A healthy gut, A healthy heart:

Transcription

1 A healthy gut, A healthy heart: The influence of gut microbiota on cardiovascular disease Fondazione Edmund Mach Francesca Fava, PhD FOODMATTERSLIVE, 19th November 2014

2 Risk factors for cardiovascular disease (CVD) Non modifiable Age Genetics/genotype Family history of CVD Sex Modifiable High blood pressure Dyslipidemia Diabetes and insulin resistance Smoking Physical inactivity Overwieght and obesity Gut Microbiota 1000 species Genome (metagenome) > 100 x human genome Metabolic endotoxemia Gut:brain axis Intestinal transit Incretins/satiety Gut:liver axis Insulin resistance Bile acids & cholesterol (enterohepatic BA circulation)

3 OBESITY EPIDEMIC Currently 300 million people obese world-wide Obese adults are up to 80 times more likely to develop type 2 diabetes than non-obese adults Obese adults are 2-3 times more likely to develop heart disease Obese adults have a 40% increased risk of dieing from cancer

4 Result Diets designed for reduced energy intake/slimming, with either reduced fat or reduced carbohydrate Microbiota approaches lean profile with weight loss no info on diets (nutrient substitution) Ley et al., Nature (2006)

5 PC2 Obese vs lean gut microbiota Lean open diet (LOD ) Obese open diet (OOD ) Obese on a saturated fat diet for 1 month (OHSFA ) n=13 Bacteroides uniformis and Prevotella copri more common in the microbiota of LOD than OOD not present in the OHSFA 5 DGGE bands pattern (PCA) [PC2]/[PC1] LOD OHS OOD Bacteroides vulgatus and Bacteroindes stercoris very frequently found in OHSFA, less frequent in OOD not present in LOD PC1 %[1] = %[2] = Fava et al in preparation

6 mmol/g faeces Fermentation end-products Faecal SCFA measured by GC Higher acetate in obese irrespective of diet Higher butyrate in obese (open diet) 40,0 35,0 30,0 25,0 20,0 15,0 10,0 5,0 0,0 ACETIC PROPIONIC I-BUTYRIC N-BUTYRIC I-VALERIC N-VALERIC N-CAPROIC LOD OOD OHSFA

7 Wang et al., 2011 Nature Koeth et al., 2013 Nature Medicine TMA/TMAO confirmed strong link with CVD in patients confirmed microbiota metabolism of L-carnitine/choline TMA TMAO TMA not produced in vegans confirmed inflammatory activity & linked to macrophage reverse cholesterol transport TMAO reduced bile acid pool

8 Δ SCFA and BA inflammation

9 Impact of traditional diets rich in fiber, polyphenols on colonic fermentation Proximal colon ~ saccharolytic Distal colon ~ proteolytic SCFA Acetate Propionate Butyrate Energy source Apoptosis Differentiation Epigenetics Gene expression Gut hormones Gut permeability Amines Indoles Ammonia Sulphides N-nitroso DNA damage Tumours Cytotoxicity Leaky gut Liver disease High fiber diets, Paleolitic, Mediterranean, rural African and Asian Enhanced mucosal barrier function and immune homeostasis Modified from George Macfarlane

10 Dietary Pro- and Prebiotics PROBIOTICS... live microorganisms which when administered in adequate amount confer a health benefit on the host (FAO, 2001). - Lactobacillus - Bifidobacterium - Escherichia coli Nissle 1917, Bacillus sporogenes, Enteorcoccus faecium, Clostridium butyricum, Saccharomyces ceriviseae PREBIOTICS. a selectively fermented ingredient that results in specific changes, in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health. Gibson et al (2010) Inulin, oligofructose, fructooligosaccharides, galactooligosaccharides, lactulose, arabinogalactan, arabinoxylan, pectic-oligosaccharides, glucooligosaccharides Resistant starch and certain whole plant foods including whole grain wheat, whole grain oats and red-wine polyphenols

11 Plasma endotoxin (LPS) increased with HF diet Upon high fat feeding or LPS injection inflammatory markers increased in liver and adipose tissue TNF-α, IL-1, IL-6 insulin resistance and obesity In CD14 mutant mice this inflammatory response was blunted Cani et al., 2007 Diabetes

12 Prebiotic (OFS) intervention in high-fat fed mice To test if the modulation of the intestinal microbiota through dietary intervention with a prebiotic can control the occurrence of high-fat diet-induced inflammation and metabolic disorders in mice. PREBIOTIC MICROBIOTA INFLAMMATION HIGH FAT DIET LPS OBESITY and TYPE 2 DIABETES Cani et al., 2007 Diabetologia

13 Experimental design C57bl 6/J mice (n=8/group) Standard control diet CT High-fat diet HF High-fat diet + cellulose HF-Cell Measurements (T 0 and T 14weeks ): High-fat diet + oligofructose HF-OFS Microbial enumeration in caecal contents Plasma LPS Inflammatory markers Glucose tolerance Insulin secretion Body weight and fat mass gain Cani et al., 2007 Diabetologia

14 Microbiota modulation in high-fat fed mice Cani et al., 2007 Diabetologia

15 Microbiota modulation in high-fat fed mice Cani et al., 2007 Diabetologia

16 Inflammatory markers CT HF (Mean±SEM; p<0.05 post hoc ANOVA) HF-Cell HF-OFS Cani et al., 2007 Diabetologia

17 Glucose tolerance & glucose-induced insulin secretion CT HF HF-Cell HF-OFS CT HF HF-Cell HF-OFS (Mean±SEM; p<0.05 post hoc ANOVA) Cani et al., 2007 Diabetologia

18 Adipose tissue gain (% of body weight) Total Body Weight Gain (g) Body weight and fat mass gain b c c a CT HF HF-Cell HF-OFS a b b c c c d b a a a a Visceral Epididymal Subcutaneous (Mean±SEM; p<0.05 post hoc ANOVA) Cani et al., 2007 Diabetologia

19 Endotoxin (EU/ml) Plasma LPS levels correlate with bifidobacteria a b b a 0 CT HF HF-Cell HF-OFS (Mean±SEM; p<0.05 post hoc ANOVA). (Pearson s correlation) Reduced inflammation and normalisation of insulin sensitivity Cani et al., 2007 Diabetologia

20 Prebiotic relief of metabolic endotoxemia through improved mucosal barrier function Inflammation Insulin resistance Hepatic fat deposition Activation of WAT & liver inflammatory pathways Satiety Food intake Maintenance of gut barrier function Immune homeostasis LPS LPS LPS Low SCFA Mucosal barrier GLP-1, GLP-2, PYY Tight junction proteins High SCFA High fat, low CHO diets induce microbiota dysbiosis Prebiotic induced bifidogenesis & microbiota biosis

21 The RISCK study: Reading, Imperial, Surrey, Cambridge, Kings Changing the type and quantity of dietary fat and carbohydrate affects metabolic syndrome and gut microbial parameters Weeks Baseline Treatment Total study n = 650; Reading cohort n = 130 (Powered for insulin sensitivity) Diet A: high SFA (run-in & control diet). Energy ~38% fat, SFA~18%, MUFA ~12%, PUFA~6%, CHO ~ 45% Diet B: high MUFA high GI. Energy ~38% fat, SFA ~10%, MUFA ~20%, PUFA ~6%, CHO ~ 45%) Diet C: high MUFA low GI. Energy ~38% fat, SFA ~10%, MUFA ~20%, PUFA ~6%, CHO ~ 45%) ~ 11 GI points lower glycaemic index Diet D: low fat high GI. Energy ~28% fat, SFA ~10%, MUFA ~11%, PUFA ~6% CHO ~ 55%) Diet E: low fat low GI. Energy ~28% fat, SFA ~10%, MUFA ~11%, PUFA ~6% CHO ~ 55%) ~ 13 GI points lower glycaemic index Jeb et al., 2010 Am J Clin Nutr

22 Log[bacterial cells/g feces wet wt Log[bacterial cells/g feces wet wt Log[bacterial cells/g feces wet wt Log[bacterial cells/g feces wet wt Faecal bacterial numbers changed with quantity of fat or carbohydrate 11 10,9 Total bacteria * * 10,2 Bacteroides spp * 10, ,7 10,6 10,5 10,4 10,3 B T 9,8 9,6 9,4 9,2 B T 10,2 10 HS (n=11) HM/HGI (n=17) HM/LGI (n=22) HC/HGI (n=21) HC/LGI (n=17) diets Bifidobacterium spp * * 9 HS (n=11) HM/HGI (n=17) HM/LGI (n=22) HC/HGI (n=21) HC/LGI (n=17) diets Faecalibacterium prausnitzii * * 9, ,5 8 7,5 7 B T 9,8 9,6 9,4 B T 6,5 9,2 6 HS (n=11) HM/HGI (n=17) HM/LGI (n=22) HC/HGI (n=21) HC/LGI (n=17) diets 9 HS (n=11) HM/HGI (n=17) HM/LGI (n=22) HC/HGI (n=21) HC/LGI (n=17) diets Fava et al., 2013 Int J Obesity

23 Faecal Bacteroides/Prevotella correlated with BMI and waist circumference Bacteroides/Prevotella (Log 10 cells/g faeces) Bacteroides/Prevotella (Log 10 cells/g faeces) Significant correlation between changes in Bacteroides/Prevotella spp faecal numbers and body BMI (a), and Waist circumference (b). Pearson s correlation, r = -0.64(a), r = (b). Fava et al., 2013 Int J Obesity

24 RISCK: Changes in metabolic parameters according to diet ΔGlucose (mmol/l) ΔInsulin (pmol/l) , , ,15 * * -8-0,2 HS HM/HGI HM/LGI HC/HGI HC/LGI HS HM/HGI HM/LGI HC/HGI HC/LGI * mmol/l, mean±sd acetate propionate n-butyrate HS (n=11) HM/HGI (n=17) HM/LGI (n=22) HC/HGI (n=21) HC/LGI (n=17) B 25.21± ± ± ± ±12.17 T 30.61±11.93* 31.04± ± ± ±10.60 B 6.28± ± ± ± ±3.79 T 7.57±3.96** 7.32± ± ± ±3.95 B 6.02± ± ± ± ±5.61 T 7.76±4.79** 7.12± ± ± ±3.77 Fava et al., 2013 Int J Obesity

25 SCFA as biomarker of healthy gut Increased faecal SCFA excretion due to decreased SCFA uptake? MCT transporters expression and apical location is promoted by luminal SCFA Increased faecal SCFA excretion could be due to decreased MCT active uptake in high fat/low CHO diets Bile salt CDCA and E. coli EPEC inhibit butyrate uptake Goncalves et al., 2012 J Cell Biochemistry Borthakur et al., 2012 Am J Physiol Gastrointest Liver Physiol

26 Whole grain cereals Epidemiological evidence whole grain cereals associated with reduced risk of CHD, diabetes, colon cancer and obesity (epidemiological studies) U.S. Food and Drug Administration health claim Diets rich in whole grain foods and other plant foods and low in total fat, saturated fat, and cholesterol, may help reduce the risk of heart disease and certain cancers Lack of information on mechanism of action, polyphenols or fermentation or both?

27 Whole grain oats vs non-whole grain breakfast cereal dietary intervention in subjects at risk of developing the metabolic syndrome Randomized, crossover study, 30 volunteers, male and female with slightly elevated levels of either total cholesterol or fasting glucose at risk of developing metabolic disorders Run-in WGO Wash out NWG Follow up Run-in NWG Wash out WGO Follow up 2 weeks 6 weeks 4 weeks 6 weeks 4 weeks Two 6 week treatment periods separated by 4 week washout periods. Whole oat grain (WGO) vs non-whole grain cereal (NWG) Samples collected before and after cereal consumption and then 4 weeks following end of consumption. Blood (fasted), 24 hour urine, saliva and fecal samples Supported by Jordans Cereals Connolly et al. in preparation

28 Whole grain oats modified gut microbiota in beneficial manner compared to non-whole grain cereal WGO WGO Whole grain oats significantly increased faecal bifidobacteria and lactobacilli. Connolly et al. in preparation

29 Whole grain oats improved blood cholesterol profiles WGO WGO Whole grain oats significantly reduced LDL and total cholesterol, reversing a trend towards elevated LDL and TC in the non-whole grain breakfast cereal treatment. Connolly et al. in preparation

30 Impact of wheat bran fibre (WBF) on gut microbiota & markers of CVD in overweight adults RUN-IN PERIOD TREATMENT PERIOD SCREENING 27 g aleurone/d Placebo Subjects: n=80, BMI > 27 FEM & Santa Chiara Hospital, TN (Dr Carlo Pedrolli), APSS, Trento Biomarkers of CVD risk 2 weeks 4 weeks T-1 T0 T1 Gut microbiota (454-pyrosequencing, FISH, qpcr) MS based metabolomics (targeted and untargeted)

31 Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Vrieze et al Gastroenterology143(4):913-6.e7.

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34 Thank you FEM-CRI, Fulvio Mattivi, Marynka Ulasewska, Urska Vrovsek, Duccio Cavalieri and Roberto Viola NN Group: Lorenza Conterno, Elena Franciosi, Carlotta de Filippo, Athanasios Koutsos, Ilaria Caraffa, Florencia Ceppa, Andrea Mancini University of Reading, Glenn Gibson, Julie Lovegrove, Michael Connolly