Gut Microbiome-Sphingolipid Metabolism-Brain Axis Interactions: Neuroprotective Effects of Amitriptyline as Functional Inhibitor of Acid Sphingomyelinase in a Mouse Model of Tauopathy.

Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology 2026
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Tauopathies are neurodegenerative diseases characterized by accumulation of hyperphosphorylated tau protein (P-tau). The gut microbiota (GM) is symbiotic with the host and altered in neurodegenerative diseases. Amitriptyline (AMI) is a functional inhibitor of acid sphingomyelinase (ASM) which is abnormally highly expressed in brains of Alzheimer patients. Little data is known about the role of colonic ASM in management of tauopathy. Therefore, the aim of this study was to investigate the role of AMI on reversing gut dysbiosis, ceramide levels, colonic inflammation and intestinal barrier disruption in tauopathy through the bidirectional gut-brain axis. P301S transgenic mice were administered AMI for 35 days. Colonic ASM, ceramides, inflammation and membrane integrity were assessed besides fecal microbiome analysis and serum lipopolysaccharides to assess intestinal membrane disruption. Levels of hippocampal P-tau, protein phosphatase 2 A and neurogenesis were assessed along with cognitive behavior. AMI treatment significantly reduced colonic ASM, ceramide levels, increased abundance of Harryflintia, Dubosiella, and Parasutterella and decreased abundance of Lactobacillus, Lachnoclostridium, Oscillibacter, Oscillospiracea UCG-003, Colidextribacter, Roseburia, Butyricicoccus, and Sphingomondales. In contrast, P301S mice displayed an altered GM profile with enriched Firmicutes and Clostridia, and low proportions of Bacteroidota- a phylum associated with intestinal barrier protection-, and Ruminococcaceae. Also, AMI treatment decreased inflammation and restored colonic membrane integrity with subsequent decrease in serum lipopolysaccharides, P-tau in hippocampus and improvement in cognitive behaviour and neurogenesis. The current results indicate that AMI has neuroprotective effects against tauopathy through modulation of ASM activity, associated ceramide levels, GM composition, colonic inflammation and membrane integrity through bidirectional gut-brain axis.

12 Figures Extracted
Fig. 1
Fig. 1 PMC
Effect of AMI on Spatial learning and long-term memory in P301S mice in the acquisition and probe phases of the MWM test. ( a ) Escape latency in the ...
Fig. 2
Fig. 2 PMC
Effect of AMI on short-term spatial memory in Y-maze, recognition memory in NOR test and motor incoordination in parallel rod floor test in P301S mice...
Fig. 3
Fig. 3 PMC
Effect of AMI treatment on ASM activity and ceramide levels on distal colon of P301S mice. ( a ) ASM activity in distal colon ( n  = 6). ( b - l ) Rel...
Fig. 4
Fig. 4 PMC
Beta-diversity, visualized by PCA of Bray–Curtis distances between different samples. ( a ) Comparison between Control, P301S, and P301S + AMI groups ...
Fig. 5
Fig. 5 PMC
Taxa with significant differences in relative abundance among the three tested groups. Violin plots describe differential relative abundance of thirty...
Fig. 6
Fig. 6 PMC
Taxa with significant differences in relative abundance among the three tested groups. Violin plots describe differential relative abundance of thirty...
Fig. 7
Fig. 7 PMC
Taxa with significant differences in relative abundance among the three tested groups. Violin plots describe differential relative abundance of thirty...
Fig. 8
Fig. 8 PMC
Beta-diversity, visualized by PCA of Bray–Curtis distances between different samples. ( a ) Comparison between P301S mice and AMI treated P301S mice g...
Fig. 9
Fig. 9 PMC
Taxa with significant differences in relative abundance between P301S mice and AMI treated P301S mice groups, the length of the bars represents the lo...
Fig. 10
Fig. 10 PMC
Effect of AMI treatment on tauopathy induced histopathological changes represented by ( a ) photomicrographs of H&E stained two distinct regions o...
Fig. 11
Fig. 11 PMC
Effect of AMI treatment on intestinal barrier disruption and subsequent serum LPS levels associated with tauopathy in P301S mice. ( a ) Photomicrograp...
Fig. 12
Fig. 12 PMC
Effect of AMI treatment on tauopathy related markers in hippocampus and inflammatory markers in distal colon of P301S mice. Panels ( a & c ) repre...