Fig. 2.

Schematic presentation of the bidirectional interaction of GBMAx in the pathogenesis of ischemic stroke and inflammatory bowel disease (IBD). With ischemic stroke, the excitability of the sympathetic nervous system, enteric neuronal loss, gut permeability, and epithelial damage increases, while gut motility decreases. Gut microbial dysbiosis and the intestinal immune response emerge simultaneously. The changes above are modulated by the GBMAx, aggravating ischemic stroke via microbial interleukin (IL)-17-positive T cell-mediated neuroinflammation. Inflammatory bowel disease (IBD) is a key driving factor for psychological disorders and stress, increasing gut permeability, bacterial translocation, and mucosal immune response and modulating the hypothalamic-pituitary axis response through the GBMAx