Did you know?
Heart Failure affects approximately 64.3 million people worldwide, yet nearly half of them are unaware they have it because the symptoms can be subtle or mistaken for other conditions.
Heart Failure
Researched by:
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Karen Pendergrass
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Karen Pendergrass
Read MoreKaren Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
Recent research reveals that the gut microbiome significantly influences heart failure progression, contributing to inflammation and other complications.
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Karen Pendergrass
Read More
Researched by:
-
Karen Pendergrass
ID
Karen Pendergrass
Read More
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.
Microbiome Signatures
Overview 
Microbiome Signature 
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Research Feed 
References Overview
Heart failure (HF) is a complex syndrome affecting millions worldwide, characterized by the heart’s inability to fill or eject blood properly. Emerging research highlights the role of gut microbiota in HF, suggesting that changes in gut metabolites are closely related to HF progression. The gut hypothesis of HF posits that reduced cardiac output and systemic congestion lead to intestinal ischemia and barrier dysfunction, resulting in bacterial translocation and inflammation. We explore the microbiome signature and gut microbiota’s involvement in HF, mechanisms mediated by gut metabolites, as well as potential interventions, including dietary changes, probiotics, fecal microbiota transplantation (FMT), and antibiotics.
Gut Hypothesis of Heart Failure
The gut hypothesis of HF, first introduced in the late 1990s, proposed that circulatory congestion and low cardiac output reduce intestinal perfusion, causing ischemia and intestinal barrier damage, leading to bacterial translocation, endotoxemia, and systemic inflammation. [1][2] Several studies have further supported the idea that metabolites like trimethylamine-n-oxide (TMAO) and SCFAs, produced by the gut microbiota, significantly impact HF progression. [3]
Primer
Research indicates that heart failure (HF) patients exhibit distinct gut microbiota profiles compared to healthy individuals. Key findings reveal an increased prevalence of pro-inflammatory bacteria such as Bacteroides/Prevotella, Campylobacter, Shigella,Salmonella, Enterococcus, and Clostridium difficile in HF patients. Conversely, there is a reduction in families like Coriobacteriaceae, Erysipelotrichaceae, and Ruminococcaceae, as well as anti-inflammatory genera such as Blautia and Collinsella. [4] Additionally, HF patients show reduced gut microbiota diversity, and an increased Firmicutes/ Bacteroidetes (F/B) ratio, which contributes to systemic conditions like persistent T-cell activation, and heightened susceptibility to hospitalization with a Clostridium difficile infection. [5][6]
Associated Conditions
Hospitalized HF patients are more frequently affected by Clostridium difficile infection, which is associated with in-hospital mortality. [7]
Metabolomic Signature of Heart Failure
Elevated metabolites contributing to heart failure (HF) have been identified, highlighting the influence of gut-derived compounds. Key metabolites include trimethylamine N-oxide (TMAO), which is produced from dietary nutrients by gut microbiota and is associated with cardiac fibrosis, hypertrophy, inflammation, and endothelial dysfunction. [8] Short-chain fatty acids (SCFAs), such as acetate, propionate, and butyrate, are derived from dietary fibers and provide energy to failing hearts, reduce inflammation, and prevent cardiac fibrosis and hypertrophy. [9]
Microbiome Signature: Heart Failure
Interventions
The gut hypothesis of HF underscores the potential of targeting gut microbiota for HF treatment. Changes in gut microbiota composition and metabolites like TMAO and SCFAs are significant in HF pathophysiology. Interventions such as dietary changes, probiotics, and possibly fecal microbiota transplantation FMT are often suggested as promising avenues for HF management.
| Intervention | Findings |
|---|---|
| Pharmacological | |
| Rifaximin | Rifaximin is commonly used to treat microbiota toxicity and translocation by exerting anti-inflammatory effects and promoting the growth of beneficial bacteria like bifidobacteria and lactobacillus. Despite these potential benefits, the effects of antibiotics on gut microbiota in heart failure (HF) have not been extensively studied. It is crucial to balance the potential benefits and risks of antibiotic use. |
| Captopril | Captopril effectively modulates neurohormonal pathways, improves renal function, reduces cardiac workload, and corrects electrolyte imbalances, contributing to improved clinical outcomes. [10] While captopril’s mechanism of action traditionally involves inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, studies suggest that captopril modulates the gut microbiota, leading to a reduction in systemic inflammation and improvement in gut barrier function, both of which are implicated in the pathogenesis of HF. [11] |
| Drug Repurposing | |
| Metformin | Originally indicated to treat type 2 diabetes mellitus, metformin has been explored for its cardioprotective effects, primarily due to its ability to improve endothelial function, reduce oxidative stress, and exert anti-inflammatory effects. It may also improve myocardial energetics and reduce the risk of HF in diabetic and non-diabetic patients. Clinical trials are assessing metformin’s efficacy in improving outcomes in patients with HF, particularly HF with preserved ejection fraction (HFpEF). [12] |
| SGLT2 inhibitors | SGLT2 inhibitors such as empagliflozin and dapagliflozin have shown significant benefits in reducing HF-related hospitalizations and cardiovascular mortality in both HF with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). [13] SGLT2 inhibitors are reported to influence gut microbiota composition, potentially by reducing glucose availability in the gut, which may inhibit pathogenic bacteria and support beneficial microbial populations. Preliminary studies in both animal models and humans suggest that these drugs can increase beneficial microbes and reduce pro-inflammatory bacteria, which might contribute to the observed reduction in inflammation and improved cardiovascular outcomes in heart failure patients treated with SGLT2 inhibitors. [14] |
| Spironolactone | Ongoing trials are investigating the effects of spironolactone in HFpEF and its potential to reduce fibrosis and improve diastolic function. As a mineralocorticoid receptor antagonist, spironolactone reduces aldosterone-induced sodium retention and cardiac remodeling. It is especially effective in reducing morbidity and mortality in HFrEF. [15] Spironolactone can modulate the gut microbiota by reducing inflammation and improving the gut barrier function, potentially reducing the translocation of gut-derived endotoxins that contribute to systemic inflammation in HF. [16] |
| Colchicine | There is emerging evidence that colchicine may influence the gut microbiota by decreasing pro-inflammatory bacteria and promoting the growth of bacteria that produce SCFAs, which have anti-inflammatory effects. These changes could help mitigate the inflammatory response in HF. Further, colchicine significantly increases Firmicutes while reducing Bacteroidetes. Overall, colchicine intervention notably decreases the abundance of Bacteroidetes, Candida, and Clostridium, which are elevated in the microbiome signature of HF. [17] |
| Diet | |
| DASH Diet | A cohort study of 35,004 participants over 22 years indicated that the DASH diet reduces heart failure (HF) risk. In HF patients, the DASH diet improves walking test performance, arterial compliance, exercise capacity, and quality of life over a 3-month intervention. [18] |
| Non-Pharmacological | |
| Fecal microbiota transplantation (FMT) | Fecal microbiota transplantation (FMT) has primarily been used to treat recurrent Clostridium difficile infection, but holds promise for several other conditions hallmarked by the microbe. While the potential effects of FMT on HF are not well studied, FMT may hold promise as a supplementary treatment for HF given the consistent findings of Clostridium difficile in HF patients. [19] |
| Lactobacillus rhamnosus GR-1 | Lactobacillus rhamnosus GR-1 can reduce hypertrophy and improve both systolic and diastolic functions of the left ventricle, indicating potential benefits for heart failure (HF) patients. [20] |
| Saccharomyces boulardii | A randomized, double-blind, placebo-controlled pilot trial targeting HF patients using Saccharomyces boulardii for 3 months showed that it could improve LVEF, shorten left atrial diameter, and lower total cholesterol and uric acid levels. [21] Saccharomyces boulardii can reduce filamentation, adhesion and biofilm formation of candida species, which are found elevated in HF patients. [22] |
| Probiotic yogurt | A triple-blind, controlled trial suggested that probiotic yogurt might help relieve inflammatory status in CHF patients by elevating sTWEAK levels, a cytokine involved in inflammation, tissue regeneration, and apoptosis. [23] |
| Supplements | |
| Berberine | Oral intake of berberine for 4 months has been shown to decrease TMAO production in animal intestines and reduce TMA and TMAO levels in both the feces and plasma of patients, exerting effects similar to those of vitamins. [24] |
| Vitamin D+ B Vitamins | A study has suggested that combining B vitamins with vitamin D can alter choline metabolism, leading to a greater reduction in TMAO levels compared to the use of vitamin D alone. [25] |
| 3,3-dimethyl-1-butanol (DMB) | DMB has been reported to improve cardiac function and reduce cardiac remodeling in heart failure (HF) mice induced by pressure overload. It achieves this by lowering plasma TMAO levels, which inhibits the TGF-β1/Smad3 and p65 NF-κB signaling pathways, thereby attenuating cardiac hypertrophy, fibrosis, and inflammation. [26] |
| High-Fiber Diet + Acetate Supplementation | High-Fiber Diet and acetate supplementation has been found to reduce the F/B ratio, while significantly increasing the abundance of the bacteria Bacteroides acidifaciens. This species has recently been shown to prevent obesity and the evolution of hypertension and heart failure in hypertensive mice.[27] |
| Microbiome Targeted Interventions (MBTIs) | |
| Carvacrol | Carvacrol (CR) shows potential as a candidate for microbiome-targeted interventions for heart failure due to its ability to positively modulate gut microbiota and reduce pathogen-induced dysbiosis. The study found that CR supplementation improved clinical outcomes in C. difficile infections, a pathogen also associated with the microbiome signature of HF. CR achieved this by increasing the abundance of beneficial bacteria like Firmicutes and reducing harmful bacteria like Proteobacteria, without significantly disrupting overall microbiome diversity. Given that gut dysbiosis and the presence of pathogens like C. difficile are linked to heart failure, CR’s ability to restore healthy gut flora suggests it could be beneficial in managing gut microbiota imbalances associated with heart failure. [28] Hypertension-induced left ventricular hypertrophy is the most important risk factor for heart failure. This study finds that carvacrol was able to ameliorate cardiac hypertrophy in in-vivo and in-vitro models. [29] |
FAQs
What are the main treatments for heart failure (HF) and what medications are commonly used?
What are the main treatments for heart failure (HF) and what medications are commonly used?
Treatments for HF include pharmacological interventions, device and interventional therapies, mechanical circulatory support (MCS), and heart transplantation. Common medications include renin-angiotensin system inhibitors (ACE inhibitors, ARBs, ARNi), beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, hydralazine, isosorbide dinitrate, and others.
What are the device and interventional therapies for HF and their associated risks?
What are the device and interventional therapies for HF and their associated risks?
Device therapies include implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT), which aim to prevent sudden cardiac death. These therapies can be invasive, costly, and may carry risks such as infection, lead displacement, and device malfunction.
What is mechanical circulatory support (MCS) and what complications are associated with it?
What is mechanical circulatory support (MCS) and what complications are associated with it?
The most widely used MCS is the left ventricular assist device (LVAD), which serves as both a bridge to transplantation and destination therapy. Complications include thromboembolism, bleeding, infection, device failure, and the need for lifelong anticoagulation therapy.
What challenges are associated with heart transplantation and how do they impact patients?
What challenges are associated with heart transplantation and how do they impact patients?
Heart transplantation faces challenges such as limited donor organ availability, potential for organ rejection, and the need for lifelong immunosuppressive therapy, which increases the risk of infections and other complications. Additionally, heart transplantation is expensive and not universally accessible.
What are the biggest concerns with current HF treatment options and why is there a need for more personalized approaches?
What are the biggest concerns with current HF treatment options and why is there a need for more personalized approaches?
Significant concerns include medication adherence and side effects, limitations of device and interventional therapies, complications of MCS, and challenges with heart transplantation. HF is a heterogeneous condition, and current treatments may not be equally effective for all patients. There is a need for more personalized approaches to optimize outcomes, improve quality of life, and provide more effective and sustainable long-term solutions.
What are the potential benefits of microbiome-targeted interventions or therapies for HF?
What are the potential benefits of microbiome-targeted interventions or therapies for HF?
Microbiome-targeted interventions, such as the use of probiotics, prebiotics, and dietary modifications, can positively influence gut health and potentially reduce inflammation, improve metabolic function, and lower harmful metabolite levels like u003ca href=u0022https://microbiomesignatures.com/definition/trimethylamine-n-oxide-tmao/u0022u003eTMAOu003c/au003e. These interventions may help alleviate HF symptoms, enhance overall cardiovascular health, and offer a complementary approach to traditional HF treatments.
Research Feed
Gut microbiota in heart failure and related interventions
July 10, 2023
/
Cardiovascular Health •
Cardiovascular Health
Did you know?
Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) is strongly linked to cardiovascular disease, potentially influencing atherosclerosis more than cholesterol, making the gut microbiome a key therapeutic target.
Alias iure reprehenderit aut accusantium. Molestiae dolore suscipit. Necessitatibus eum quaerat. Repudiandae suscipit quo necessitatibus. Voluptatibus ullam nulla temporibus nobis. Atque eaque sed totam est assumenda. Porro modi soluta consequuntur veritatis excepturi minus delectus reprehenderit est. Eveniet labore ut quas minima aliquid quibusdam. Vitae possimus fuga praesentium eveniet debitis exercitationem deleniti.
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Altered Gut Microbiota in Chronic Heart Failure: A Pathway to New Therapies
January 31, 2022
/
Cardiovascular Health •
Cardiovascular Health
Did you know?
Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) is strongly linked to cardiovascular disease, potentially influencing atherosclerosis more than cholesterol, making the gut microbiome a key therapeutic target.
Heart Failure •
Heart Failure
Did you know?
Heart Failure affects approximately 64.3 million people worldwide, yet nearly half of them are unaware they have it because the symptoms can be subtle or mistaken for other conditions.
Alias iure reprehenderit aut accusantium. Molestiae dolore suscipit. Necessitatibus eum quaerat. Repudiandae suscipit quo necessitatibus. Voluptatibus ullam nulla temporibus nobis. Atque eaque sed totam est assumenda. Porro modi soluta consequuntur veritatis excepturi minus delectus reprehenderit est. Eveniet labore ut quas minima aliquid quibusdam. Vitae possimus fuga praesentium eveniet debitis exercitationem deleniti.
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Microbiome Insiders can read two study summaries for any topic on Microbiome.
TMAO: how gut microbiota contributes to heart failure
August 21, 2020
/
Cardiovascular Health •
Cardiovascular Health
Did you know?
Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) is strongly linked to cardiovascular disease, potentially influencing atherosclerosis more than cholesterol, making the gut microbiome a key therapeutic target.
Alias iure reprehenderit aut accusantium. Molestiae dolore suscipit. Necessitatibus eum quaerat. Repudiandae suscipit quo necessitatibus. Voluptatibus ullam nulla temporibus nobis. Atque eaque sed totam est assumenda. Porro modi soluta consequuntur veritatis excepturi minus delectus reprehenderit est. Eveniet labore ut quas minima aliquid quibusdam. Vitae possimus fuga praesentium eveniet debitis exercitationem deleniti.
Create a free account to unlock this study summary.
Microbiome Insiders can read two study summaries for any topic on Microbiome.
Fecal Microbiota Transplantation (FMT)
Fecal Microbiota Transplantation (FMT) involves transferring fecal bacteria from a healthy donor to a patient to restore microbiome balance.
Trimethylamine N-Oxide (TMAO)
TMAO is a metabolite formed when gut bacteria convert dietary nutrients like choline and L-carnitine into trimethylamine (TMA), which is then oxidized in the liver to TMAO. This compound is linked to cardiovascular disease, as it promotes atherosclerosis, thrombosis, and inflammation, highlighting the crucial role of gut microbiota in influencing heart health.
Trimethylamine N-Oxide (TMAO)
TMAO is a metabolite formed when gut bacteria convert dietary nutrients like choline and L-carnitine into trimethylamine (TMA), which is then oxidized in the liver to TMAO. This compound is linked to cardiovascular disease, as it promotes atherosclerosis, thrombosis, and inflammation, highlighting the crucial role of gut microbiota in influencing heart health.
Trimethylamine N-Oxide (TMAO)
TMAO is a metabolite formed when gut bacteria convert dietary nutrients like choline and L-carnitine into trimethylamine (TMA), which is then oxidized in the liver to TMAO. This compound is linked to cardiovascular disease, as it promotes atherosclerosis, thrombosis, and inflammation, highlighting the crucial role of gut microbiota in influencing heart health.
Fecal Microbiota Transplantation (FMT)
Fecal Microbiota Transplantation (FMT) involves transferring fecal bacteria from a healthy donor to a patient to restore microbiome balance.
Fecal Microbiota Transplantation (FMT)
Fecal Microbiota Transplantation (FMT) involves transferring fecal bacteria from a healthy donor to a patient to restore microbiome balance.
References
- Elevated Soluble CD14 Receptors and Altered Cytokines in Chronic Heart Failure.. Anker, Stefan D., Karl R. Egerer, Hans-Dieter Volk, Wolfgang J. Kox, Philip A. Poole-Wilson, and Andrew J. S. Coats.. (The American Journal of Cardiology 79: 1426–30. (1997))
- Endotoxin and Immune Activation in Chronic Heart Failure: a Prospective Cohort Study.. Niebauer, Josef, Hans-Dieter Volk, Michael Kemp, Martin Dominguez, Ralf R. Schumann, Mathias Rauchhaus, Philip A. Poole-Wilson, Andrew J. S. Coats, and Stefan D. Anker.. (The Lancet 353: 1838–42. (1999))
- Gut Microbiota in Heart Failure and Related Interventions.. Chen, An-Tian, Jian Zhang, and Yuhui Zhang.. (iMeta 2, e125. (2023))
- Alterations of the Gut Microbiota in Patients With Severe Chronic Heart Failure.. Sun, Weiju, Debing Du, Tongze Fu, Ying Han, Peng Li, and Hong Ju.. (Frontiers in Microbiology 12: 813289.(2022))
- Gut Microbiota in Heart Failure Patients With Preserved Ejection Fraction (GUMPTION Study).. Huang, Ziyin, Xiaofei Mei, Yufeng Jiang, Tan Chen, and Yafeng Zhou.. (Frontiers in Cardiovascular Medicine 8: 803744. (2022))
- Hospitalized Patients with Heart Failure and Common Bacterial Infections: A Nationwide Analysis of Concomitant Clostridium Difficile Infection Rates and In-Hospital Mortality.. Mamic, Petra, Paul A. Heidenreich, Haley Hedlin, Lakshika Tennakoon, and Kristan L. Staudenmayer.. (Journal of Cardiac Failure 22: 891–900. (2016))
- TMAO: how gut microbiota contributes to heart failure.. Zhang Y, Wang Y, Ke B, Du J.. (Transl Res. (2021))
- Short-Chain Fatty Acids Outpace Ketone Oxidation in the Failing Heart.. Carley, Andrew N., Santosh K. Maurya, Matthew Fasano, Yang Wang, Craig H. Selzman, Stavros G. Drakos, and E. Douglas Lewandowski.. (Circulation. (2021))
- Captopril in heart failure. A double blind controlled trial.. Cleland JG, Dargie HJ, Hodsman GP, et al.. (Br Heart J. (1984))
- Hypotensive effect of captopril on deoxycorticosterone acetate-salt-induced hypertensive rat is associated with gut microbiota alteration.. Wu H, Lam TYC, Shum TF, Tsai TY, Chiou J.. (Hypertens Res. (2022))
- Effects of Metformin in Heart Failure: From Pathophysiological Rationale to Clinical Evidence.. Salvatore T, Galiero R, Caturano A, et al.. (Biomolecules. (2021))
- SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence.. Talha KM, Anker SD, Butler J.. (Int J Heart Fail. (2023))
- Effects of Oral Glucose-Lowering Agents on Gut Microbiota and Microbial Metabolites.. Wang D, Liu J, Zhou L, Zhang Q, Li M, Xiao X.. (Front Endocrinol (Lausanne). (2022))
- The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.. Pitt B, Zannad F, Remme WJ, et al.. (N Engl J Med. (1999))
- Mineralocorticoid receptor blockade improved gut microbiota dysbiosis by reducing gut sympathetic tone in spontaneously hypertensive rats.. González-Correa, Moleón,Miñano et al.. (Biomedicine & Pharmacotherapy (2023))
- Potential roles of gut microbiota and microbial metabolites in chronic inflammatory pain and the mechanisms of therapy drugs.. Li JS, Su SL, Xu Z, et al.. (Ther Adv Chronic Dis. (2022))
- The DASH diet is associated with a lower risk of heart failure: a cohort study.. Ibsen DB, Levitan EB, Åkesson A, Gigante B, Wolk A.. (Eur J Prev Cardiol. (2022))
- Fecal microbiota transplant, its usefulness beyond Clostridioides difficile in gastrointestinal diseases.. Núñez F P, Quera R, Bay C, Thomson P.. (Gastroenterol Hepatol. (2022).)
- Probiotic Therapy With Saccharomyces Boulardii for Heart Failure Patients: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial.. Costanza, Annelise C., Samuel D. Moscavitch, Hugo C. C. Faria Neto, and Evandro T. Mesquita.. (International Journal of Cardiology 179: 348–50. (2015))
- The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.. Krasowska A, Murzyn A, Dyjankiewicz A, Łukaszewicz M, Dziadkowiec D.. (FEMS Yeast Res. (2009))
- The Impact of Probiotic Yogurt Versus Ordinary Yogurt on Serum sTWEAK, sCD163, ADMA, LCAT and BUN in Patients with Chronic Heart Failure: A Randomized, Triple-Blind, Controlled Trial.. Pourrajab, Behnaz, Nasim Naderi et al.. (Journal of the Science of Food and Agriculture 102: 6024–35. 2022.)
- Berberine Treats Atherosclerosis Via A Vitamine-Like Effect Down-Regulating Choline-TMA-TMAO Production Pathway in Gut Microbiota.. Ma, Shu-Rong, Qian Tong, Yuan Lin, Li-Bin Pan, Jie Fu, Ran Peng, Xian-Feng Zhang, et al.. (Signal Transduction and Targeted Therapy 7: 207. (2022))
- Plasma Trimethylamine-N-Oxide Following Supplementation with Vitamin D or D Plus B Vitamins.. Obeid, Rima, Hussain M. Awwad, Susanne H. Kirsch, Christiane Waldura, Wolfgang Herrmann, Stefan Graeber, and Juergen Geisel.. (Molecular Nutrition & Food Research 61: 1600358. (2017))
- 3,3-Dimethyl-1-butanol Attenuates Cardiac Remodeling in Pressure-Overload-Induced Heart Failure Mice. Wang, Guangji, Bin Kong, Wei Shuai, Hui Fu, Xiaobo Jiang, and He Huang.. (The Journal of Nutritional Biochemistry 78: 108341 (2020))
- A High-Fiber Diet or Dietary Supplementation of Acetate Attenuate Hyperoxia-Induced Acute Lung Injury.. Chu SJ, Tang SE, Pao HP, Wu SY, Liao WI.. (Nutrients. (2022))
- Protective Effect of Carvacrol against Gut Dysbiosis and Clostridium difficile Associated Disease in a Mouse Model.. Mooyottu S, Flock G, Upadhyay A, Upadhyaya I, Maas K, Venkitanarayanan K.. (Front Microbiol. (2017))
- Carvacrol Ameliorates Pathological Cardiac Hypertrophy in Both In-vivo and In-vitro Models.. Jamhiri M, Safi Dahaj F, Astani A, et al.. (Iran J Pharm Res. (2019))
Anker, Stefan D., Karl R. Egerer, Hans-Dieter Volk, Wolfgang J. Kox, Philip A. Poole-Wilson, and Andrew J. S. Coats.
Elevated Soluble CD14 Receptors and Altered Cytokines in Chronic Heart Failure.The American Journal of Cardiology 79: 1426–30. (1997)
Niebauer, Josef, Hans-Dieter Volk, Michael Kemp, Martin Dominguez, Ralf R. Schumann, Mathias Rauchhaus, Philip A. Poole-Wilson, Andrew J. S. Coats, and Stefan D. Anker.
Endotoxin and Immune Activation in Chronic Heart Failure: a Prospective Cohort Study.The Lancet 353: 1838–42. (1999)
Chen, An-Tian, Jian Zhang, and Yuhui Zhang.
Gut Microbiota in Heart Failure and Related Interventions.iMeta 2, e125. (2023)
Sun, Weiju, Debing Du, Tongze Fu, Ying Han, Peng Li, and Hong Ju.
Alterations of the Gut Microbiota in Patients With Severe Chronic Heart Failure.Frontiers in Microbiology 12: 813289.(2022)
Huang, Ziyin, Xiaofei Mei, Yufeng Jiang, Tan Chen, and Yafeng Zhou.
Gut Microbiota in Heart Failure Patients With Preserved Ejection Fraction (GUMPTION Study).Frontiers in Cardiovascular Medicine 8: 803744. (2022)
Mamic, Petra, Paul A. Heidenreich, Haley Hedlin, Lakshika Tennakoon, and Kristan L. Staudenmayer.
Hospitalized Patients with Heart Failure and Common Bacterial Infections: A Nationwide Analysis of Concomitant Clostridium Difficile Infection Rates and In-Hospital Mortality.Journal of Cardiac Failure 22: 891–900. (2016)
Zhang Y, Wang Y, Ke B, Du J.
TMAO: how gut microbiota contributes to heart failure.Transl Res. (2021)
Carley, Andrew N., Santosh K. Maurya, Matthew Fasano, Yang Wang, Craig H. Selzman, Stavros G. Drakos, and E. Douglas Lewandowski.
Short-Chain Fatty Acids Outpace Ketone Oxidation in the Failing Heart.Circulation. (2021)
Cleland JG, Dargie HJ, Hodsman GP, et al.
Captopril in heart failure. A double blind controlled trial.Br Heart J. (1984)
Wu H, Lam TYC, Shum TF, Tsai TY, Chiou J.
Hypotensive effect of captopril on deoxycorticosterone acetate-salt-induced hypertensive rat is associated with gut microbiota alteration.Hypertens Res. (2022)
Salvatore T, Galiero R, Caturano A, et al.
Effects of Metformin in Heart Failure: From Pathophysiological Rationale to Clinical Evidence.Biomolecules. (2021)
Talha KM, Anker SD, Butler J.
SGLT-2 Inhibitors in Heart Failure: A Review of Current Evidence.Int J Heart Fail. (2023)
Wang D, Liu J, Zhou L, Zhang Q, Li M, Xiao X.
Effects of Oral Glucose-Lowering Agents on Gut Microbiota and Microbial Metabolites.Front Endocrinol (Lausanne). (2022)
Pitt B, Zannad F, Remme WJ, et al.
The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.N Engl J Med. (1999)
González-Correa, Moleón,Miñano et al.
Mineralocorticoid receptor blockade improved gut microbiota dysbiosis by reducing gut sympathetic tone in spontaneously hypertensive rats.Biomedicine & Pharmacotherapy (2023)
Li JS, Su SL, Xu Z, et al.
Potential roles of gut microbiota and microbial metabolites in chronic inflammatory pain and the mechanisms of therapy drugs.Ther Adv Chronic Dis. (2022)
Ibsen DB, Levitan EB, Åkesson A, Gigante B, Wolk A.
The DASH diet is associated with a lower risk of heart failure: a cohort study.Eur J Prev Cardiol. (2022)
Núñez F P, Quera R, Bay C, Thomson P.
Fecal microbiota transplant, its usefulness beyond Clostridioides difficile in gastrointestinal diseases.Gastroenterol Hepatol. (2022).
Costanza, Annelise C., Samuel D. Moscavitch, Hugo C. C. Faria Neto, and Evandro T. Mesquita.
Probiotic Therapy With Saccharomyces Boulardii for Heart Failure Patients: A Randomized, Double-Blind, Placebo-Controlled Pilot Trial.International Journal of Cardiology 179: 348–50. (2015)
Krasowska A, Murzyn A, Dyjankiewicz A, Łukaszewicz M, Dziadkowiec D.
The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation.FEMS Yeast Res. (2009)
Pourrajab, Behnaz, Nasim Naderi et al.
The Impact of Probiotic Yogurt Versus Ordinary Yogurt on Serum sTWEAK, sCD163, ADMA, LCAT and BUN in Patients with Chronic Heart Failure: A Randomized, Triple-Blind, Controlled Trial.Journal of the Science of Food and Agriculture 102: 6024–35. 2022.
Ma, Shu-Rong, Qian Tong, Yuan Lin, Li-Bin Pan, Jie Fu, Ran Peng, Xian-Feng Zhang, et al.
Berberine Treats Atherosclerosis Via A Vitamine-Like Effect Down-Regulating Choline-TMA-TMAO Production Pathway in Gut Microbiota.Signal Transduction and Targeted Therapy 7: 207. (2022)
Obeid, Rima, Hussain M. Awwad, Susanne H. Kirsch, Christiane Waldura, Wolfgang Herrmann, Stefan Graeber, and Juergen Geisel.
Plasma Trimethylamine-N-Oxide Following Supplementation with Vitamin D or D Plus B Vitamins.Molecular Nutrition & Food Research 61: 1600358. (2017)
Wang, Guangji, Bin Kong, Wei Shuai, Hui Fu, Xiaobo Jiang, and He Huang.
3,3-Dimethyl-1-butanol Attenuates Cardiac Remodeling in Pressure-Overload-Induced Heart Failure MiceThe Journal of Nutritional Biochemistry 78: 108341 (2020)
Chu SJ, Tang SE, Pao HP, Wu SY, Liao WI.
A High-Fiber Diet or Dietary Supplementation of Acetate Attenuate Hyperoxia-Induced Acute Lung Injury.Nutrients. (2022)
Mooyottu S, Flock G, Upadhyay A, Upadhyaya I, Maas K, Venkitanarayanan K.
Protective Effect of Carvacrol against Gut Dysbiosis and Clostridium difficile Associated Disease in a Mouse Model.Front Microbiol. (2017)
Jamhiri M, Safi Dahaj F, Astani A, et al.
Carvacrol Ameliorates Pathological Cardiac Hypertrophy in Both In-vivo and In-vitro Models.Iran J Pharm Res. (2019)