Revitalizing myocarditis treatment through gut microbiota modulation: unveiling a promising therapeutic avenue

Abstract

Numerous studies have demonstrated that gut microbiota plays an important role in the development and treatment of different cardiovascular diseases, including hypertension, heart failure, myocardial infarction, arrhythmia, and atherosclerosis. Furthermore, evidence from recent studies has shown that gut microbiota contributes to the development of myocarditis. Myocarditis is an inflammatory disease that often results in myocardial damage. Myocarditis is a common cause of sudden cardiac death in young adults. The incidence of myocarditis and its associated dilated cardiomyopathy has been increasing yearly. Myocarditis has gained significant attention on social media due to its association with both COVID-19 and COVID-19 vaccinations. However, the current therapeutic options for myocarditis are limited. In addition, little is known about the potential therapeutic targets of myocarditis. In this study, we review (1) the evidence on the gut-heart axis, (2) the crosslink between gut microbiota and the immune system, (3) the association between myocarditis and the immune system, (4) the impact of gut microbiota and its metabolites on myocarditis, (5) current strategies for modulating gut microbiota, (6) challenges and future directions for targeted gut microbiota in the treatment of myocarditis. The approach of targeting the gut microbiota in myocarditis is still in its infancy, and this is the study to explore the gut microbiota-immune system-myocarditis axis. Our findings are expected to pave the way for the use of gut microbiota as a potential therapeutic target in the treatment of myocarditis.

Clinical Characteristics and Mechanisms of Acute Myocarditis

“…Experimental mouse models indicate that mTOR (mammalian target of rapamycin) inhibitors improve survival in mice with lamin A/C mutations 134 and also lead to resolution of granulomatous infiltrates, prevention of fibrosis, and improved cardiac function. This finding may represent a novel therapeutic target in cardiac sarcoidosis.…”

“…Emerging evidence suggests that gut microbiota dysbiosis may be implicated in the development of myocarditis, particularly autoimmune myocarditis, and may represent a novel therapeutic avenue for treating and preventing acute myocarditis in susceptible individuals (Figure 4B). 134 Some gut microbiota appear to modulate immune cell activity and the production of proinflammatory cytokines. 135 Commensal bacteroides have been shown to produce a MYH6 mimic, ß-galactosidase, which may activate cross-reactive Th17 cells and result in myocardial inflammation.…”

Brain-Heart Axis and the Inflammatory Response: Connecting Stroke and Cardiac Dysfunction

“…Murine models demonstrate antibioticmediated changes in gut microbiota composition attenuate cardiac inflammatory injury [141]. Inhibiting cardiotoxic bacterial species skews microbiota profiles toward cardioprotection, mitigating experimental autoimmune myocarditis [142]. Prebiotics/probiotics favorably modulate trimethylamine-N-oxide levels and generation of cardioprotective metabolites like short-chain fatty acids through directed microbiota metabolism [143].…”

Ginsenoside Rg5 Activates the LKB1/AMPK/mTOR Signaling Pathway and Modifies the Gut Microbiota to Alleviate Nonalcoholic Fatty Liver Disease Induced by a High-Fat Diet

“…Nevertheless, the impact of Rg 5 on NAFLD and its underlying mechanisms remains unclear. Furthermore, fecal microbiota transplantation (FMT) has garnered attention as a focus of recent research, displaying promising outcomes in the treatment of various conditions, including obesity [ 13 ]. Therefore, the aim of this study was to explore the effect of Rg 5 on NAFLD, with special attention paid to elucidating the role of gut microbiota and providing new insights into the potential target and mechanism of Rg 5 as an NAFLD therapeutic agent.…”