Dietary metabolism, the gut microbiome, and heart failure
By W. H. W. Tang, Daniel Y. Li, Stanley L Hazen. Nature Reviews Cardiology, 2018
659 citations recorded by the source corpus.
Advances in our understanding of how the gut microbiota contributes to human health and diseases have expanded our insight into how microbial composition and function affect the human host. Heart failure is associated with splanchnic circulation congestion, leading to bowel wall oedema and impaired intestinal barrier function. This situation is thought to heighten the overall inflammatory state via increased bacterial translocation and the presence of bacterial products in the systemic blood circulation. Several metabolites produced by gut microorganisms from dietary metabolism have been linked to pathologies such as atherosclerosis, hypertension, heart failure, chronic kidney disease, obesity, and type 2 diabetes mellitus. These findings suggest that the gut microbiome functions like an endocrine organ by generating bioactive metabolites that can directly or indirectly affect host physiology. In this Review, we discuss several newly discovered gut microbial metabolic pathways, including the production of trimethylamine and trimethylamine N-oxide, short-chain fatty acids, and secondary bile acids, that seem to participate in the development and progression of cardiovascular diseases, including heart failure. We also discuss the gut microbiome as a novel therapeutic target for the treatment of cardiovascular disease, and potential strategies for targeting intestinal microbial processes.Metabolites produced by gut microorganisms from dietary metabolism have been linked to the pathogenesis of heart failure, suggesting that the gut microbiome functions like an endocrine organ. In this Review, Tang and colleagues discuss the gut microbial metabolic pathways involved in heart failure and propose the gut microbiome as a therapeutic target.Key pointsThe gut hypothesis of heart failure (HF) postulates that bowel wall oedema and impaired intestinal barrier function in HF can promote bacterial translocation and inflammation.Changes in the composition and diversity of the gut microbiota have been observed in patients with HF.Microbial metabolites, especially those derived from dietary nutrients, can generate paracrine and endocrine effects that can lead to an increased susceptibility to HF.Novel therapeutic strategies targeting gut microbial metabolic pathways and/or metabolites, as well as altering gut microbial composition, have the potential to modulate cardiovascular disease susceptibility and prevent progression to HF.
Subfields: Epidemiology, Molecular Biology, Physiology
View Paper: https://www.semanticscholar.org/paper/2d188c8a4a0b7f0a587d01042154b977700f34d3
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