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Atherosclerosis. 2018 Jun;273:91-97. doi: 10.1016/j.atherosclerosis.2018.04.015. Epub 2018 Apr 17.

Metabolic products of the intestinal microbiome and extremes of atherosclerosis.

Author information

1
Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada; Dept. of Neurology, McMaster University, Hamilton, Canada.
2
Dept. Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Canada.
3
Dept. Molecular and Cell Biology, University of Guelph, Guelph, Canada.
4
Depts. of Urology and Microbiology, Schulich School of Medicine and Dentistry, Western University, London, Canada.
5
Dept. Physiology & Pharmacology, Schulich School of Medicine and Dentistry Western University, London, Canada.
6
Department of Radiology, University of Calgary, Calgary, Canada.
7
Schulich School of Medicine and Dentistry M.D. Candidate (CIHR Summer Research Training Program), Canada.
8
Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada; Divisions of Neurology and Clinical Pharmacology, Western University, London, Canada. Electronic address: dspence@robarts.ca.

Abstract

BACKGROUND AND AIMS:

There is increasing awareness that the intestinal microbiome plays an important role in human health. We investigated its role in the burden of carotid atherosclerosis, measured by ultrasound as total plaque area.

METHODS:

Multiple regression with traditional risk factors was used to identify three phenotypes among 316/3056 patients attending vascular prevention clinics. Residual score (RES; i.e. the distance off the regression line, similar to standard deviation) was used to identify the 5% of patients with much less plaque than predicted by their risk factors (Protected, RES <-2), the 90% with about as much plaque as predicted (Explained, RES -2 to 2), and the 5% with much more plaque than predicted (Unexplained RES >2). Metabolic products of the intestinal microbiome that accumulate in renal failure - gut-derived uremic toxins (GDUT) - were assayed in plasma by ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry.

RESULTS:

Plasma levels of trimethylamine n-oxide (TMAO), p-cresyl sulfate, p-cresyl glucuronide, and phenylacetylglutamine were significantly lower among patients with the Protected phenotype, and higher in those with the Unexplained phenotype, despite no significant differences in renal function or in dietary intake of nutrient precursors of GDUT. In linear multiple regression with a broad panel of risk factors, TMAO (p = 0.011) and p-cresyl sulfate (p = 0.011) were significant independent predictors of carotid plaque burden.

CONCLUSIONS:

The intestinal microbiome appears to play an important role in atherosclerosis. These findings raise the possibility of novel approaches to treatment of atherosclerosis such as fecal transplantation and probiotics.

KEYWORDS:

Atherosclerosis; Intestinal microbiome; Renal impairment; Resistant atherosclerosis; TMAO

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