Collinsella aerofaciens Mediates Protection Against Hypertensive Intracerebral Hemorrhage through the Allantoin-ECH1 Signaling Axis

This study establishes a gut-brain axis in hypertensive intracerebral hemorrhage (ICH). Through metagenomic analysis of 330 human fecal samples, the researchers identified that the gut commensal Collinsella aerofaciens and its metabolite allantoin protect against ICH. Mechanistically, allantoin binds to and stabilizes the cerebrovascular enzyme ECH1, activating the CAMKK-AMPK-RUNX1 signaling pathway to suppress vascular inflammation, oxidative stress, and smooth muscle cell apoptosis—ultimately reducing ICH incidence and severity independent of blood pressure. These findings reveal novel therapeutic targets for ICH prevention through microbiome modulation.