Gut microbiota in heart failure and related interventions

What was reviewed?

The Gut Microbiota in Heart Failure and Related Interventions Review article examines the relationship between heart failure (HF) and the gut microbiota, exploring the gut hypothesis of HF, the role of gut microbiota metabolites, and potential microbiome-targeted interventions (MBTIs). The review provides a comprehensive overview of the current understanding of how changes in gut microbiota composition and its metabolites contribute to HF progression and discusses various interventions, including dietary changes, probiotic therapy, fecal microbiota transplantation (FMT), antibiotics, and other novel approaches.

Who was reviewed?

The review synthesizes findings from various studies involving HF patients and animal models to understand the connection between gut microbiota and HF. It also evaluates research on different interventions and their effects on gut microbiota and HF. Specific studies cited include investigations of bacterial species present in HF patients compared to healthy controls, the impact of gut microbiota metabolites like trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs) on HF, and the efficacy of interventions like the DASH diet, Mediterranean diet, probiotics, FMT, and antibiotics.

What were the most important findings of this review?

The review highlights the gut hypothesis of heart failure (HF), where reduced cardiac output and systemic congestion lead to diminished intestinal perfusion, ischemia, and barrier dysfunction. This allows bacterial translocation and endotoxin release, worsening inflammation and HF. HF patients show increased pathogenic bacteria (e.g., Bacteroides, Eubacterium rectale) and decreased beneficial bacteria (e.g., Lachnospiraceae, Ruminococcaceae). Key gut microbiota metabolites, such as TMAO, SCFAs, TMAVA, and PAGln, significantly impact HF. TMAO promotes cardiac fibrosis, hypertrophy, and inflammation, while SCFAs have protective effects, preventing cardiac hypertrophy and fibrosis, reducing inflammation, and providing energy to the failing heart.

What are the greatest implications of this review?

The greatest implications of the Gut Microbiota in Heart Failure and Related Interventions review are manifold. It highlights the therapeutic potential of targeting gut microbiota as a promising avenue for heart failure (HF) treatment, suggesting that a deeper understanding of the interactions between gut microbiota and HF could lead to novel strategies that complement existing therapies. Personalized medicine approaches, including dietary changes, probiotics, and potentially fecal microbiota transplantation (FMT), could be tailored to individual patients to address specific microbial imbalances contributing to HF. The review also underscores the importance of preventive strategies, such as adopting diets that support a healthy gut microbiota, in reducing the risk and progression of HF, which could have significant public health implications. Additionally, the review calls for further research to elucidate the mechanisms linking gut microbiota and HF, assess the long-term efficacy and safety of various interventions, and explore the roles of other metabolites and bacterial species in HF. Such research could pave the way for new diagnostic and therapeutic tools in HF management. Overall, the review emphasizes the critical role of gut microbiota in HF and suggests that targeting it could revolutionize HF treatment and prevention.