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Gut bacteria linked to heart failure severity: toxic gut flora in the bloodstream may be a consequence of chronic heart failure.

Scientists in Italy and Germany are homing in on a possible link between pathogenic gut flora and chronic heart failure (CHF).

The goal of the Italian study, led by Dr. Evasio Pasini, of the Medical Center of Lumezzane, Brescia, Italy, was to measure the presence of pathogenic (disease-causing) gut flora and intestinal permeability (sometimes called "leaky gut") and their association with disease severity, venous blood congestion, and inflammation in patients with CHF.

MASSIVE QUANTITIES. The study involved 80 participants--60 with CHF and 20 healthy controls. Scientists found that the CHF patients had "massive quantities" of pathogenic bacteria. These included Candida, a fungus that is a form of yeast; Campylobacter, a major cause of food-borne diarrhea; Shigella and Salmonella, which cause diarrhea, fever, and stomach cramps; and Yersinia enterocolitica, which causes similar symptoms. The patients with CHF also had increased inflammation, intestinal permeability, and right atrial pressure, a sign of venous blood congestion (a condition wherein the veins can't pump enough blood back to the heart). The patients with moderate to severe CHF had more pathogens than those with mild CHF.


NOT MANY OPTIONS. Researchers said that reestablishing the gut microbiota might be the only option for patients to reverse intestinal dysbiosis--toxic bacteria in the digestive tract. (When the gut flora is in healthy balance, the condition is called "orthobiosis.") They said also that confirmation of the link between gut pathogenic bacteria and CHF severity suggests that "personalized therapeutic strategies" that target the microbial pathway might be needed.

As soon as CHF is diagnosed in a patient, gut microbiota need to be continually investigated, says Dr. Pasini, adding that measuring gut bacteria development could provide "important clinical information to treat complicated, multiorgan syndromes." The study was published in JACC: Heart Failure Dec. 9, 2015.

CONFIRMS EARLIER RESEARCH. The current study confirms a previous investigation undertaken by scientists in Germany and England of altered intestinal function in patients with CHF (JACC, July 16, 2007). Investigators said that CHF is a multisystem disorder that affects the heart and circulation, but also the musculoskeletal, neuroendocrine, metabolic, and immune systems, and is now recognized as a state of chronic inflammation. One hypothesis is that much of the inflammation derives from endotoxins entering the circulatory system from the gut. The investigators noted that CHF patients have a decrease in intestinal mucosal pH, which increases intestinal mucosal permeability. This allows the endotoxins to enter the circulation through the gut wall if the barrier function is impaired by various diseases. Tests undertaken by the researchers showed a 35 percent increase in intestinal permeability in CHF patients than in controls.

Gut barrier breakdown

"The intestinal epithelium is a single-cell layer that constitutes the largest and most important barrier against the external environment. It acts as a selectively permeable barrier, permitting the absorption of nutrients, electrolytes, and water, while maintaining an effective defense against intraluminal toxins, antigens, and enteric flora. There has been increasing recognition of an association between disrupted intestinal barrier function and the development of autoimmune and inflammatory diseases."

--Intestinal barrier function: molecular regulation and disease pathogenesis, The Journal of Allergy and Clinical Immunology, July 2009
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Publication:Duke Medicine Health News
Date:May 1, 2016
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