Multimodal neuroimaging-microbiota integration identifies Akkermansia as a modulator of alcohol-induced gut-liver-brain pathology

Alcohol use disorder (AUD) disrupts the gut-liver-brain axis, but specific microbial targets remain poorly defined. Researchers used longitudinal advanced diffusion MRI and fecal 16S rRNA profiling in Marchigian Sardinian alcohol-preferring rats at baseline, after four weeks of voluntary alcohol intake, and after six weeks of abstinence. Random forest models combining neuroimaging and microbiota data improved phase classification and identified Akkermansia as the microbial feature most strongly associated with alcohol-related white matter microstructural abnormalities. Alcohol exposure caused widespread white matter alterations and gut dysbiosis with reduced microbial diversity. To test causality, Akkermansia muciniphila was administered during abstinence. Supplementation restored intestinal mucus, reduced liver injury markers, and elevated myelin basic protein levels in affected white matter regions. These findings support a causal role for Akkermansia in persistent white matter damage in AUD and establish a multimodal framework for microbiome-based target discovery across gut-liver-brain axis disorders.