Muralitharan Rikeish R, Jama Hamdi A, Xie Liang, Peh Alex, Snelson Matthew, Marques Francine Z
From the Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science (R.R.M., H.A.J., L.X., A.P., F.Z.M.), Monash University, Melbourne, Australia.
Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia (R.R.M.).
Hypertension. 2020 Dec;76(6):1674-1687. doi: 10.1161/HYPERTENSIONAHA.120.14473. Epub 2020 Oct 5.
There is increasing evidence of the influence of the gut microbiota on hypertension and its complications, such as chronic kidney disease, stroke, heart failure, and myocardial infarction. This is not surprising considering that the most common risk factors for hypertension, such as age, sex, medication, and diet, can also impact the gut microbiota. For example, sodium and fermentable fiber have been studied in relation to both hypertension and the gut microbiota. By combining second- and, now, third-generation sequencing with metabolomics approaches, metabolites, such as short-chain fatty acids and trimethylamine N-oxide, and their producers, have been identified and are now known to affect host physiology and the cardiovascular system. The receptors that bind these metabolites have also been explored with positive findings-examples include known short-chain fatty acid receptors, such as G-protein coupled receptors GPR41, GPR43, GPR109a, and OLF78 in mice. GPR41 and OLF78 have been shown to have inverse roles in blood pressure regulation, whereas GPR43 and GPR109A have to date been demonstrated to impact cardiac function. New treatment options in the form of prebiotics (eg, dietary fiber), probiotics (eg, spp.), and postbiotics (eg, the short-chain fatty acids acetate, propionate, and butyrate) have all been demonstrated to be beneficial in lowering blood pressure in animal models, but the underlying mechanisms remain poorly understood and translation to hypertensive patients is still lacking. Here, we review the evidence for the role of the gut microbiota in hypertension, its risk factors, and cardiorenal complications and identify future directions for this exciting and fast-evolving field.
越来越多的证据表明,肠道微生物群对高血压及其并发症,如慢性肾病、中风、心力衰竭和心肌梗死有影响。考虑到高血压最常见的风险因素,如年龄、性别、药物和饮食,也会影响肠道微生物群,这并不奇怪。例如,钠和可发酵纤维已被研究与高血压和肠道微生物群的关系。通过将第二代测序以及现在的第三代测序与代谢组学方法相结合,已鉴定出短链脂肪酸和氧化三甲胺等代谢物及其产生者,现在已知它们会影响宿主生理和心血管系统。与这些代谢物结合的受体也已被探索并取得了积极成果,例如已知的短链脂肪酸受体,如小鼠中的G蛋白偶联受体GPR41、GPR43、GPR109a和OLF78。已证明GPR41和OLF78在血压调节中具有相反作用,而GPR43和GPR109A迄今为止已被证明会影响心脏功能。益生元(如膳食纤维)、益生菌(如 种)和后生元(如短链脂肪酸乙酸盐、丙酸盐和丁酸盐)等新的治疗选择在动物模型中均已证明对降低血压有益,但潜在机制仍知之甚少,且仍缺乏向高血压患者的转化。在这里,我们综述了肠道微生物群在高血压、其风险因素和心肾并发症中的作用证据,并确定了这个令人兴奋且快速发展的领域的未来方向。