Evidence for clinical interventions targeting the gut microbiome in cardiometabolic disease.
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Karen Pendergrass
What was reviewed?
The review evaluated the evidence for clinical effects of various microbiome-targeted interventions (MBTIs) on cardiometabolic traits. The interventions assessed included dietary changes, dietary supplementation, prebiotics, probiotics, synbiotics, and other therapeutic strategies targeting the gut microbiome. The review aimed to understand how these interventions influence cardiometabolic health outcomes and to identify the mechanisms through which the gut microbiome modulates these effects.
Who was reviewed?
The review synthesized findings from a broad range of human studies, including clinical intervention trials targeting the gut microbiome to improve cardiometabolic health. The reviewed studies included diverse populations across different geographic regions, though a notable disparity was observed, with a lack of trials from South Asia and Africa. The participants in these studies suffered from various cardiometabolic conditions such as obesity, type 2 diabetes, hypertension, dyslipidemia, non-alcoholic fatty liver disease, and cardiovascular diseases.
What were the most important findings of this review?
Influence of the Gut Microbiome on Cardiometabolic Risk: The gut microbiome plays a critical role in cardiometabolic health by sensing metabolic changes, modulating physiological responses, and translating dietary and therapeutic interventions into health outcomes via its metabolites.
Efficacy of Interventions: Over 70% of clinical intervention studies reported significant improvements in cardiometabolic traits. Prebiotic interventions were most likely to alter gut microbiome composition, followed by dietary interventions and then probiotic interventions. There was no significant difference in efficacy between single strain and multi-strain probiotic/synbiotic interventions in improving cardiometabolic outcomes or altering gut microbiome composition.
Mechanistic Insights:The gut microbiome modulates cardiometabolic health through microbial metabolites such as short-chain fatty acids (SCFAs), secondary bile acids, phenylacetylglutamine, and trimethylamine-N-oxide. The microbiome can act as a sensor, modulator, and translator of physiological changes and dietary interventions, impacting inflammation, insulin sensitivity, and blood lipid levels.
Geographical and Intervention Disparities: Most studies were conducted in Europe and North America, with significant gaps in research from South Asia and Africa. Dietary interventions, especially those combined with other interventions, showed the highest efficacy in improving cardiometabolic health and altering the gut microbiome.
What are the greatest implications of this review?
Potential for Targeted Therapies: The review highlights the potential for using microbiome-targeted interventions to improve cardiometabolic health. These interventions can complement traditional treatments and offer personalized therapeutic strategies based on individual microbiome profiles.
Importance of Comprehensive Approaches: Broader dietary interventions and prebiotics, which target a wider range of gut microbiome components, appear to be more effective than single-strain probiotics. This suggests that comprehensive approaches targeting the microbiome holistically are more beneficial for cardiometabolic health.
Need for Standardized and Large-Scale Studies: The review underscores the necessity for well-designed, large-scale clinical trials with standardized protocols to identify specific therapeutic targets and mechanisms. Consistency in study design and outcomes is crucial for developing evidence-based guidelines for microbiome-targeted therapies.
Geographical Research Gaps: There is a need to conduct more research in underrepresented regions such as South Asia and Africa to understand the global applicability of microbiome-targeted interventions and to address regional health disparities.
Mechanistic Understanding and Biomarkers: Further research is needed to elucidate the specific mechanisms through which the gut microbiome influences cardiometabolic health. Identifying robust biomarkers of microbiome functional changes will aid in developing precise therapeutic strategies and improve the predictability of intervention outcomes.