Heart failure affects at least 26 million people worldwide and is increasing in prevalence leading to an increase in related expenditures. Despite advances in therapies and prevention, mortality and morbidity are still high and quality of life reduced. A new clinical study, the GutHeart Trial, strives to examine the relationship between the bacterial composition of the gut and inflammatory and metabolic pathways in the cardiovascular system.
Heart failure is a chronic and progressive condition where the heart muscle cannot pump enough blood to meet the body’s needs. The heart tries to compensate for this inability to keep up with its workload by enlarging, developing more muscle mass or pumping faster while the body narrows blood vessels and diverts blood away from less important tissues and organs like the kidneys. In heart failure, these processes continue until they worsen, and the compensation no longer suffices which leads to shortness of breath, fatigue, and a variety of other symptoms. In heart failure patients this decreased cardiac output contributes to ischemia and oedema of the gut wall. Basically, the gut does not receive proper blood supply and fluid may build up and can lead to increased gut permeability or secondary inflammation.
Our gut contains a dynamic microbial community referred to as the gut microbiome, the composition of the population determines the type and number of molecules that challenge the mucosal barrier and interaction with the immune system in the gut. Individuals with a particular disease, such as inflammatory bowel disease, have a different microbial gut community than a healthy individual. Previous studies have shown that the gut microbiome is important in intestinal inflammation as well as systemic inflammation and metabolic disorders such as diabetes. Research has shown that leakage of microbial products can occur across the gut wall potentially causing systemic inflammation by activating the innate immune system. This leakage could induce the release of inflammatory cytokines that act as a suppressor of cardiac function by several pathways.
The GutHeart Trial, as described in ESC Heart Failure, proposes a clinical trial that will enroll patients with heart failure to receive the antibiotic rifaximin, a probiotic yeast, or no treatment on top of the usual heart failure treatments. Four centers will randomize 150 heart failure patients who are stable to receive treatment for three months, with further follow up after six months. "To the best of our knowledge, the GutHeart trial is the first intervention study to assess the profile of the gut microbiota in heart failure patients and the way this profile is affected by drugs that act locally in the gut," said first author Dr. Cristiane C. K. Mayerhofer, of Oslo University Hospital, in Norway. "The new knowledge can pave the way for new innovative treatment strategies and will lead to a better understanding of how gut leakage is associated with inflammatory processes and heart failure."The goal is to gain insight into important disease processes involving the gut microbiome in heart failure patients. This knowledge could lead to new therapeutic strategies to prevent and decrease inflammation in heart failure patients.
To learn more about the importance of gut microbes in health watch the video below!
American Heart Association
