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Change in gut microbiome precedes symptomatic Alzheimer's disease and is correlated with amyloid-beta accumulation in the brain

Shoubridge, A. P.; Manning, S. K.; Tan, S.; Kidson, S.; Richard, A.; Trinder, J.; Miller, S.; Laver, K.; Rahja, M.; Robertson, J.; Crotty, M.; Taylor, S. L.; Rogers, G. B.

2026-10-19 neurology
10.64898/2026.10.15.26365677 medRxiv
Show abstract

INTRODUCTION: Alzheimer's disease (AD) begins with cerebral amyloid-beta (A{beta}) deposition decades before clinical symptoms. While the microbiota-gut-brain axis has been implicated in AD, its role in this preclinical phase remains unclear. We examined potential links between gut microbiome features and presymptomatic cerebral A{beta} burden. METHODS: Asymptomatic individuals (n=101, median age 70.0 years, 53% female) underwent cognitive assessment, cerebral A{beta} quantification, and stool metagenomic sequencing. Associations between microbial characteristics and A{beta} levels were performed using multivariable-adjusted ordinal logistic regression. RESULTS: Gut microbiota composition varied with A{beta} levels (p(perm)=0.03, R2=0.014). Higher A{beta} was associated with increased Alistipes communis, and decreased Anaerotignum faecicola and Eubacterium rectale, abundance (q<0.001). A{beta}-associated microbiome traits corresponded to lower biosynthetic capacity for {gamma}-aminobutyric acid, and systemic regulators of immunity and autophagy (q<0.01). DISCUSSION: Early A{beta} accumulation is associated with distinct gut microbial signatures and reduced neuroactive metabolic potential, identifying targets for potential preclinical AD intervention.

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