, is central to GS function and blood-brain barrier integrity, but in cerebral ischemia (CI), GS disruption and AQP-4 mislocalization drive cytotoxic edema, inflammation, and vascular dysfunction, worsening outcomes. This review aimed to examine the role of the GS in CI, focusing on pathophysiology and potential therapeutic targets. A PubMed-based literature review was conducted, selecting 51 studies from 115 screened that addressed GS, AQP-4, and ischemic stroke. Evidence suggests that modulating GS flow, through strategies such as enhancing arterial pulsations or regulating AQP-4, may reduce edema and neuroinflammation, although selectively targeting AQP-4 without impairing waste clearance remains a key challenge. The GS represents a promising therapeutic target in ischemic stroke, and a deeper understanding of its physiology may guide the development of neuroprotective interventions; future research should refine pharmacological strategies to optimize glymphatic function and improve recovery in CI patients.

Spinal cord injury (SCI) is defined as physical damage that alters the function and structure of the spinal cord. Traumatic causes, such as vehicle accidents, falls, and violence, account for 90% of SCI cases. Recent evidence suggests that early intensive care unit (ICU) monitoring improves patient prognosis, highlighting the importance of prompt ICU admission and early decompression surgery. This review includes 50 publications selected based on specific criteria to gather evidence on the current management of SCI in acute settings. Pharmacological agents have been studied for their neuroprotective properties, offering hope for improved neurological outcomes. Several clinical trials are evaluating new pharmacological alternatives for SCI. In conclusion, the current management of acute SCI should focus on standardized treatments addressing ventilatory, cardiopulmonary, and hematologic complications, all of which directly impact long-term neurological and functional prognosis. New neuroprotective agents currently in clinical trials show promising results and should be further studied to determine their role in acute SCI management.