Targeting the Microbiome in Heart Failure
- 869 Downloads
Heart failure is the leading cause of mortality and morbidity in the world today. While there have been major advances in our understanding of the pathophysiology of heart failure over the past decades, disease progression remains inevitable in the majority of patients and effective therapies to prevent heart failure are still lacking. Research has turned to better understand the gut microbiome because alterations in their ecosystems have been associated with various downstream chronic conditions including cardiovascular diseases. The gut microbiome is complex and diverse in nature, making it difficult to generalize to specific populations or individual patients. Nevertheless, current evidence has found links between heart failure and alterations in microbial composition and function, since heart failure has long been associated with impaired intestinal barrier function and bacterial translocation leading to inflammatory and immune responses. Recent studies have also shed light on the contributions of gut microbiota-derived metabolites from dietary nutrients that can promote adverse effects in the setting of cardiorenal diseases. In this review, we will discuss the role of gut microbiome in the setting of heart failure and potential interventional approaches that may potentially lower the risk of disease progression in heart failure.
KeywordsHeart failure Microbiome Cardiovascular disease Gut microbiome
Compliance with Ethical Standards
Conflict of Interest
Wilson Tang is supported by grants from the National Institutes of Health (NIH) and the Office of Dietary Supplements (R01HL103866, P20HL113452, R01DK106000, R01HL126827). Dr. Tang is a section editor for Current Treatment Options in Cardiovascular Medicine.
Allyson Zabell declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 9.•• Wang Z, Klipfell E, Bennett BJ, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011;472(7341):57–63. Seminal paper describing the contributory role of trimethylamine N-oxide in atherogenesis and the obligatory participation of gut microbiome.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.• Peschel T, Schonauer M, Thiele H, Anker SD, Schuler G, Niebauer J. Invasive assessment of bacterial endotoxin and inflammatory cytokines in patients with acute heart failure. Eur J Heart Fail. 2003;5(5):609–14. Early work demonstrating the presence of bacterial endotoxin and inflammatory cytokines in acute heart failure.CrossRefPubMedGoogle Scholar
- 26.von Haehling S, Genth-Zotz S, Bolger AP, et al. Effect of noradrenaline and isoproterenol on lipopolysaccharide-induced tumor necrosis factor-alpha production in whole blood from patients with chronic heart failure and the role of beta-adrenergic receptors. Am J Cardiol. 2005;95(7):885–9.CrossRefGoogle Scholar
- 29.• Tang WH, Wang Z, Fan Y, et al. Prognostic value of elevated levels of intestinal microbe-generated metabolite trimethylamine-N-oxide in patients with heart failure: refining the gut hypothesis. J Am Coll Cardiol. 2014;64(18):1908–14. First demonstration of association between elevated TMAO and prognosis in heart failure.CrossRefPubMedGoogle Scholar
- 35.• Organ CL, Otsuka H, Bhushan S, et al. Choline diet and its gut microbe-derived metabolite, trimethylamine N-oxide, exacerbate pressure overload-induced heart failure. Circ Heart Fail. 2016;9(1):e002314. Animal studies demonstrating the contribution of dietary-induced TMAO production and cardiac remodeling in mouse model.CrossRefPubMedGoogle Scholar
- 37.De Filippis F, Pellegrini N, Vannini L, et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2015;28:gutjnl-2015.Google Scholar
- 41.• Gan XT, Ettinger G, Huang CX, et al. Probiotic administration attenuates myocardial hypertrophy and heart failure after myocardial infarction in the rat. Circ Heart Fail. 2014;7(3):491–9. Probiotics intervention with signals of attenuating cardiac remodeling in a rat heart failure model.CrossRefPubMedGoogle Scholar