Abstract 3090: Oral Administration Of Akkermansia Muciniphila Ameliorates Venous Wall Fibrosis: Therapeutic Implication Of A Novel Probiotic Therapy Against Post-thrombotic Syndrome

Abstract

Introduction: Post-thrombotic syndrome (PTS) is the most common sequelae of deep vein thrombosis (DVT), manifested as venous insufficiency in up to 50% of patients. Unfortunately, none of the existing therapies, including anticoagulants and thrombolytics, have shown definitive effects for PTS, presenting a vital unmet clinical need. Akkermansia Muciniphila (AKK) , a gut commensal anaerobic bacterium, has been recognized with pleiotropic benefits in a wide range of diseases including cardiometabolic disorders. However, its therapeutic and mechanistic implications in thromboembolic diseases and the subsequent PTS remain unknown. We hypothesize that probiotic therapy with live AKK after DVT formation could ameliorate venous wall fibrosis, indicative of PTS. Methods: In male specific-pathogen free c57b6/j mice (10-12 weeks), DVT was experimentally created via partial ligation of inferior vena cava (IVC) as previously established, leading to progressive venous fibrosis. For the probiotic treatment, AKK (strain BAA-835) was cultured using BHI broth in an anaerobic Coy chamber, followed by daily oral gavage to mice beginning from day 1 post-DVT induction. At day 14 post-procedure, IVC was collected for Masson Trichrome and immunofluorescent staining, followed by quantitation of venous collagen deposition/fibrosis and phosphorylation of endoplasmic reticulum (ER) stress PERK kinase. Endpoint plasma specimens were collected to quantify the circulating levels of trimethylamine N-oxide (TMAO). Results: Post-DVT probiotic therapy with live AKK effectively mitigated venous wall fibrosis in comparison to BHI culture media gavage alone (fibrotic area: 61.12±6.64 vs 53.17±5.99; p<0.05). TMAO, the only microbial metabolite associated with thromboembolic risk, was significantly reduced in plasma following AKK probiotic therapy. Furthermore, phosphorylation of ER stress PERK, which is directly activated by TMAO and critically contributes to myofibroblast activation and organ fibrosis, was inhibited in the AKK -treated IVC (435.09±26.49 vs 326.86±17.61; p<0.01). Conclusion: Our current study supports the potential use of Post-DVT AKK probiotic therapy for the treatment of PTS, possibly via modulating the TMAO-PERK axis.