Product of metabolic activity of intestinal microbium trimethylamine-N-oxide (TMAO)— biomarker of progression of atherosclerosis-copy in the heart of the heart

Abstract

The literature data on the importance of intestinal microbiota as an endocrine organ— producer of biologically active metabolites, which perform key functions to maintain metabolic homeostasis of the whole organism, in particular the condition of the cardiovascular system, are analyzed. Clinical and experimental studies using a metabolomical approach have shown that the development of atherosclerotic CVD is often associated with elevated levels of one of the microbial metabolites, trimethylamine N-oxide (TMAO). TMAO may be a sensitive prognostic biomarker of complications of type 2 diabetes, including atherosclerosis and cardiovascular disease. The precursor of TMAO is trimethylamine (TMA), formed by intestinal bacteria from food phosphatidylcholine and L-carnitine. In the liver, TMA is converted to TMAO under the influence of hepatic flavin monooxygenase 3.The mechanisms of the proatherogenic effect of elevated levels of TMAO include effects on bile acid and cholesterol metabolism, platelet hyperactivation, stimulation of inflammatory processes and oxidative stress, induction of endothelial disfunction and endoplasmic reticulum stress. It has been established that TMAO, in conditions of chronic elevation, can contribute to cardiometabolic diseases. Elevated levels of TMAO in dysmetabolic conditions (obesity, type2 diabetes, atherosclerosis, or coronary heart disease) have been suggested to be largely associated with the gut microbiota profile. Therefore, regulating the ratio of intestinal microorganisms or their ability to form a precursor of TMAO— TMA, may be a way to develop new tools for the prevention and treatment of atherosclerosis and prevent the progression of cardiovascular complications, including in patients with type 2 diabetes. Studies have shown that inhibiting various stages of TMAO production can reduce TMAO levels and help treat atherosclerosis and diabetes.