Effects of Lactobacillus rhamnosus supplementation on inflammatory and oxidative biomarkers, gut microbiota profile, gut metabolites and cardiac remodeling in patients with Myocardial Infarction

Abstract

Background: Coronary artery disease (CAD) is a condition which affects the arteries that supply the heart with blood. It is usually caused by atherosclerosis which is a buildup of plaque inside the artery walls. Treatments for CAD usually include lifestyle changes and medications, sometimes in combination with cardiac procedures or surgery. According to recent studies, gut microbiota modification with probiotics can prevent the progression of atherosclerosis and its complications. The aim of this study was to determine the effect of probiotic supplementation on inflammatory and oxidative stress indices, gut microbiota profile, gut metabolites and cardiac remodeling in patients with myocardial infarction (MI). Materials & Methods: This randomized, double-blind, and placebo-controlled clinical trial was performed on 44 patients with a recent diagnosis of MI who underwent percutaneous coronary intervention (PCI). Patients were randomly assigned to receive either Lactobacillus rhamnosus capsules 1.6 ×109 colonyforming unit (CFU) with their lunch in intervention group or the capsules that contain maltodextrin in placebo (control) group for 12 weeks. Also, all the participants received a moderate calorie restricted dietary plan. The program was designed to enable weight loss of 7–10% of weight, at a rate of 0.5–1 kg/wk throughout the intervention. General and clinical information, anthropometric, dietary intake, Beck Depression Inventory (BDI), and MacNew quality of life (QOL) information were obtained at baseline and end of study. Biochemical indices including intestinal metabolites (Toll-like receptor 4: TLR4, Lipopolysaccharides: LPS and Trimethylamine N-oxide: TMAO), total antioxidant capacity (TAC), Malondialdehyde; MDA and levels of MMP-9, Procolagen, TGF-β, Lipid profile (TC, LDL-C, HDL-C and TG), and inflammatory markers (high sensitivity Creactive protein (hs-CRP), IL1-Beta, IL-10) were assessed before and after the intervention. Stool were taken before and after the intervention to examine the gut microbiota profile (the quantity of Firmicutes, Bacteroidetes and L. rhamnosus). Echocardiography was used for all subjects to evaluate CR process. Data analysis was done using SPSS software version 21 through independent t-test, paired t-test and ANCOVA tests.Results: The mean age of the subjects was 52.13 ± 9.74 years and their mean BMI was 27.37 kg/m 2. There were no significant differences between the groups in terms of dietary intakes, weight, BMI, physical activity levels and biochemical variable at baseline. Moreover, no significant changes were shown in systolic and diastolic blood pressure, anthropometric indices, dietary intake and echocardiography variables between two groups after intervention. Total BDI score decreased significantly in patients who received probiotic supplements compared to the placebo group. The total mean QOL score improved as well. In addition, increases in TAC and decrease in MDA, gut metabolites (LPS and TMAO), TGFBeta., Lipid profile (TC, LDL-C), and inflammatory markers (hs-CRP, IL1-β) were statically stronger in patients receiving probiotic supplementation than the placebo group. L. rhamnosus statically increased in intervention group while Bacteroidetes non-significantly increased in both groups. Conclusion: Lactobacillus rhamnosus supplementation for 12 weeks decreased some lipid profile, inflammatory markers, and oxidative stress and gut metabolites in CAD patients. The probiotic had significant effect on QOL, appetite and BDI score. These data provide preliminary evidence that probiotic supplementation has beneficial effects on metabolic endotoxemia, TMAO, and gut microbiota profile in subjects with CAD Hence, it seems that daily intake of probiotic in combination with diet can be useful for CAD patients. However, further studies are needed to evaluate long-term effect of probiotics species.