Chronic kidney disease (CKD) patients have an increased risk of cardiovascular diseases (CVDs). The present study aimed to investigate the gut microbiota and blood trimethylamine-N-oxide concentration (TMAO) in Chinese CKD patients and explore the underlying explanations through the animal experiment. The median plasma TMAO level was 30.33 μmol/L in the CKD patients, which was significantly higher than the 2.08 μmol/L concentration measured in the healthy controls. Next-generation sequence revealed obvious dysbiosis of the gut microbiome in CKD patients, with reduced bacterial diversity and biased community constitutions. CKD patients had higher percentages of opportunistic pathogens from gamma-Proteobacteria and reduced percentages of beneficial microbes, such as Roseburia, Coprococcus, and Ruminococcaceae. The PICRUSt analysis demonstrated that eight genes involved in choline, betaine, L-carnitine and trimethylamine (TMA) metabolism were changed in the CKD patients. Moreover, we transferred faecal samples from CKD patients and healthy controls into antibiotic-treated C57BL/6 mice and found that the mice that received gut microbes from the CKD patients had significantly higher plasma TMAO levels and different composition of gut microbiota than did the comparative mouse group. Our present study demonstrated that CKD patients had increased plasma TMAO levels due to contributions from both impaired renal functions and dysbiosis of the gut microbiota.

Chronic high-salt diet-associated renal injury is a key risk factor for the development of hypertension. However, the mechanism by which salt triggers kidney damage is poorly understood. Our study investigated how high salt (HS) intake triggers early renal injury by considering the ‘gut-kidney axis’. We fed mice 2% NaCl in drinking water continuously for 8 weeks to induce early renal injury. We found that the ‘quantitative’ and ‘qualitative’ levels of the intestinal microflora were significantly altered after chronic HS feeding, which indicated the occurrence of enteric dysbiosis. In addition, intestinal immunological gene expression was impaired in mice with HS intake. Gut permeability elevation and enteric bacterial translocation into the kidney were detected after chronic HS feeding. Gut bacteria depletion by non-absorbable antibiotic administration restored HS loading-induced gut leakiness, renal injury and systolic blood pressure elevation. The fecal microbiota from mice fed chronic HS could independently cause gut leakiness and renal injury. Our current work provides a novel insight into the mechanism of HS-induced renal injury by investigating the role of the intestine with enteric bacteria and gut permeability and clearly illustrates that chronic HS loading elicited renal injury and dysfunction that was dependent on the intestine.

Galacto-oligosaccharides (GOS) are prebiotics that positively affect the host's gut microbiota, which is important for the health of the host. Most previous studies focused on specific flora components (e.g. Bifidobacterium and Lactobacillus); very few have investigated the relationship between flora and metabolites. Here, we used 16S rRNA analysis and metabolomics to analyze the effect of GOS on microbiota and metabolites. Results show that the abundance of Ruminococcaceae and Oscillibacter decreased significantly in GOS-fed mice. Twenty-one metabolites, including oleic acid, arachidic acid, and behenic acid, decreased significantly in the GOS-fed mice. Fatty acid synthesis and blood triglyceride content significantly decreased in the GOS-fed mice compared with those in the control mice, suggesting that GOS may improve lipid metabolism in mice. Additionally, after three weeks of a GOS-rich diet, the mouse microbiota was significantly enriched in Alloprevotella, Bacteroides, and Parasutterella. The blood glucose level of the GOS-fed group was significantly higher than that of the control group, whereas the abundance of Coprococcus and Odoribacter (butyrate-producing bacteria) was significantly decreased. The metabolism of butyrate, known to reduce plasma glucose levels, was significantly downregulated in the GOS-fed mice, an effect potentially detrimental to the glucose metabolism of the host. This dual-omics analysis provided important information on the changes in host-microbe-metabolite interactions resulting from GOS supplementation. Our results provide evidence that GOS may improve lipid metabolism, and that long-term GOS supplementation had a detrimental effect on the host's glucose metabolism, which could be important for optimizing methods of prebiotic supplementation and developing approaches to prevent diseases using prebiotic interventions.

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