Decreased Kidney Function Is Associated with Enhanced Hepatic Flavin Monooxygenase Activity and Increased Circulating Trimethylamine N-Oxide Concentrations in Mice
Open accessAbstract
Circulating trimethylamine N-oxide (TMAO) predicts poor cardiovascular outcomes in patients with chronic kidney disease (CKD). Accumulation of serum TMAO has been observed in CKD patients; however, the mechanisms contributing to this finding have been inadequately explored. The purpose of this study was to investigate the mechanisms responsible for TMAO accumulation in the setting of decreased kidney function using a CKD mouse model. Mice were fed a diet supplemented with 0.2% adenine to induce CKD, which resulted in increased serum TMAO concentrations (females: CKD 29.4 ± 32.1 μ M vs. non-CKD 6.9 ± 6.1 μ M, P < 0.05; males: CKD 18.5 ± 13.1 μ M vs. non-CKD 1.0 ± 0.5 μ M, P < 0.001). As anticipated, accumulation of circulating TMAO was accompanied by a decrease in renal clearance (females: CKD 5.2 ± 3.8 μ l/min vs. non-CKD 90.4 ± 78.1 μ l/min, P < 0.01; males: CKD 10.4 ± 8.1 μ l/min vs. non-CKD 260.4 ± 134.5 μ l/min; P < 0.001) and fractional excretion of TMAO. Additionally, CKD animals exhibited an increase in hepatic flavin monooxygenase (FMO)-mediated formation of TMAO (females: CKD 125920 ± 2181 pmol/mg per 60 minutes vs. non-CKD 110299 ± 4196 pmol/mg per 60 minutes, P < 0.001; males: CKD 131286 ± 2776 pmol/mg per 60 minutes vs. non-CKD 74269 ± 1558 pmol/mg per 60 minutes, P < 0.001), which likely resulted from increased FMO3 expression in CKD mice. The current study provides evidence that both decreased renal clearance and increased hepatic production of TMAO may contribute to increments in serum TMAO in the setting of CKD. Hepatic FMO activity may represent a novel therapeutic target for lowering circulating TMAO in CKD patients.
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These observations have been replicated in multiple independent observational cohorts across a spectrum of CKD patients.
“These observations have since been replicated in multiple independent observational cohorts across a spectrum of CKD patients199–203.”
From Dietary metabolism, the gut microbiome, and heart failure (2019) · cites this paper as [200]
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- Authors
- Johnson, C., Prokopienko, A. J., West, R. E., Nolin, T. D., & Stubbs, J. R.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Drug Metabolism and Disposition
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 46
- Issue
- 9
- Pages
- 1304-1309
- ISSN
- 0090-9556 (ISSN-L)
- OpenAlex
- W2809440501
- Cited by
- 31
- References
- 31
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 7 · 2018: 2
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Drug Metabolism and Disposition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association (15GRNT25700231)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Polyamine Metabolism and Applications
- Keywords
- trimethylamine N-oxide, chronic kidney disease, flavin-containing monooxygenase, FMO3, adenine-induced CKD, cardiovascular risk, gut microbiota metabolites
- MeSH terms
- Animals, Enzyme Activation, Female, Kidney, Male, Methylamines, Mice, Inbred C57BL, Microsomes, Liver, Oxygenases, Hepatocytes, Mice, Renal Insufficiency, Chronic
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