Статья
Состав и метаболиты кишечной микробиоты как новые детерминанты развития сердечно-сосудистой патологии
Хронические неинфекционные заболевания представляют одну из ключевых медицинских проблем XXI века. Лидирующее место среди причин смертности в данной группе занимают сердечно-сосудистые заболевания (ССЗ), патогенез которых до сих пор имеет потенциал к более полному раскрытию и обнаружению ранее неизвестных, но значимых «участников». Последние десятилетия характеризуются активным изучением роли бактерий кишечника в инициации и прогрессированию ССЗ, итогом которого стало признание микробиоты как потенциально нового фактора риска ССЗ. Развитие методики секвенирования наряду с биоинформатическим анализом позволило ученым интенсивно расширять знания о составе микробиоты и функциях ее метаболитов в поддержании здоровья и развитии атеросклероза, артериальной гипертонии, хронической сердечной недостаточности. Взаимодействие макро- и микроорганизмов опосредовано множеством путей, среди которых в качестве основных «игроков» выделяют триметиламин-N-оксид (ТМАО), короткоцепочечные жирные кислоты (КЦЖК) и вторичные желчные кислоты. TMAO известен участием в развитии атеросклероза и увеличением риска основных сердечно-сосудистых событий. КЦЖК и вторичные желчные кислоты в большинстве работ показали протективную роль в отношении развития ССЗ. Большое внимание уделяется роли липополисахарида грамотрицательных бактерий в развитии состояния системного низкоуровневого воспаления за счет метаболической эндотоксемии, которая вносит вклад в прогрессирование развития ССЗ. Описанные взаимодействия привлекают внимание к перспективе влияния на отдельные звенья патогенеза ССЗ посредством модуляции функции и состава микробиоты кишечника. Данный обзор нацелен на освещение современных данных о механизмах влияния микробиоты кишечника и ее метаболитов на сердечно-сосудистый риск и события, а также существующие результаты и перспективы воздействия на системные эффекты бактерий кишечника.
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