Cited by 559Gut microbiota and healthBlood Coagulation and Thrombosis MechanismsPlatelet Disorders and Treatments

The DOI matches its Crossref record; 62 of the 62 references it cites were found in a registry or an index; none of the 42 sources its claims cite is checked for support yet.

Development of a gut microbe–targeted nonlethal therapeutic to inhibit thrombosis potential

Open access

Abstract

Trimethylamine N-oxide (TMAO) is a gut microbiota-derived metabolite that enhances both platelet responsiveness and in vivo thrombosis potential in animal models, and TMAO plasma levels predict incident atherothrombotic event risks in human clinical studies. TMAO is formed by gut microbe-dependent metabolism of trimethylamine (TMA) moiety-containing nutrients, which are abundant in a Western diet. Here, using a mechanism-based inhibitor approach targeting a major microbial TMA-generating enzyme pair, CutC and CutD (CutC/D), we developed inhibitors that are potent, time-dependent, and irreversible and that do not affect commensal viability. In animal models, a single oral dose of a CutC/D inhibitor significantly reduced plasma TMAO levels for up to 3 d and rescued diet-induced enhanced platelet responsiveness and thrombus formation, without observable toxicity or increased bleeding risk. The inhibitor selectively accumulated within intestinal microbes to millimolar levels, a concentration over 1-million-fold higher than needed for a therapeutic effect. These studies reveal that mechanism-based inhibition of gut microbial TMA and TMAO production reduces thrombosis potential, a critical adverse complication in heart disease. They also offer a generalizable approach for the selective nonlethal targeting of gut microbial enzymes linked to host disease limiting systemic exposure of the inhibitor in the host.

Overview

Integrity signals

Registry

Crossref · 10.1038/s41591-018-0128-1

Cites

62 of 62 references verified0 citation errors · 0 not checkable

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Nothing to recompute.

Verification

Claims the paper makes

62 Own result · 23 Not checked yet · 12 Own interpretation · 3 Own method · 2 No basis given

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Show all 51 claims

  • It may state two separate claims as one. 43
  • Probably not a substantial claim. 9
51 of 51
  • The paper relies on this without support.

    The mouse models used for platelet function and thrombosis predict human clinical effects of the inhibitors.

    “Herein we show that a mechanism-based non-lethal inhibitor of the gut microbial TMAO pathway designed to selectively accumulate within the gut microbial compartment, can serve as a new therapeutic approach for attenuating thrombosis while simultaneously limiting systemic exposure in the host.”
  • The paper relies on this without support.

    The CutC/D enzymes and microbial cultures used in screening represent the diversity of human gut microbial choline TMA lyases.

    “We developed a tiered screening assay system to test for broad efficacy among phylogenetically diverse commensal bacteria that contain CutC/D and robust choline TMA lyase activity.”
  • The paper relies on this without support.

    The absence of toxicity in mice over the studied exposure periods predicts safety in humans.

    “No signs of toxicity were observed in mice following chronic exposure to wholly effective doses of FMC (10 mg/kg) or IMC (100 mg/kg)”
  • The paper relies on this without support.

    The mouse models used in these studies predict human TMAO metabolism, thrombosis, and therapeutic response.

    “These studies suggest a new potential target for the treatment of subjects at risk for thrombotic complications and cardiovascular disease.”
  • The paper relies on this without support.

    The inhibitor-induced changes in mouse cecal microbiota composition represent effects on the human gut microbiome.

    “It is also notable that both IMC and FMC induced a shift in mouse cecal microbiota composition”
  • The paper relies on this without support.

    The absence of systemic toxicity and bleeding effects in mice predicts safety in humans.

    “Importantly, no evidence of systemic toxicity was observed and our treatment did not adversely affect bleeding potential”
6 of 6

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Metadata

Authors
Roberts, A. B., Gu, X., Buffa, J. A., Hurd, A. G., Wang, Z., Zhu, W., Gupta, N., Skye, S. M., Cody, D. B., Levison, B. S., Barrington, W. T., Russell, M. W., Reed, J. M., Duzan, A., Lang, J. M., Fu, X., Li, L., Myers, A. J., Rachakonda, S., DiDonato, J. A., Brown, J. M., Gogonea, V., Lusis, A. J., Garcia-Garcia, J. C., & Hazen, S. L.
Affiliations
  • Cleveland Clinic (US)
  • Procter & Gamble (United States) (US)
  • University of California, Los Angeles (US)
  • Cleveland State University (US)
Corresponding author
Hazen, Stanley L.
Venue
Nature Medicine
Published
2018-08-06
Volume
24
Issue
9
Pages
1407-1417
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2884566703
Cited by
552
References
62
Citations by year
2026: 56 · 2025: 66 · 2024: 54 · 2023: 77 · 2022: 80 · 2021: 76 · 2020: 77 · 2019: 47 · 2018: 18
FWCI
19.46
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Cleveland Clinic
  • National Institutes of Health (5t32dk007470-35)
  • National Institute on Alcohol Abuse and Alcoholism (P50AA024333)
  • National Heart, Lung, and Blood Institute (P01HL030568, R01HL126827, R01HL103866, R01HL122283, P01HL028481)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106000, T32-DK 007470)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
Keywords
trimethylamine N-oxide, gut microbiota, thrombosis, platelet response, mechanism-based inhibitors, irreversible inhibitors, atherothrombosis, Western diet, thrombus formation
MeSH terms
Gastrointestinal Microbiome, Hexanols, Animals, Bacteria, Choline, Diet, Mice, Inbred C57BL, Oxidoreductases, N-Demethylating, Platelet Aggregation, Thrombosis

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