Gut flora an early marker for heart failure?

It has long been known that heart failure and gut health are linked. But the latest data obtained by German scientists provides insights into how gut colonisation is associated with the development and progress of heart failure.

In the guts of patients with heart failure, important groups of bacteria are found less frequently and the gut flora is not as diverse as in healthy individuals. The gut, therefore, has a worse blood supply in instances of heart failure; the intestinal wall is thicker and more permeable, while bacteria and bacterial components may find their way into the blood. Moreover, scientists know that the composition of the gut bacteria is altered in other widespread diseases such as type 2 diabetes.

Against this backdrop, researchers at the German Centre for Cardiovascular Research (DZHK) investigated whether and how the gut flora in patients with heart failure changes. In order to do this, they analysed the gut bacteria in stool samples of healthy individuals and patients with heart failure. The project was headed by Professor Norbert Frey of the University Hospital Schleswig-Holstein, Campus Kiel, and conducted in close cooperation with Professor Andre Franke at the Christian-Albrechts-Universität zu Kiel, whose team found that the sections of the bacterial genome deciphered the distinction of the microorganism.

The results showed that a significantly lower proportion of different bacteria are found in the guts of patients with heart failure than in healthy controls. Individual important families of bacteria are significantly reduced. It is still unclear whether the gut flora is altered as a result of heart failure or whether it may be a trigger for this disease.

The observed pattern of the reduced genera and families of bacteria seems very characteristic of heart failure, which is why these results may be new points of departure for therapies. The differences between healthy individuals and those with heart failure, thus, came about mainly through the loss of bacteria of the genera Blautia and Collinsella, as well as two previously unknown genera that belong to the families Erysipelotrichaceae and Ruminococcaceae. 

Other research projects have shown that the occurrence of Blautia curbs inflammations. Similarly, the genus Faecalibacterium is associated with anti-inflammatory mechanisms. It is, however, not only reduced in patients with heart failure.

Since heart failure is accompanied by a chronic inflammation, one theory is that the gut flora fosters the systemic inflammation. Yet scientists currently believe that the gut flora changes as a consequence of heart failure. The German researchers believe it is plausible that an altered bacterial profile could also be a risk factor or an early disease marker for heart failure. This is supported by the recent characterisation of trimethylamine N-oxide (TMAO), a metabolic product of gut bacteria, as an independent risk factor for the mortality rate in patients with heart failure.

Further investigations are scheduled to clarify the cause and effect of altered gut flora in patients with heart failure. The scientists anticipate obtaining new knowledge on how heart failure occurs and progresses.