Hypertension Opens the Flood Gates to the Gut Microbiota
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There continues to be a rapidly evolving interest in the role of the gut microbiome in cardiovascular disease. It has long been known that the gut microbiome has a fundamentally mutualistic, symbiotic relationship with the human host. However, from earlier observations using mice grown in germ-free environments to more recent advances in identifying unique metabolic products of the gut microbiome,1 the data have led to a compelling story linking cardiovascular disease to the trillions of prokaryotic organisms that live in the human gut.
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In this issue of Circulation Research, Santisteban et al2 have provided provocative data demonstrating very definitively that, in 2 different animal models of hypertension, there is decreased expression of several tight junction proteins in the gut and a concomitant increase in intestinal permeability. Furthermore, their data show that in the spontaneously hypertensive rat model, the increase in permeability is a result of increased sympathetic nerve activity before the development of hypertension. They therefore conclude that there is a direct, causal link between the sympathetic nerve activity derived from the central nervous system and increased gut permeability (Figure). They further hypothesize that the changes in gut permeability result in hypertension and cause a shift in the types of bacteria that are present in the gut. Finally, they have shown that the changes in sympathetic activity resulting in increased gut permeability are also associated with an increase in inflammatory cells within the intestinal wall thus …