Gut Microbiota Signature in Heart Failure Defined From Profiling of 2 Independent Cohorts

Kummen, Martin; Mayerhofer, Cristiane C.K.; Vestad, Beate; Broch, Kaspar; Awoyemi, Ayodeji; Storm-Larsen, Christopher; Ueland, Thor; Yndestad, Arne; Hov, Johannes R.; Trøseid, Marius

doi:10.1016/j.jacc.2017.12.057

Cited by 165 publications

(145 citation statements)

References 4 publications

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“…We have previously reported data from this study population, consisting of two cohorts comprising a total of 84 well‐treated patients with HF and 266 control subjects, showing that the gut microbiota composition differed considerably between patients and controls . In the present study, we extended these findings to show that (i) the overall microbial community (beta diversity) differed between HF patients and controls; (ii) patients with HF had a lower abundance of bacteria in the Firmicutes phylum and a higher abundance of Bacteroidetes (a decreased F/B ratio); (iii) patients who reached an endpoint during follow‐up (listing for heart transplantation or all‐cause mortality) had lower bacterial richness and F/B ratio; and (iv) a lower fibre intake correlated with dysbiosis in HF, including a lower bacterial richness and a lower abundance of four of the bacterial genera that were reduced in HF.…”

Section: Discussionsupporting

confidence: 60%

“…The study cohort has been briefly described previously . We performed a cross‐sectional collection of stool samples from two independent cohorts ( discovery cohort , n = 40 and validation cohort , n = 44) of patients with HF with reduced ejection fraction treated at the Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, from July 2014 to December 2016.…”

Section: Methodsmentioning

confidence: 99%

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Low fibre intake is associated with gut microbiota alterations in chronic heart failure

et al. 2020

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Aims Recent reports have suggested that patients with heart failure (HF) have an altered gut microbiota composition; however, associations with diet remain largely uninvestigated. We aimed to explore differences in the gut microbiota between patients with HF with reduced ejection fraction and healthy controls, focusing on associations with diet and disease severity. Methods and results The microbiota composition of two cross-sectional cohorts (discovery, n = 40 and validation, n = 44) of patients with systolic HF and healthy controls (n = 266) was characterized by sequencing of the bacterial 16S rRNA gene. The overall microbial community (beta diversity) differed between patients with HF and healthy controls in both cohorts (P < 0.05). Patients with HF had shifts in the major bacterial phyla, resulting in a lower Firmicutes/Bacteroidetes (F/B) ratio than controls (P = 0.005). Patients reaching a clinical endpoint (listing for heart transplant or death) had lower bacterial richness and lower F/B ratio than controls (P < 0.01). Circulating levels of trimethylamine-N-oxide were associated with meat intake (P = 0.016), but not with gut microbiota alterations in HF. Low bacterial richness and low abundance of several genera in the Firmicutes phylum were associated with low fibre intake. Conclusions The gut microbiota in HF was characterized by decreased F/B ratio and reduced bacterial diversity associated with clinical outcome. The gut microbiota alterations in HF were partly related to low fibre intake, emphasizing the importance of diet as a covariate in future studies. Our data could provide a rationale for targeting the gut microbiota in HF with high-fibre diet.

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Section: Discussionsupporting

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Low fibre intake is associated with gut microbiota alterations in chronic heart failure

et al. 2020

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“…These studies have also found significant differences between the gut microbial composition of HFrEF patients and healthy controls (also referred to as beta‐diversity, which denotes diversity within separate regions and conditions) . Whereas Kummen et al . found a reduction in SCFA butyrate‐producing bacterial species in stable HFrEF patients, Kamo et al .…”

Section: Gut Microbes and Dysbiosismentioning

confidence: 99%

“…In the realm of HF, using 16S rRNA gene amplicon sequencing from stool samples, several cross‐sectional studies have found that compared to healthy controls without HF, both acutely decompensated and stable HF patients with reduced ejection fraction (HFrEF) have a significant reduction in alpha‐diversity (the diversity within a local area denoting species richness and abundance levels) of gut bacteria . These studies have also found significant differences between the gut microbial composition of HFrEF patients and healthy controls (also referred to as beta‐diversity, which denotes diversity within separate regions and conditions) . Whereas Kummen et al .…”

Section: Gut Microbes and Dysbiosismentioning

confidence: 99%

“…Another major challenge for the gut dysbiosis theory is that the taxonomic classification of gut bacteria can be done at several levels (phylum, class, order, family, genus and finally down to species) . Various studies in HF patients and other disorders have analysed differences in gut bacterial composition between diseased and disease‐free healthy controls at different taxonomic levels of classifications and hence these studies have invariably ended up finding some statistically significant association . However, this does not prove causality and is likely a major reason why a common microbiome related to HF has not been identified yet and why studies have failed to strongly corroborate each other's results (other than low microbial diversity seen in HF patients).…”

Section: Challenges and Solutions To The Gut Dysbiosis Theorymentioning

confidence: 99%

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Gut dysbiosis and heart failure: navigating the universe within

Madan

Mehra

2020

European J of Heart Fail

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Alternations in gut microbial composition (i.e. loss of microbial diversity or ‘gut dysbiosis’) have been associated with heart failure with reduced ejection fraction (HFrEF). It has also been suggested that increased chronic low‐level inflammation and immune system dysregulation seen in patients with HFrEF could be related to gut dysbiosis and increased intestinal permeability. Hence, the concept of modulating gut microbial composition with the goal of reducing systemic inflammation and controlling HFrEF progression has generated a substantial interest in the scientific community. However, several challenges to the gut dysbiosis theory remain as the exact gut microbial composition in HFrEF patients in these studies is not the same and a common microbiome linked to HFrEF is not yet established. With the advances in culture independent sequencing techniques it has also become evident that the gut microbiome may be much more diverse than previously believed. Further, various ‘omic’ technologies have enabled us to appreciate the potential role of gut microbial metabolites in various physiological processes in the host. Hence, identification of specific gut microbial metabolites may offer an alternative approach at solving this gut microbiome‐HFrEF puzzle. In the current review, we evaluate the concept of gut symbiosis, the potential role of gut dysbiosis in systemic inflammation and HFrEF, and finally highlight the challenges faced by the gut dysbiosis theory in HFrEF and provide a framework for the possible solutions.

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