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The Gut–Brain Axis in Sleep Deprivation: Mechanisms, Dysbiosis, and Potential Therapeutic Avenues

Articles InPress

Document Type : Review Article

Authors

1 Exercise Physiology Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Physiology and Medical Physics, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

10.30476/ijms.2025.108475.4351

Abstract

Sleep is fundamental to metabolic regulation, cardiovascular health, immune balance, and cognitive performance. Emerging evidence indicates that sleep deprivation alters gut microbial communities and immune signaling, thereby influencing the gut-brain axis. This narrative review synthesized current findings on how sleep loss engages gut–brain pathways and evaluated therapeutic avenues linked to specific mechanisms, drawing on peer-reviewed human and animal studies and prioritizing sleep- and brain-relevant outcomes. Evidence converged on three mechanistic pillars: (1) circadian and microbial misalignment, which disrupts diurnal microbiome dynamics; (2) inflammatory and barrier dysfunction loops that increase permeability and immune activation; and (3) altered neurotransmitter and metabolite signaling, including shifts in tryptophan pathways and reduced short-chain fatty acid production, with downstream effects on neuroinflammation and plasticity. Human data supported associations between sleep loss, poor sleep quality, and impaired cognition. However, causal inference was limited by small sample sizes, study heterogeneity, and mixed endpoints. Interventions such as probiotics, prebiotics, postbiotics, synbiotics, diet-based short-chain fatty acid strategies, and chronobiotics are biologically plausible, yet they are supported mainly by small trials or preclinical models. Fecal microbiota transplantation shows exploratory, yet faces significant safety, standardization, and regulatory challenges. Collectively, the evidence indicated that sleep deprivation disrupts gut microbiota composition and gut-brain signaling, with consequences for neuroinflammation, neurotransmitter balance, and cognition. This review highlighted the consequent need for standardized endpoints, strain-resolved microbiome analyses, and well-powered randomized controlled trials.

Highlights

Esmail Karami (Google Scholar) 
Behzad Bazgir (Google Scholar) 

Keywords

References
  1. Guo C, Piao S, Wang C, Yu L, Wang K, Qu Q, et al. The prevalence and associated factors of sleep deprivation among healthy college students in China: a cross-sectional survey. PeerJ. 2023;11:e16009. doi: 10.7717/peerj.16009. PubMed PMID: 37744238; PubMed Central PMCID: PMC10512935.
  2. Liew SC, Aung T. Sleep deprivation and its association with diseases- a review. Sleep Med. 2021;77:192-204. doi: 10.1016/j.sleep.2020.07.048. PubMed PMID: 32951993.
  3. Mukherjee U, Sehar U, Brownell M, Reddy PH. Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer’s disease in elderly. Ageing Res Rev. 2024;100:102457. doi: 10.1016/j.arr.2024.102457. PubMed PMID: 39154978; PubMed Central PMCID: PMC11415889.
  4. Smith RP, Easson C, Lyle SM, Kapoor R, Donnelly CP, Davidson EJ, et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14:e0222394. doi: 10.1371/journal.pone.0222394. PubMed PMID: 31589627; PubMed Central PMCID: PMC6779243.
  5. Sun J, Fang D, Wang Z, Liu Y. Sleep Deprivation and Gut Microbiota Dysbiosis: Current Understandings and Implications. Int J Mol Sci. 2023;24. doi: 10.3390/ijms24119603. PubMed PMID: 37298553; PubMed Central PMCID: PMC10253795.
  6. Beurel E. Stress in the microbiome-immune crosstalk. Gut Microbes. 2024;16:2327409. doi: 10.1080/19490976.2024.2327409. PubMed PMID: 38488630; PubMed Central PMCID: PMC10950285.
  7. Singh RK, Chang HW, Yan D, Lee KM, Ucmak D, Wong K, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15:73. doi: 10.1186/s12967-017-1175-y. PubMed PMID: 28388917; PubMed Central PMCID: PMC5385025.
  8. Tian Y, Yang W, Chen G, Men C, Gu Y, Song X, et al. An important link between the gut microbiota and the circadian rhythm: imply for treatments of circadian rhythm sleep disorder. Food Sci Biotechnol. 2022;31:155-64. doi: 10.1007/s10068-021-01015-6. PubMed PMID: 35186346; PubMed Central PMCID: PMC8817960.
  9. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015;28:203-9. PubMed PMID: 25830558; PubMed Central PMCID: PMC4367209.
  10. Ullah H, Arbab S, Tian Y, Liu CQ, Chen Y, Qijie L, et al. The gut microbiota-brain axis in neurological disorder. Front Neurosci. 2023;17:1225875. doi: 10.3389/fnins.2023.1225875. PubMed PMID: 37600019; PubMed Central PMCID: PMC10436500.
  11. Wang Z, Wang Z, Lu T, Chen W, Yan W, Yuan K, et al. The microbiota-gut-brain axis in sleep disorders. Sleep Med Rev. 2022;65:101691. doi: 10.1016/j.smrv.2022.101691. PubMed PMID: 36099873.
  12. Das M, Muralitharan G, Saini S, Patra S. Sleep, gut microbiota, and mind-body medicine. Brain Behavior and Immunity Integrative. 2025;11:100128. doi: 10.1016/j.bbii.2025.100128.
  13. Supasitdikul T, Mazariegos JRR, Nhat NN, Tung YT, Yang DF, Lee LJ, et al. Sleep Deprivation Alters Gut Microbiome Diversity and Taxonomy: A Systematic Review and Meta-Analysis of Human and Rodent Studies. J Sleep Res. 2026;35:e70125. doi: 10.1111/jsr.70125. PubMed PMID: 40562421.
  14. Lotti S, Dinu M, Colombini B, Amedei A, Sofi F. Circadian rhythms, gut microbiota, and diet: Possible implications for health. Nutr Metab Cardiovasc Dis. 2023;33:1490-500. doi: 10.1016/j.numecd.2023.05.009. PubMed PMID: 37246076.
  15. Gutierrez Lopez DE, Lashinger LM, Weinstock GM, Bray MS. Circadian rhythms and the gut microbiome synchronize the host’s metabolic response to diet. Cell Metab. 2021;33:873-87. doi: 10.1016/j.cmet.2021.03.015. PubMed PMID: 33789092.
  16. Neroni B, Evangelisti M, Radocchia G, Di Nardo G, Pantanella F, Villa MP, et al. Relationship between sleep disorders and gut dysbiosis: what affects what? Sleep Med. 2021;87:1-7. doi: 10.1016/j.sleep.2021.08.003. PubMed PMID: 34479058.
  17. Parkar SG, Kalsbeek A, Cheeseman JF. Potential Role for the Gut Microbiota in Modulating Host Circadian Rhythms and Metabolic Health. Microorganisms. 2019;7. doi: 10.3390/microorganisms7020041. PubMed PMID: 30709031; PubMed Central PMCID: PMC6406615.
  18. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Sci. 2015;8:143-52. doi: 10.1016/j.slsci.2015.09.002. PubMed PMID: 26779321; PubMed Central PMCID: PMC4688585.
  19. Marwaha K, Cain R, Asmis K, Czaplinski K, Holland N, Mayer DCG, et al. Exploring the complex relationship between psychosocial stress and the gut microbiome: implications for inflammation and immune modulation. J Appl Physiol (1985). 2025;138:518-35. doi: 10.1152/japplphysiol.00652.2024. PubMed PMID: 39813028.
  20. Rusch JA, Layden BT, Dugas LR. Signalling cognition: the gut microbiota and hypothalamic-pituitary-adrenal axis. Front Endocrinol (Lausanne). 2023;14:1130689. doi: 10.3389/fendo.2023.1130689. PubMed PMID: 37404311; PubMed Central PMCID: PMC10316519.
  21. Yang DF, Huang WC, Wu CW, Huang CY, Yang YSH, Tung YT. Acute sleep deprivation exacerbates systemic inflammation and psychiatry disorders through gut microbiota dysbiosis and disruption of circadian rhythms. Microbiol Res. 2023;268:127292. doi: 10.1016/j.micres.2022.127292. PubMed PMID: 36608535.
  22. Alruwaili NW, Alqahtani N, Alanazi MH, Alanazi BS, Aljrbua MS, Gatar OM. The effect of nutrition and physical activity on sleep quality among adults: a scoping review. Sleep Science and Practice. 2023;7:8. doi: 10.1186/s41606-023-00090-4.
  23. Theorell-Haglow J, Lemming EW, Michaelsson K, Elmstahl S, Lind L, Lindberg E. Sleep duration is associated with healthy diet scores and meal patterns: results from the population-based EpiHealth study. J Clin Sleep Med. 2020;16:9-18. doi: 10.5664/jcsm.8112. PubMed PMID: 31957658; PubMed Central PMCID: PMC7052994.
  24. Aziz T, Hussain N, Hameed Z, Lin L. Elucidating the role of diet in maintaining gut health to reduce the risk of obesity, cardiovascular and other age-related inflammatory diseases: recent challenges and future recommendations. Gut Microbes. 2024;16:2297864. doi: 10.1080/19490976.2023.2297864. PubMed PMID: 38174551; PubMed Central PMCID: PMC10773664.
  25. Kim B, Song A, Son A, Shin Y. Gut microbiota and epigenetic choreography: Implications for human health: A review. Medicine (Baltimore). 2024;103:e39051. doi: 10.1097/MD.0000000000039051. PubMed PMID: 39029010; PubMed Central PMCID: PMC11398772.
  26. Reva K, Laranjinha J, Rocha BS. Epigenetic Modifications Induced by the Gut Microbiota May Result from What We Eat: Should We Talk about Precision Diet in Health and Disease? Metabolites. 2023;13. doi: 10.3390/metabo13030375. PubMed PMID: 36984815; PubMed Central PMCID: PMC10051796.
  27. Wu Q, Gao G, Kwok LY, Lv H, Sun Z. Insomnia: the gut microbiome connection, prospects for probiotic and postbiotic therapies, and future directions. J Adv Res. 2026;82:267-93. doi: 10.1016/j.jare.2025.07.005. PubMed PMID: 40651630; PubMed Central PMCID: PMC13000951.
  28. Morrison DJ, Preston T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism. Gut Microbes. 2016;7:189-200. doi: 10.1080/19490976.2015.1134082. PubMed PMID: 26963409; PubMed Central PMCID: PMC4939913.
  29. Archana, Gupta AK, Noumani A, Panday DK, Zaidi F, Sahu GK, et al. Gut microbiota derived short-chain fatty acids in physiology and pathology: An update. Cell Biochem Funct. 2024;42:e4108. doi: 10.1002/cbf.4108. PubMed PMID: 39228159.
  30. Lange O, Proczko-Stepaniak M, Mika A. Short-Chain Fatty Acids-A Product of the Microbiome and Its Participation in Two-Way Communication on the Microbiome-Host Mammal Line. Curr Obes Rep. 2023;12:108-26. doi: 10.1007/s13679-023-00503-6. PubMed PMID: 37208544; PubMed Central PMCID: PMC10250490.
  31. Magzal F, Even C, Haimov I, Agmon M, Asraf K, Shochat T, et al. Associations between fecal short-chain fatty acids and sleep continuity in older adults with insomnia symptoms. Sci Rep. 2021;11:4052. doi: 10.1038/s41598-021-83389-5. PubMed PMID: 33603001; PubMed Central PMCID: PMC7893161.
  32. O’Riordan KJ, Collins MK, Moloney GM, Knox EG, Aburto MR, Fulling C, et al. Short chain fatty acids: Microbial metabolites for gut-brain axis signalling. Mol Cell Endocrinol. 2022;546:111572. doi: 10.1016/j.mce.2022.111572. PubMed PMID: 35066114.
  33. Peng L, Li ZR, Green RS, Holzman IR, Lin J. Butyrate enhances the intestinal barrier by facilitating tight junction assembly via activation of AMP-activated protein kinase in Caco-2 cell monolayers. J Nutr. 2009;139:1619-25. doi: 10.3945/jn.109.104638. PubMed PMID: 19625695; PubMed Central PMCID: PMC2728689.
  34. Yan H, Ajuwon KM. Butyrate modifies intestinal barrier function in IPEC-J2 cells through a selective upregulation of tight junction proteins and activation of the Akt signaling pathway. PLoS One. 2017;12:e0179586. doi: 10.1371/journal.pone.0179586. PubMed PMID: 28654658; PubMed Central PMCID: PMC5487041.
  35. Kim CH. Complex regulatory effects of gut microbial short-chain fatty acids on immune tolerance and autoimmunity. Cell Mol Immunol. 2023;20:341-50. doi: 10.1038/s41423-023-00987-1. PubMed PMID: 36854801; PubMed Central PMCID: PMC10066346.
  36. Dalile B, Van Oudenhove L, Vervliet B, Verbeke K. The role of short-chain fatty acids in microbiota-gut-brain communication. Nat Rev Gastroenterol Hepatol. 2019;16:461-78. doi: 10.1038/s41575-019-0157-3. PubMed PMID: 31123355.
  37. Church JS, Bannish JAM, Adrian LA, Rojas Martinez K, Henshaw A, Schwartzer JJ. Serum short chain fatty acids mediate hippocampal BDNF and correlate with decreasing neuroinflammation following high pectin fiber diet in mice. Front Neurosci. 2023;17:1134080. doi: 10.3389/fnins.2023.1134080. PubMed PMID: 37123365; PubMed Central PMCID: PMC10130583.
  38. Banarase TA, Sammeta SS, Wankhede NL, Mangrulkar SV, Rahangdale SR, Aglawe MM, et al. Mitophagy regulation in aging and neurodegenerative disease. Biophys Rev. 2023;15:239-55. doi: 10.1007/s12551-023-01057-6. PubMed PMID: 37124925; PubMed Central PMCID: PMC10133433.
  39. Deng I, Corrigan F, Zhai G, Zhou XF, Bobrovskaya L. Lipopolysaccharide animal models of Parkinson’s disease: Recent progress and relevance to clinical disease. Brain Behav Immun Health. 2020;4:100060. doi: 10.1016/j.bbih.2020.100060. PubMed PMID: 34589845; PubMed Central PMCID: PMC8474547.
  40. Hou K, Wu ZX, Chen XY, Wang JQ, Zhang D, Xiao C, et al. Microbiota in health and diseases. Signal Transduct Target Ther. 2022;7:135. doi: 10.1038/s41392-022-00974-4. PubMed PMID: 35461318; PubMed Central PMCID: PMC9034083.
  41. Solanki R, Karande A, Ranganathan P. Emerging role of gut microbiota dysbiosis in neuroinflammation and neurodegeneration. Front Neurol. 2023;14:1149618. doi: 10.3389/fneur.2023.1149618. PubMed PMID: 37255721; PubMed Central PMCID: PMC10225576.
  42. Wang Z, Chen WH, Li SX, He ZM, Zhu WL, Ji YB, et al. Gut microbiota modulates the inflammatory response and cognitive impairment induced by sleep deprivation. Mol Psychiatry. 2021;26:6277-92. doi: 10.1038/s41380-021-01113-1. PubMed PMID: 33963281.
  43. Zhang M, Zhang M, Kou G, Li Y. The relationship between gut microbiota and inflammatory response, learning and memory in mice by sleep deprivation. Front Cell Infect Microbiol. 2023;13:1159771. doi: 10.3389/fcimb.2023.1159771. PubMed PMID: 37293204; PubMed Central PMCID: PMC10244646.
  44. Zhao M, Chu J, Feng S, Guo C, Xue B, He K, et al. Immunological mechanisms of inflammatory diseases caused by gut microbiota dysbiosis: A review. Biomed Pharmacother. 2023;164:114985. doi: 10.1016/j.biopha.2023.114985. PubMed PMID: 37311282.
  45. Fang H, Yao T, Li W, Pan N, Xu H, Zhao Q, et al. Efficacy and safety of fecal microbiota transplantation for chronic insomnia in adults: a real world study. Front Microbiol. 2023;14:1299816. doi: 10.3389/fmicb.2023.1299816. PubMed PMID: 38088972; PubMed Central PMCID: PMC10712199.
  46. Kim CS, Cha L, Sim M, Jung S, Chun WY, Baik HW, et al. Probiotic Supplementation Improves Cognitive Function and Mood with Changes in Gut Microbiota in Community-Dwelling Older Adults: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. J Gerontol A Biol Sci Med Sci. 2021;76:32-40. doi: 10.1093/gerona/glaa090. PubMed PMID: 32300799; PubMed Central PMCID: PMC7861012.
  47. Salonen T, Jokinen E, Satokari R, Lahtinen P. Randomized, double-blinded, placebo-controlled pilot study: efficacy of faecal microbiota transplantation on chronic fatigue syndrome. J Transl Med. 2023;21:513. doi: 10.1186/s12967-023-04227-y. PubMed PMID: 37516837; PubMed Central PMCID: PMC10386223.
  48. Sanborn V, Aljumaah M, Azcarate-Peril MA, Gunstad J. Examining the cognitive benefits of probiotic supplementation in physically active older adults: A randomized clinical trial. Appl Physiol Nutr Metab. 2022;47:871-82. doi: 10.1139/apnm-2021-0557. PubMed PMID: 35617704.
  49. Skjevling L, Goll R, Hanssen HM, Johnsen PH. Faecal microbiota transplantation (FMT) in Norwegian outpatients with mild to severe myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): protocol for a 12-month randomised double-blind placebo-controlled trial. BMJ Open. 2024;14:e073275. doi: 10.1136/bmjopen-2023-073275. PubMed PMID: 38858151; PubMed Central PMCID: PMC11168185.
  50. Tanaka A, Sanada K, Miyaho K, Tachibana T, Kurokawa S, Ishii C, et al. The relationship between sleep, gut microbiota, and metabolome in patients with depression and anxiety: A secondary analysis of the observational study. PLoS One. 2023;18:e0296047. doi: 10.1371/journal.pone.0296047. PubMed PMID: 38117827; PubMed Central PMCID: PMC10732403.
  51. Grosicki GJ, Riemann BL, Flatt AA, Valentino T, Lustgarten MS. Self-reported sleep quality is associated with gut microbiome composition in young, healthy individuals: a pilot study. Sleep Med. 2020;73:76-81. doi: 10.1016/j.sleep.2020.04.013. PubMed PMID: 32795890; PubMed Central PMCID: PMC7487045.
  52. Haimov I, Magzal F, Tamir S, Lalzar M, Asraf K, Milman U, et al. Variation in Gut Microbiota Composition is Associated with Sleep Quality and Cognitive Performance in Older Adults with Insomnia. Nat Sci Sleep. 2022;14:1753-67. doi: 10.2147/NSS.S377114. PubMed PMID: 36225322; PubMed Central PMCID: PMC9550024.
  53. Zhang Q, Yun Y, An H, Zhao W, Ma T, Wang Z, et al. Gut Microbiome Composition Associated With Major Depressive Disorder and Sleep Quality. Front Psychiatry. 2021;12:645045. doi: 10.3389/fpsyt.2021.645045. PubMed PMID: 34093266; PubMed Central PMCID: PMC8175648.
  54. Ahmadi S, Taghizadieh M, Mehdizadehfar E, Hasani A, Khalili Fard J, Feizi H, et al. Gut microbiota in neurological diseases: Melatonin plays an important regulatory role. Biomed Pharmacother. 2024;174:116487. doi: 10.1016/j.biopha.2024.116487. PubMed PMID: 38518598.
  55. Gao K, Mu CL, Farzi A, Zhu WY. Tryptophan Metabolism: A Link Between the Gut Microbiota and Brain. Adv Nutr. 2020;11:709-23. doi: 10.1093/advances/nmz127. PubMed PMID: 31825083; PubMed Central PMCID: PMC7231603.
  56. Jenkins TA, Nguyen JC, Polglaze KE, Bertrand PP. Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients. 2016;8. doi: 10.3390/nu8010056. PubMed PMID: 26805875; PubMed Central PMCID: PMC4728667.
  57. Mhanna A, Martini N, Hmaydoosh G, Hamwi G, Jarjanazi M, Zaifah G, et al. The correlation between gut microbiota and both neurotransmitters and mental disorders: A narrative review. Medicine (Baltimore). 2024;103:e37114. doi: 10.1097/MD.0000000000037114. PubMed PMID: 38306525; PubMed Central PMCID: PMC10843545.
  58. Suda K, Matsuda K. How Microbes Affect Depression: Underlying Mechanisms via the Gut-Brain Axis and the Modulating Role of Probiotics. Int J Mol Sci. 2022;23. doi: 10.3390/ijms23031172. PubMed PMID: 35163104; PubMed Central PMCID: PMC8835211.
  59. Chen Y, Xu J, Chen Y. Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. 2021;13. doi: 10.3390/nu13062099. PubMed PMID: 34205336; PubMed Central PMCID: PMC8234057.
  60. Hamamah S, Aghazarian A, Nazaryan A, Hajnal A, Covasa M. Role of Microbiota-Gut-Brain Axis in Regulating Dopaminergic Signaling. Biomedicines. 2022;10. doi: 10.3390/biomedicines10020436. PubMed PMID: 35203645; PubMed Central PMCID: PMC8962300.
  61. Pires L, Gonzalez-Paramás AM, Heleno SA, Calhelha RC. Gut Microbiota as an Endocrine Organ: Unveiling Its Role in Human Physiology and Health. Applied Sciences. 2024;14:9383. PubMed PMID: doi:10.3390/app14209383.
  62. Siegel JM. The neurotransmitters of sleep. J Clin Psychiatry. 2004;65:4-7. PubMed PMID: 15575797; PubMed Central PMCID: PMC8761080.
  63. Wang Y, Qiao H, Zhang Y. Changes of Dopamine and Tyrosine Hydroxylase Levels in the Brain of Germ-free Mice. Iran J Biotechnol. 2023;21:e2798. doi: 10.30498/ijb.2022.236732.2798. PubMed PMID: 36811101; PubMed Central PMCID: PMC9938933.
  64. Yassin LK, Nakhal MM, Alderei A, Almehairbi A, Mydeen AB, Akour A, et al. Exploring the microbiota-gut-brain axis: impact on brain structure and function. Front Neuroanat. 2025;19:1504065. doi: 10.3389/fnana.2025.1504065. PubMed PMID: 40012737; PubMed Central PMCID: PMC11860919.
  65. Bjorvatn B, Gronli J, Hamre F, Sorensen E, Fiske E, Bjorkum AA, et al. Effects of sleep deprivation on extracellular serotonin in hippocampus and frontal cortex of the rat. Neuroscience. 2002;113:323-30. doi: 10.1016/s0306-4522(02)00181-1. PubMed PMID: 12127089.
  66. Gruenbaum BF, Merchant KS, Zlotnik A, Boyko M. Gut Microbiome Modulation of Glutamate Dynamics: Implications for Brain Health and Neurotoxicity. Nutrients. 2024;16. doi: 10.3390/nu16244405. PubMed PMID: 39771027; PubMed Central PMCID: PMC11677762.
  67. Guo J, Guo J, Rao X, Zhang R, Li Q, Zhang K, et al. Exploring the pathogenesis of insomnia and acupuncture intervention strategies based on the microbiota-gut-brain axis. Front Microbiol. 2024;15:1456848. doi: 10.3389/fmicb.2024.1456848. PubMed PMID: 39364160; PubMed Central PMCID: PMC11446747.
  68. Varinthra P, Anwar S, Shih SC, Liu IY. The role of the GABAergic system on insomnia. Tzu Chi Med J. 2024;36:103-9. doi: 10.4103/tcmj.tcmj_243_23. PubMed PMID: 38645778; PubMed Central PMCID: PMC11025592.
  69. Zheng P, Zeng B, Liu M, Chen J, Pan J, Han Y, et al. The gut microbiome from patients with schizophrenia modulates the glutamate-glutamine-GABA cycle and schizophrenia-relevant behaviors in mice. Sci Adv. 2019;5:eaau8317. doi: 10.1126/sciadv.aau8317. PubMed PMID: 30775438; PubMed Central PMCID: PMC6365110.
  70. Dahlin M, Elfving A, Ungerstedt U, Amark P. The ketogenic diet influences the levels of excitatory and inhibitory amino acids in the CSF in children with refractory epilepsy. Epilepsy Res. 2005;64:115-25. doi: 10.1016/j.eplepsyres.2005.03.008. PubMed PMID: 15961283.
  71. Wu M, Zhang X, Feng S, Freda SN, Kumari P, Dumrongprechachan V, et al. Dopamine pathways mediating affective state transitions after sleep loss. Neuron. 2024;112:141-54. doi: 10.1016/j.neuron.2023.10.002. PubMed PMID: 37922904; PubMed Central PMCID: PMC10841919.
Iranian Journal of Medical Sciences

Articles InPress, Corrected Proof
Available Online from 01 August 2026
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  • Received: 13 September 2025
  • Revised: 25 October 2025
  • Accepted: 16 November 2025
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