title: Exploring the Microbiome in Heart Failure.
abstract: Recent years have brought interesting insights into the human gut microbiota and have highlighted its increasingly recognized impact on cardiovascular (CV) diseases, including heart failure (HF). Changes in composition of gut microbiota, called dysbiosis, can trigger systemic inflammation, which is known to be involved in the pathophysiology of HF. Trimethylamine N-oxide (TMAO), which is derived from gut microbiota metabolites of specific dietary nutrients, has emerged as a key contributor to cardiovascular disease pathogenesis. Elevated TMAO levels have been reported to be associated with poor outcomes in patients with both HF and chronic kidney disease (CKD). Dysbiosis of gut microbiota can contribute to higher levels of TMAO and the generation of uremic toxins, progressing to both HF and CKD. Therefore, this bidirectional relationship between HF and CKD through gut microbiota may be a novel therapeutic target for the cardiorenal syndrome. However, the mechanisms by which gut microbiota could influence the development of heart failure are still unknown, and there are still some questions regarding the causative effects of TMAO and the underlying mechanistic link that explains how TMAO might directly or indirectly promote CV diseases including HF. Further studies are warranted to clarify the function of TMAO on the pathophysiology of cardiorenal syndrome and the handling of TMAO levels by the kidneys.
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.affiliation: Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kirsop
authors.affiliation: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. tangw@ccf.org.|Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. tangw@ccf.org.|Center for Clinical Genomics, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA. tangw@ccf.org.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D059347:Cardio-Renal Syndrome / Q000378:metabolism / Q000503:physiopathology; D000069196:Gastrointestinal Microbiome / Q000502:physiology*; D006333:Heart Failure / Q000382:microbiology / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D008744:Methylamines / Q000378:metabolism; D064307:Microbiota / Q000502:physiology
chemical_list: D008744:Methylamines; C005855:trimethyloxamine
keywords: Cardiorenal syndrome; Cardiovascular disease; Chronic kidney disease; Gut microbiota; Heart failure; Trimethylamine N-oxide