Shalin S Patel, Mazyar Malakouti, Salil Sethi and Robert J Chilton
The rising prevalence of obesity and Type 2 diabetes mellitus (T2DM) worldwide is a primary public health concern as it heavily impacts risk of cardiovascular disease (CVD) and other comorbid diseases. Promising research in the last decade implicates gut microbiota as an important contributor to risk of developing obesity, T2DM and CVD. Animal models of obesity and insulin resistance identify that germ free mice have decreased risk of obesity and insulin resistance despite being on high fat sugar rich diet compared to conventional mice. Obesity is shown to be transmissible through faecal microbiome transplantation from obese phenotype mice to germ free mice. There is also growing evidence that gut microbiota metabolism of choline to Trimethylamine-N-Oxide (TMAO) is directly linked to increased cardiovascular risk. TMAO is a proatherogenic molecule which has been shown to increase atherosclerotic plaque burden in murine atherosclerosis model. Also, clinical cohort studies have established increased TMAO levels as an independent predictor for major adverse cardiovascular events including death, myocardial infarction and stroke. As it stands, intestinal microbiota-mediated pathogenesis of obesity, T2DM and CVD is still an emerging research direction and has the potential for leading to new diagnostic and therapeutic strategies.