The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review

Zhang, Zhiqiang; Kang, Wenkai; Mi, Yu; Zhong, Xin; He, Yulong

doi:10.3390/pathogens14111145

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The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review

by

Zhiqiang Zhang

^1,2,†,

Wenkai Kang

^1,2,†,

Yu Mi

¹,

Xin Zhong

^1,2,* and

Yulong He

^2,*

¹

Tomas Lindahl Nobel Laureate Laboratory, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China

²

Digestive Diseases Center, Guangdong Provincial Key Laboratory of Digestive Cancer Research, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China

^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Pathogens 2025, 14(11), 1145; https://doi.org/10.3390/pathogens14111145

Submission received: 26 September 2025 / Revised: 31 October 2025 / Accepted: 7 November 2025 / Published: 11 November 2025

(This article belongs to the Special Issue Gut–Brain Axis in Neurodevelopment: Microbial Metabolites and Neurological Function)

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Abstract

Autism spectrum disorder is markedly heterogeneous and frequently accompanied by gastrointestinal symptoms that often correlate with behavioral phenotypes. Emerging evidence suggests that the microbiota–gut–brain axis may contribute to these associations through multiple bidirectional communication routes—including neural, immune, and endocrine pathways, as well as microbial metabolites such as short-chain fatty acids and tryptophan–kynurenine intermediates. This narrative review synthesizes clinical, mechanistic, and interventional evidence published between January 2010 and July 2025, clarifies the extent to which current data support association versus causation, evaluates key confounding factors, summarizes evidence for interventions such as probiotics, prebiotics, and fecal microbiota transplantation, and outlines future directions for precision research and targeted interventions based on functional pathways and stratified subgroups.

Keywords: autism spectrum disorder; Brain–Gut Axis; microbiota; metabolism; Signs and Symptoms; Digestive

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MDPI and ACS Style

Zhang, Z.; Kang, W.; Mi, Y.; Zhong, X.; He, Y. The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review. Pathogens 2025, 14, 1145. https://doi.org/10.3390/pathogens14111145

AMA Style

Zhang Z, Kang W, Mi Y, Zhong X, He Y. The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review. Pathogens. 2025; 14(11):1145. https://doi.org/10.3390/pathogens14111145

Chicago/Turabian Style

Zhang, Zhiqiang, Wenkai Kang, Yu Mi, Xin Zhong, and Yulong He. 2025. "The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review" Pathogens 14, no. 11: 1145. https://doi.org/10.3390/pathogens14111145

APA Style

Zhang, Z., Kang, W., Mi, Y., Zhong, X., & He, Y. (2025). The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review. Pathogens, 14(11), 1145. https://doi.org/10.3390/pathogens14111145

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The Microbiota–Gut–Brain Axis in Autism: Associations, Causal Inference, and Interventions—A Narrative Review

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