Gut Microbiome and Kidney Disease : Reconciling Optimism and Skepticism

Western lifestyle with high salt consumption leads to hypertension and cardiovascular disease. High salt may additionally drive autoimmunity by inducing T helper (TH)17 cells, which may also contribute to hypertension. Induction of TH17 cells depends on the gut microbiota, yet the effect of salt on the gut microbiome is unknown. In mouse model systems, we show that high salt intake affects the gut microbiome, particularly by depleting Lactobacillus murinus. Consequently, L. murinus treatment prevents salt-induced aggravation of actively-induced experimental autoimmune encephalomyelitis and salt-sensitive hypertension, by modulating TH17 cells. In line with these findings, moderate high salt challenge in a pilot study in humans reduces intestinal survival of Lactobacillus spp. along with increased TH17 cells and blood pressure. Our results connect high salt intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions. Show more

Trimethylamine (TMA) N-oxide (TMAO), a gut-microbiota-dependent metabolite, both enhances atherosclerosis in animal models and is associated with cardiovascular risks in clinical studies. Here, we investigate the impact of targeted inhibition of the first step in TMAO generation, commensal microbial TMA production, on diet-induced atherosclerosis. A structural analog of choline, 3,3-dimethyl-1-butanol (DMB), is shown to non-lethally inhibit TMA formation from cultured microbes, to inhibit distinct microbial TMA lyases, and to both inhibit TMA production from physiologic polymicrobial cultures (e.g., intestinal contents, human feces) and reduce TMAO levels in mice fed a high-choline or L-carnitine diet. DMB inhibited choline diet-enhanced endogenous macrophage foam cell formation and atherosclerotic lesion development in apolipoprotein e(-/-) mice without alterations in circulating cholesterol levels. The present studies suggest that targeting gut microbial production of TMA specifically and non-lethal microbial inhibitors in general may serve as a potential therapeutic approach for the treatment of cardiometabolic diseases. Show more

The human gut microbiome has been associated with many health factors but variability between studies limits exploration of effects between them. Gut microbiota profiles are available for >2700 members of the deeply phenotyped TwinsUK cohort, providing a uniform platform for such comparisons. Here, we present gut microbiota association analyses for 38 common diseases and 51 medications within the cohort. We describe several novel associations, highlight associations common across multiple diseases, and determine which diseases and medications have the greatest association with the gut microbiota. These results provide a reference for future studies of the gut microbiome and its role in human health. Show more