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Sun D, Lu J, Zhang Y, Liu J, Liu Z, Yao B, Guo Y, Wang X. Characterization of a Novel CYP1A2 Knockout Rat Model Constructed by CRISPR/Cas9. Drug Metab Dispos 2021; 49:638-647. [PMID: 34074728 DOI: 10.1124/dmd.121.000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
CYP1A2, as one of the most important cytochrome P450 isoforms, is involved in the biotransformation of many important endogenous and exogenous substances. CYP1A2 also plays an important role in the development of many diseases because it is involved in the biotransformation of precancerous substances and poisons. Although the generation of Cyp1a2 knockout (KO) mouse model has been reported, there are still no relevant rat models for the study of CYP1A2-mediated pharmacokinetics and diseases. In this report, CYP1A2 KO rat model was established successfully by CRISPR/Cas9 without any detectable off-target effect. Compared with wild-type rats, this model showed a loss of CYP1A2 protein expression in the liver. The results of pharmacokinetics in vivo and incubation in vitro of specific substrates of CYP1A2 confirmed the lack of function of CYP1A2 in KO rats. In further studies of potential compensatory effects, we found that CYP1A1 was significantly upregulated, and CYP2E1, CYP3A2, and liver X receptor β were downregulated in KO rats. In addition, CYP1A2 KO rats exhibited a significant increase in serum cholesterol and free testosterone accompanied by mild liver damage and lipid deposition, suggesting that CYP1A2 deficiency affects lipid metabolism and liver function to a certain extent. In summary, we successfully constructed the CYP1A2 KO rat model, which provides a useful tool for studying the metabolic function and physiologic function of CYP1A2. SIGNIFICANCE STATEMENT: Human CYP1A2 not only metabolizes clinical drugs and pollutants but also mediates the biotransformation of endogenous substances and plays an important role in the development of many diseases. However, there are no relevant CYP1A2 rat models for the research of pharmacokinetics and diseases. This study successfully established CYP1A2 knockout rat model by using CRISPR/Cas9. This rat model provides a powerful tool to study the function of CYP1A2 in drug metabolism and diseases.
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Affiliation(s)
- Dongyi Sun
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jian Lu
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuanjin Zhang
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Jie Liu
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Zongjun Liu
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Bingyi Yao
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yuanqing Guo
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Xin Wang
- Changning Maternity and Infant Health Hospital (D.S., J.Lu, Y.Z., J.Liu, B.Y., Y.G., X.W.), Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences (D.S, J.Lu, Y.Z., J.Liu, X.W.), East China Normal University, Shanghai, People's Republic of China and Department of Cardiology, Central Hospital of Shanghai Putuo District (Z.L.), Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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Apical sodium-dependent bile acid transporter, drug target for bile acid related diseases and delivery target for prodrugs: Current and future challenges. Pharmacol Ther 2020; 212:107539. [PMID: 32201314 DOI: 10.1016/j.pharmthera.2020.107539] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/11/2020] [Indexed: 02/06/2023]
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Rao A, van de Peppel IP, Gumber S, Karpen SJ, Dawson PA. Attenuation of the Hepatoprotective Effects of Ileal Apical Sodium Dependent Bile Acid Transporter (ASBT) Inhibition in Choline-Deficient L-Amino Acid-Defined (CDAA) Diet-Fed Mice. Front Med (Lausanne) 2020; 7:60. [PMID: 32158763 PMCID: PMC7052288 DOI: 10.3389/fmed.2020.00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/10/2020] [Indexed: 12/15/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a major growing worldwide health problem. We previously reported that interruption of the enterohepatic circulation of bile acids using a non-absorbable apical sodium-dependent bile acid transporter inhibitor (ASBTi; SC-435) reduced the development of NAFLD in high fat diet fed mice. However, the ability of ASBTi treatment to impact the progression of NAFLD to non-alcoholic steatohepatitis (NASH) and fibrosis in a diet-induced mouse model remains untested. In the current study, we assessed whether ASBTi treatment is hepatoprotective in the choline-deficient, L-amino acid-defined (CDAA) diet model of NASH-induced fibrosis. Methods: Male C57Bl/6 mice were fed with: (A) choline-sufficient L-amino acid-defined diet (CSAA) (31 kcal% fat), (B) CSAA diet plus ASBTi (SC-435; 60 ppm), (C) CDAA diet, or (D) CDAA diet plus ASBTi. Body weight and food intake were monitored. After 22 weeks on diet, liver histology, cholesterol and triglyceride levels, and gene expression were measured. Fecal bile acid and fat excretion were measured, and intestinal fat absorption was determined using the sucrose polybehenate method. Results: ASBTi treatment reduced bodyweight gain in mice fed either the CSAA or CDAA diet, and prevented the increase in liver to body weight ratio observed in CDAA-fed mice. ASBTi significantly reduced hepatic total cholesterol levels in both CSAA and CDAA-fed mice. ASBTi-associated significant reductions in hepatic triglyceride levels and histological scoring for NAFLD activity were observed in CSAA but not CDAA-fed mice. These changes correlated with measurements of intestinal fat absorption, which was significantly reduced in ASBTi-treated mice fed the CSAA (85 vs. 94%, P < 0.001) but not CDAA diet (93 vs. 93%). As scored by Ishak staging of Sirius red stained liver sections, no hepatic fibrosis was evident in the CSAA diet mice. The CDAA diet-fed mice developed hepatic fibrosis, which was increased by the ASBTi. Conclusions: ASBT inhibition reduced intestinal fat absorption, bodyweight gain and hepatic steatosis in CSAA diet-fed mice. The effects of the ASBTi on steatosis and fat absorption were attenuated in the context of dietary choline-deficiency. Inhibition of intestinal absorption of fatty acids may be involved in the therapeutic effects of ASBTi treatment.
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Affiliation(s)
- Anuradha Rao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ivo P van de Peppel
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States
| | - Saul J Karpen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Paul A Dawson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
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Ticho AL, Malhotra P, Dudeja PK, Gill RK, Alrefai WA. Intestinal Absorption of Bile Acids in Health and Disease. Compr Physiol 2019; 10:21-56. [PMID: 31853951 PMCID: PMC7171925 DOI: 10.1002/cphy.c190007] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The intestinal reclamation of bile acids is crucial for the maintenance of their enterohepatic circulation. The majority of bile acids are actively absorbed via specific transport proteins that are highly expressed in the distal ileum. The uptake of bile acids by intestinal epithelial cells modulates the activation of cytosolic and membrane receptors such as the farnesoid X receptor (FXR) and G protein-coupled bile acid receptor 1 (GPBAR1), which has a profound effect on hepatic synthesis of bile acids as well as glucose and lipid metabolism. Extensive research has focused on delineating the processes of bile acid absorption and determining the contribution of dysregulated ileal signaling in the development of intestinal and hepatic disorders. For example, a decrease in the levels of the bile acid-induced ileal hormone FGF15/19 is implicated in bile acid-induced diarrhea (BAD). Conversely, the increase in bile acid absorption with subsequent overload of bile acids could be involved in the pathophysiology of liver and metabolic disorders such as fatty liver diseases and type 2 diabetes mellitus. This review article will attempt to provide a comprehensive overview of the mechanisms involved in the intestinal handling of bile acids, the pathological implications of disrupted intestinal bile acid homeostasis, and the potential therapeutic targets for the treatment of bile acid-related disorders. Published 2020. Compr Physiol 10:21-56, 2020.
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Affiliation(s)
- Alexander L. Ticho
- Department of Physiology and Biophysics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pooja Malhotra
- Division of Gastroenterology & Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pradeep K. Dudeja
- Division of Gastroenterology & Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Ravinder K. Gill
- Division of Gastroenterology & Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Waddah A. Alrefai
- Division of Gastroenterology & Hepatology, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- jesse Brown VA Medical Center, Chicago, Illinois, USA
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van de Peppel IP, Bertolini A, van Dijk TH, Groen AK, Jonker JW, Verkade HJ. Efficient reabsorption of transintestinally excreted cholesterol is a strong determinant for cholesterol disposal in mice. J Lipid Res 2019; 60:1562-1572. [PMID: 31324653 PMCID: PMC6718438 DOI: 10.1194/jlr.m094607] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Transintestinal cholesterol excretion (TICE) is a major route for eliminating cholesterol from the body and a potential therapeutic target for hypercholesterolemia. The underlying mechanism, however, is largely unclear, and its contribution to cholesterol disposal from the body is obscured by the counteracting process of intestinal cholesterol reabsorption. To determine the quantity of TICE independent from its reabsorption, we studied two models of decreased intestinal cholesterol absorption. Cholesterol absorption was inhibited either by ezetimibe or, indirectly, by the genetic inactivation of the intestinal apical sodium-dependent bile acid transporter (ASBT; SLC10A2). Both ezetimibe treatment and Asbt inactivation virtually abrogated fractional cholesterol absorption (from 46% to 4% and 6%, respectively). In both models, fecal neutral sterol excretion and net intestinal cholesterol balance were considerably higher than in control mice (5- and 7-fold, respectively), suggesting that, under physiological conditions, TICE is largely reabsorbed. In addition, the net intestinal cholesterol balance was increased to a similar extent but was not further increased when the models were combined, suggesting that the effect on cholesterol reabsorption was already maximal under either condition alone. On the basis of these findings, we hypothesize that the inhibition of cholesterol (re)absorption combined with stimulating TICE will be most effective in increasing cholesterol disposal.
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Affiliation(s)
- Ivo P van de Peppel
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna Bertolini
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Theo H van Dijk
- Department of Laboratory Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert K Groen
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Laboratory of Experimental Vascular Medicine University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Johan W Jonker
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Henkjan J Verkade
- Section of Molecular Metabolism and Nutrition, Department of Pediatrics,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Chothe PP, Czuba LC, Ayewoh EN, Swaan PW. Tyrosine Phosphorylation Regulates Plasma Membrane Expression and Stability of the Human Bile Acid Transporter ASBT (SLC10A2). Mol Pharm 2019; 16:3569-3576. [DOI: 10.1021/acs.molpharmaceut.9b00426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paresh P. Chothe
- Department of Pharmaceutical Sciences, University of Maryland, 20 Penn Street, Baltimore, Maryland 21201, United States
| | - Lindsay C. Czuba
- Department of Pharmaceutical Sciences, University of Maryland, 20 Penn Street, Baltimore, Maryland 21201, United States
| | - Ebehiremen N. Ayewoh
- Department of Pharmaceutical Sciences, University of Maryland, 20 Penn Street, Baltimore, Maryland 21201, United States
| | - Peter W. Swaan
- Department of Pharmaceutical Sciences, University of Maryland, 20 Penn Street, Baltimore, Maryland 21201, United States
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Liang C, Zhao J, Lu J, Zhang Y, Ma X, Shang X, Li Y, Ma X, Liu M, Wang X. Development and Characterization of MDR1 (Mdr1a/b) CRISPR/Cas9 Knockout Rat Model. Drug Metab Dispos 2018; 47:71-79. [DOI: 10.1124/dmd.118.084277] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023] Open
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Kumagai Y, Amano H, Sasaki Y, Nakagawa C, Maeda M, Oikawa I, Furuie H. Effect of single and multiple doses of elobixibat, an ileal bile acid transporter inhibitor, on chronic constipation: A randomized controlled trial. Br J Clin Pharmacol 2018; 84:2393-2404. [PMID: 29959787 PMCID: PMC6138487 DOI: 10.1111/bcp.13698] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/01/2018] [Accepted: 06/12/2018] [Indexed: 12/16/2022] Open
Abstract
AIMS Elobixibat is a minimally absorbed ileal bile acid transporter inhibitor. This study aimed to investigate the safety, tolerability, efficacy, pharmacokinetics and pharmacodynamics of elobixibat in Japanese patients with chronic constipation. METHODS This study consisted of single-dose and multiple-dose tests with a dose-escalating design. Sixty patients including females and males were randomized into five dose levels of elobixibat (2.5, 5, 10, 15 or 20 mg, n = 10 per level) and corresponding placebo (n = 2 per group). A crossover design was used to examine food effect in single-dose test. Patients received test tablets once daily for 14 days in multiple-dose test. We assessed pharmacokinetic-dose proportionality, levels of serum high- and low-density lipoprotein cholesterol and plasma 7α-hydroxy-4-cholesten-3-one (C4), food effect and sex-specific effect. Adverse events and bowel functions such as bowel movements, stool consistency and straining were also evaluated. RESULTS Food consumption reduced systemic exposure by around 80% [e.g. least squares mean (ratio of breakfast/no breakfast) maximum plasma concentration: 0.2085 (90% confidence interval, 0.1371-0.3172) at 15 mg] while increased plasma C4 level (P < 0.001). In the multiple-dose test, elobixibat reduced low-density lipoprotein cholesterol and increased C4 whilst unaltering high-density lipoprotein cholesterol level. The increased spontaneous bowel movement frequency was correlated with higher dosage and higher C4 level (R2 = 0.5929 at Week 2). Adverse events were mainly gastrointestinal symptoms, most of which were mild. CONCLUSIONS Elobixibat should be taken before breakfast. Once-daily administration of elobixibat was found to be safe and tolerated up to 20 mg in female and male patients with chronic constipation.
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Affiliation(s)
- Yuji Kumagai
- Kitasato University East Hospital, Kanagawa, Japan
| | - Hideki Amano
- Department of Pharmacology, Kitasato University School of Medicine, Kanagawa, Japan
| | | | | | - Mika Maeda
- Kitasato University East Hospital, Kanagawa, Japan
| | - Ichiro Oikawa
- Clinical Development Department, EA Pharma Co., Ltd., Tokyo, Japan
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Li J, Dawson PA. Animal models to study bile acid metabolism. Biochim Biophys Acta Mol Basis Dis 2018; 1865:895-911. [PMID: 29782919 DOI: 10.1016/j.bbadis.2018.05.011] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/19/2022]
Abstract
The use of animal models, particularly genetically modified mice, continues to play a critical role in studying the relationship between bile acid metabolism and human liver disease. Over the past 20 years, these studies have been instrumental in elucidating the major pathways responsible for bile acid biosynthesis and enterohepatic cycling, and the molecular mechanisms regulating those pathways. This work also revealed bile acid differences between species, particularly in the composition, physicochemical properties, and signaling potential of the bile acid pool. These species differences may limit the ability to translate findings regarding bile acid-related disease processes from mice to humans. In this review, we focus primarily on mouse models and also briefly discuss dietary or surgical models commonly used to study the basic mechanisms underlying bile acid metabolism. Important phenotypic species differences in bile acid metabolism between mice and humans are highlighted.
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Affiliation(s)
- Jianing Li
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Emory University, Atlanta, GA 30322, United States
| | - Paul A Dawson
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Emory University, Atlanta, GA 30322, United States.
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Wilson A, McLean C, Kim RB. Trimethylamine-N-oxide: a link between the gut microbiome, bile acid metabolism, and atherosclerosis. Curr Opin Lipidol 2016; 27:148-54. [PMID: 26959704 DOI: 10.1097/mol.0000000000000274] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This article evaluates the link between trimethylamine-N-oxide (TMAO) and bile acids and the consequent impact on the development of atherosclerosis. RECENT FINDINGS Elevation in plasma TMAO concentrations is associated with an increased risk of cardiovascular disease in many different patient cohorts. In addition to the recently identified direct effects of TMAO on the development of atherosclerosis, other components involved in TMAO metabolism may also have an impact. Furthermore, the relationship between TMAO and bile acid regulation is emerging as a possible mediator of atherosclerosis. SUMMARY Studies that are emerging highlight the mechanistic relationship of TMAO to the development atherosclerosis in addition to its role as disease biomarker. The interplay between TMAO and bile acid metabolism mediated through multiple factors, such as the gut microbiome, farnesoid X receptor signaling, and flavin monooxygenase 3 activity may help identify another pathway by which atherosclerosis occurs. In this review, we discuss the most recent data regarding atherosclerosis, TMAO, and bile acid metabolism.
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Affiliation(s)
- Aze Wilson
- aDivisions of Clinical Pharmacology bGastroenterology, Department of Medicine cDepartment of Physiology and Pharmacology, Western University, London, ON, Canada
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