Gut microbiota and neuromuscular disorders: a comprehensive review.

Abstract: Emerging evidence highlights a bidirectional interaction between the gut microbiota (GM) and the neuromuscular system, suggesting that microbial composition and metabolic activity may play a pivotal role in the pathophysiology of several neuromuscular diseases (NMDs). This comprehensive review synthesizes current evidence on GM alterations across a broad spectrum of NMDs, emphasizing their potential implications for disease mechanisms and management. Gut microbial shifts have been consistently associated with immune dysregulation, systemic inflammation, and metabolic disturbances that may contribute to neuromuscular dysfunction. Beyond their pathogenetic relevance, these alterations hold diagnostic and therapeutic promise. Probiotic supplementation, dietary modulation, and other microbiota-targeted strategies have shown preliminary benefits in alleviating symptoms and improving metabolic balance in selected NMDs, although existing studies remain limited and heterogeneous. This review offers an integrative perspective, positioning the GM not only as a potential biomarker for diagnosis and disease monitoring but also as a novel therapeutic target. A deeper understanding of the gut-muscle-nerve axis could pave the way for more personalized and mechanism-based approaches in neuromuscular medicine, particularly for disorders where disease-modifying treatments are still lacking. Further well-designed, longitudinal, and mechanistic studies are warranted to elucidate causal relationships and translate microbiome research into clinical application.