The Gut Microbiota and Short-Chain Fatty Acids Profile in Postural Orthostatic Tachycardia Syndrome

Abstract

Postural orthostatic tachycardia syndrome (POTS) is a devastating chronic form of orthostatic intolerance associated with excessive heart rate increase without hypotension during upright posture. POTS patients exhibit increased circulating norepinephrine levels with exaggerated sympathetic nervous system response upon standing. Emerging evidence suggests a role for the gut microbiome in cardiovascular disorders. However, the etiology of POTS and whether the gut microbiome plays a role are not fully elucidated. We assessed whether the gut microbiome and fecal short-chain fatty acids were different in POTS patients (N = 25) compared to healthy control (N = 23) women. Patients underwent hemodynamic measurements while supine and upon standing. Fecal samples were collected and analyzed using shotgun sequencing and Liquid Chromatography-High Resolution Mass Spectrometry and dietary habits were measured with a fitness application. We found that POTS patients in the standing position had higher circulating norepinephrine and epinephrine levels and increased heart rate. There were no differences in diet composition between groups. Of note dietary salt intake was also similar despite the fact that these patients are advised to consume a high salt diet. Alpha and beta diversity were similar between groups. We observed no differences in bacteria at the phylum levels or Firmicutes to Bacteroidetes ratio. We found no significant differences at the genus level, but observed trends in certain bacteria. Lachnoclostridium genus were higher in POTS when compared to the control group. On the other hand, Coprococcus and Coprobacter, were lower in POTS patients compared to controls. Although our KEGG metabolic pathways indicated differences related to short-chain fatty acids (SCFAs), we found that both POTS patients and healthy controls had similar levels of SCFAs. These results suggest POTs per se may have limited effects on gut microbiota composition and derived SCFAs. Further studies are needed to assess the role of the alterations observed at the genus level.

Ethanol extract of Pueraria lobata improve acute myocardial infarction in rats via regulating gut microbiota and bile acid metabolism

“…Lachnoclostridium was strongly associated with CVD. For example, Lachnoclostridium has been reported to be higher in postural orthostatic tachycardia syndrome (POTS) than in the control group, which implied that Lachnoclostridium was involved in the development of CVD (Ishimwe et al, 2022). Additionally, Lachnoclostridium , which were increased in atherosclerosis patients and atrial fibrillation (AF) patients, can produced high amounts of trimethylamine N ‐oxide (TMAO) in the human gut (Cai et al, 2022; Rath et al, 2018; Tabata et al, 2021).…”

Recent Advances in Understanding Peripheral and Gut Immune Cell-Mediated Salt-Sensitive Hypertension and Nephropathy

“…98 The gut microbiome, mainly characterized by its symbiotic properties, harbors a community of microorganisms (or microbiota), as well as a structural materials and metabolites, playing a vital role in human physiology. 99,100 A disturbance in gut microbiome equilibrium, or dysbiosis, is associated with dysregulation of metabolic and physiological functions, [101][102][103] but the significance of gut health as an extrarenal mechanism of blood pressure regulation in salt-sensitive hypertension is not fully understood. 104,105 Excess dietary salt intake influences the gut-kidney axis in hypertension through regulation of the immune system and oxidative stress.…”