Cited by 5,597Gut microbiota and healthMetabolomics and Mass Spectrometry StudiesAtherosclerosis and Cardiovascular Diseases

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Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease

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Abstract

Metabolomics studies hold promise for the discovery of pathways linked to disease processes. Cardiovascular disease (CVD) represents the leading cause of death and morbidity worldwide. Here we used a metabolomics approach to generate unbiased small-molecule metabolic profiles in plasma that predict risk for CVD. Three metabolites of the dietary lipid phosphatidylcholine--choline, trimethylamine N-oxide (TMAO) and betaine--were identified and then shown to predict risk for CVD in an independent large clinical cohort. Dietary supplementation of mice with choline, TMAO or betaine promoted upregulation of multiple macrophage scavenger receptors linked to atherosclerosis, and supplementation with choline or TMAO promoted atherosclerosis. Studies using germ-free mice confirmed a critical role for dietary choline and gut flora in TMAO production, augmented macrophage cholesterol accumulation and foam cell formation. Suppression of intestinal microflora in atherosclerosis-prone mice inhibited dietary-choline-enhanced atherosclerosis. Genetic variations controlling expression of flavin monooxygenases, an enzymatic source of TMAO, segregated with atherosclerosis in hyperlipidaemic mice. Discovery of a relationship between gut-flora-dependent metabolism of dietary phosphatidylcholine and CVD pathogenesis provides opportunities for the development of new diagnostic tests and therapeutic approaches for atherosclerotic heart disease.

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Metadata

Authors
Wang, Z., Klipfell, E., Bennett, B. J., Koeth, R., Levison, B. S., DuGar, B., Feldstein, A. E., Britt, E. B., Fu, X., Chung, Y.-M., Wu, Y., Schauer, P., Smith, J. D., Allayee, H., Tang, W. H. W., DiDonato, J. A., Lusis, A. J., & Hazen, S. L.
Affiliations
  • Cleveland Clinic (US)
  • University of California, Los Angeles (US)
  • Cleveland State University (US)
  • University of Southern California (US)
Corresponding author
Hazen, Stanley L.
Venue
Nature
Published
2011-04
Volume
472
Issue
7341
Pages
57-63
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W2115944543
Cited by
5,597
References
62
Citations by year
2026: 375 · 2025: 416 · 2024: 451 · 2023: 449 · 2022: 537 · 2021: 563 · 2020: 513 · 2019: 391 · 2018: 380 · 2017: 334 · 2016: 296 · 2015: 266 · 2014: 224 · 2013: 183 · 2012: 157
FWCI
80.19
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • EngagedScholarship @ Cleveland State University (Cleveland State University) (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (P20AA017837)
  • National Heart, Lung, and Blood Institute (P01 HL-30568, P01HL030568, R01HL103931, K99HL102223, P01HL087018-020001, R01HL098193, P01HL076491, P01HL098055, P01-HL28481, P01HL087018, R01HL103866, P01HL028481)
  • National Institute of General Medical Sciences (T32GM007250)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32‐DK‐07789, R01DK080732, T32DK007789)
  • National Center for Research Resources (UL1RR024989)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolomics and Mass Spectrometry Studies
  • Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
Keywords
trimethylamine N-oxide, phosphatidylcholine metabolism, gut microbiota, cardiovascular risk, atherosclerosis, choline, betaine, foam cells, macrophage scavenger receptor, flavin-containing monooxygenase, plasma metabolites, germ-free mice, dietary supplementation, cardiovascular risk prediction
MeSH terms
Animals, Betaine, Cardiovascular Diseases, Choline, Diet, Dietary Fats, Female, Gene Expression Regulation, Germ-Free Life, Humans, Cholesterol, HDL, Liver, Macrophages, Methylamines, Mice, Inbred C57BL, Oxygenases, Phenotype, Phosphatidylcholines, Biomarkers, Risk Assessment, Gastrointestinal Tract, Atherosclerosis, Receptors, Scavenger, Mice, Metabolomics

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