Cholesterol lowering with bile salt hydrolase-active probiotic bacteria, mechanism of action, clinical evidence, and future direction for heart health applications.
BACKGROUND
Cardiovascular diseases (CVD) are the leading cause of global mortality and morbidity. Current CVD treatment methods include dietary intervention, statins, fibrates, niacin, cholesterol absorption inhibitors, and bile acid sequestrants. These formulations have limitations and, thus, additional treatment modalities are needed. Probiotic bacteria, especially bile salt hydrolase (BSH)-active probiotic bacteria, have demonstrated cholesterol-lowering efficacy in randomized controlled trials.


METHODS
This review describes the current treatments for CVD and the need for additional therapeutics. Gut microbiota etiology of CVD, cholesterol metabolism, and the role of probiotic formulations as therapeutics for the treatment and prevention of CVD are described. Specifically, we review studies using BSH-active bacteria as cholesterol-lowering agents with emphasis on their cholesterol-lowering mechanisms of action. Potential limitations and future directions are also highlighted.


CONCLUSIONS
Numerous clinical studies have concluded that BSH-active probiotic bacteria, or products containing them, are efficient in lowering total and low-density lipoprotein cholesterol. However, the mechanisms of action of BSH-active probiotic bacteria need to be further supported. There is also the need for a meta-analysis to provide better information regarding the therapeutic use of BSH-active probiotic bacteria. The future of BSH-active probiotic bacteria most likely lies as a combination therapy with already existing treatment options.
Micropharma Ltd, 141 avenue du President Kennedy, UQAM Biological Sciences Building, 5th Floor, Suite 5569 Montreal, Quebec, H2X 3Y7, Canada.
Mitchell L
ML
Jones
Catherine
C
Tomaro-Duchesneau
Christopher J
CJ
Martoni
Satya
S
Prakash
D000581:Amidohydrolases / Q000737:chemistry*; D000818:Animals; D000924:Anticholesteremic Agents; D002784:Cholesterol / Q000378:metabolism*; D041981:Gastrointestinal Tract / Q000382:microbiology; D006331:Heart Diseases / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D006949:Hyperlipidemias / Q000188:drug therapy; D054892:Metagenome; D019936:Probiotics / Q000737:chemistry* / Q000627:therapeutic use*
D000924:Anticholesteremic Agents; D002784:Cholesterol; D000581:Amidohydrolases; C023154:choloylglycine hydrolase