Review ArticleIntersections Between Microbiome and Heart Failure: Revisiting the Gut Hypothesis
Section snippets
Gut Microbiota in Health and Disease
There are ∼1014 bacterial organisms belonging to >2,000 species within our bodies, the vast majority being in the gut.1 These are commensal microorganisms that colonize in the human gut and play a crucial role in protection from environmental exposure, digestion, and absorption of nutrients.2, 3, 4 The phylogenetic composition of the bacterial communities evolves toward an adult-like configuration during the 1st few years of life. The shaping of gut microbiota is largely influenced by lifestyle
Alteration of Gut and Gut Microbiota in Heart Failure
The gut is a blood-demanding organ, and villi (and microvilli) are prone to functional ischemia due to reduced blood flow.12 The arteries form dense capillary networks close to the top of the villi. This anatomic arrangement allows countercurrent exchange of oxygen from the arteries to the veins along their course within the villus. This results in a descending gradient of tissue oxygen concentration from the base to the tip of the villus. This gradient is inversely related to blood flow12;
Potential Intervention Strategies
Therapeutic tools available to modulate the microbiota-driven pathogenesis of HF remain limited. However, based on evidence that mechanistically links gut microbiota and HF, potential intervention strategies include targeting the composition of the microbiota or the biochemical pathways (Table 1). The composition of the microbiota can be modulated by diet,61 antibiotics, prebiotics/probiotics, and fecal transplantation. The biochemical pathways involved in microbiota-driven pathology can be
Conclusion
Millions of years of coevolution between humans and microorganisms have led to a mutualistic relationship, in which diverse ecosystems of gut microbiota contribute to the maintenance of our metabolic homeostasis. The interaction of heart and gut, or heart-intestine axis, has emerged as a novel concept to provide new insights into the intricate mechanisms of HF. However, at the present time the role of gut microbiota–targeted interventions remains uncertain in the absence of solid well conducted
Disclosures
None.
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Funding: National Institutes of Health and Office of Dietary Supplements (R01HL103931, P20HL113452, 1R01DK106000). Dr Nagatomo is the recipient of the Postdoctoral Fellowship award from the Myocarditis Foundation (MYF1401MF).