Gut Microbiota as a Potential Treatment Target in Patient with Chronic Heart Failure
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MEDICINE
Gut Microbiota as a Potential Treatment Target in Patient with Chronic Heart Failure Joshua Henrina 1
&
Irvan Cahyadi 1 & Hoo Felicia Hadi Gunawan 1 & Leonardo Paskah Suciadi 1
Accepted: 28 July 2020 / Published online: 4 August 2020 # Springer Nature Switzerland AG 2020
Abstract Chronic heart failure (CHF) is a pandemic with a high mortality rate and a high economic burden. The complexity of heart failure clinical syndromes requires approaches through different therapeutic targets. Intestinal dysbiosis is a condition in the human intestinal tract characterized by an imbalance of bacteria, causing various adverse effects. It has been linked with more than 20 diseases and clinical syndromes, including chronic heart failure. The composition of intestinal microbiota is influenced by structural and functional changes of the intestine, which happens in patients with CHF, through a complex network of cytokines, metabolic products, and numerous regulatory molecules. This condition provides exciting new fields for searching for a novel treatment for chronic heart failure. Several interventions, including diet, probiotic, prebiotic, antibiotic, even fecal microbial transplant, have previously been studied. This article discusses the reciprocal relationship between the heart and the gut microbiota through various changes in the gut microbiota composition, intestinal dysfunction, and altered bacterial metabolites and the potential therapies for modulating gut microbiota composition as a target of therapy for CHF. Keywords Chronic heart failure . Microbiota . TMAO (trimethylamine-n-oxide) . Diet . Prebiotic . Probiotic . Antibiotic . FMT (fecal microbial transplantation)
Background Chronic heart failure (CHF) is characterized by a fall in cardiac output caused by structural/functional etiologies, resulting in decreased systemic perfusion and exhibiting typical signs and symptoms [1]. Chronic heart failure is a pandemic disease, affecting more than 26 million people worldwide [2]. According to population-based studies, CHF involves 1–2% of the population. Consequently, there is a steep increase in healthcare spending. It is estimated that the total health expenditure spent on this disease is 31 billion dollars, 10% more than expenditures of other cardiovascular diseases in the United States [3]. This article is part of the Topical Collection on Medicine * Joshua Henrina [email protected] 1
Siloam Heart Institute, Siloam Hospitals Kebon Jeruk, Jl. Perjuangan No.8, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11530, Indonesia
Despite recent advances in CHF treatments, the mortality rate is still high compared to other chronic diseases and its 5year mortality rate similar to many cancers [4]. This is due to the complexity of heart failure clinical syndromes. Thus, there has been a dire need of new therapeutic targets for this multifaceted disease. Currently, there has been an interest in the human gastrointestinal system and its microbiome as a target of therapy,
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