Researchers design new class of drugs to counter cardiovascular disease

pharmafile | August 14, 2018 | News story | Manufacturing and Production TMAO, cardiovascular, gut microbe, heart attack, research 

Cleveland Clinic researchers have designed a potential new class of drugs that may reduce the risk of cardiovascular disease by targeting a microbial pathway in the gut; a study published in Nature Medicine has shown.

The study, which took place in mice, demonstrated that the new drugs reversed two major risk factors for cardiovascular disease. By lowering levels of TMAO (trimethylamine N-oxide), a gut bacteria by-product that forms during digestion, the drugs were able to counter increased platelet responsiveness and excessive clot formation, two major factors for heart conditions.

High levels of TMAO in the blood have been shown as good predictors for heart attack, stroke and death risk. TMAO is produced when gut bacteria digest certain nutrients such as choline, lecithin and carnitine that are abundant in animal products.  The nutrients are particularly prevalent in red meat, egg yolks and high fat dairy products. TMAO was also shown to increase the potential for clotting which thus increased the risk of heart attacks and strokes.

However the new study demonstrated that a new series of inhibitors was able to interrupt the gut microbial pathways that produce TMAO. The new drugs which are structurally similar to choline trick the pathways into taking them in as nutrients. However once absorbed they proceed to block the production of TMAO by inactivating the gut microbe enzyme choline utilization protein C (cutC).

“To our knowledge, this is the most potent therapy to date for ‘drugging’ the microbiome to alter a disease process.  In addition, gut bacteria are altered but not killed by this drug, and there were no observable toxic side effects,” said Dr. Hazen who led the study. “The approach developed could potentially be used to target other gut microbial pathways. We look forward to advancing this novel therapeutic strategy into humans.”  

The researchers found that just one oral dose of the drug reduced levels of TMAO for up to three days. Significantly, the drugs were designed to not kill the bacterial cells and, therefore, likely do not contribute to antibiotic resistance.

Louis Goss

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