title: Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome: An open-label, randomized study.
abstract: BACKGROUND
  Recent studies in animal models have shown a link between ingestion of dietary phosphatidylcholine (PC), choline, l-carnitine and cardiovascular risk. Intestinal microbiota-dependent metabolism of PC and l-carnitine is involved in formation of trimethylamine (TMA), which is further metabolized to the proatherogenic compound trimethylamine-N-oxide (TMAO). It has been suggested that changes in gut microbiota by supplementation of probiotic drinks might alter TMAO levels. Hence, the aim of this analysis was to investigate the impact of Lactobacillus casei Shirota (LcS) on formation of TMAO in subjects with metabolic syndrome.
  
  
  METHODS
  In a single-center, prospective, randomized-controlled study 30 subjects with metabolic syndrome were randomized to receive either 3 times daily 6.5 × 10(9) CFU (colony-forming units) LcS (probiotic group) or not (standard therapy group) for 12 weeks. TMAO plasma levels were quantified by means of liquid chromatography and tandem mass spectrometry.
  
  
  RESULTS
  Thirteen patients in the probiotic group and 15 in the standard therapy group finished the study. Mean age was 52 ± 11 and 55 ± 9 years, respectively. TMAO levels decreased during the intervention period in both groups (from 4.66 ± 2.66 μM to 4.31 ± 2.04 μM in the probiotic group and from 4.64 ± 2.75 μM to 4.40 ± 2.14 μM in the control group). Changes in TMAO between subjects receiving LcS (-0.25 ± 2.39 μM) and controls (-0.34 ± 2.23 μM) were not significantly different (p = 0.510).
  
  
  CONCLUSIONS
  In conclusion, intake of LcS for 12 weeks did not affect levels of TMAO in patients with metabolic syndrome.
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Cardiovascular Diabetology Research Group, Graz, Austria. Electronic address: norbert.tripolt@medunigraz.at.
authors.forename: Norbert J
authors.initials: NJ
authors.lastname: Tripolt
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Graz, Austria. Electronic address: bettina.leber@medunigraz.at.
authors.forename: Bettina
authors.initials: B
authors.lastname: Leber
authors.affiliation: Medical University of Graz, Center for Medical Research, Core Facility for Mass Spectrometry, Graz, Austria. Electronic address: alexander.triebl@medunigraz.at.
authors.forename: Alexander
authors.initials: A
authors.lastname: Triebl
authors.affiliation: Medical University of Graz, Center for Medical Research, Core Facility for Mass Spectrometry, Graz, Austria. Electronic address: harald.koefeler@medunigraz.at.
authors.forename: Harald
authors.initials: H
authors.lastname: Köfeler
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Graz, Austria. Electronic address: vanessa.stadlbauer@medunigraz.at.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Stadlbauer
authors.affiliation: Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Cardiovascular Diabetology Research Group, Graz, Austria; Centre for Biomarker Research in Medicine (CBmed), Graz, Austria. Electronic address: ha.sourij@medunigraz.at.
authors.forename: Harald
authors.initials: H
authors.lastname: Sourij
mesh_terms: D000328:Adult; D001317:Austria; D015415:Biomarkers / Q000097:blood; D002853:Chromatography, Liquid; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D007780:Lacticaseibacillus casei / Q000254:growth & development / Q000378:metabolism*; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D008744:Methylamines / Q000097:blood*; D008875:Middle Aged; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D053719:Tandem Mass Spectrometry; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008744:Methylamines; C005855:trimethyloxamine
keywords: Gut microbiota; Lactobacillus casei Shirota (LcS); Metabolic syndrome; Microbiome; Trimethylamine-N-oxide (TMAO)