Evidence of a causal and modifiable relationship between kidney function and circulating trimethylamine N-oxide.

Petros Andrikopoulos, Judith Aron-Wisnewsky, Rima Chakaroun, Antonis Myridakis, Sofia K Forslund, Trine Nielsen, Solia Adriouch, Bridget Holmes, Julien Chilloux, Sara Vieira-Silva, Gwen Falony, Joe-Elie Salem, Fabrizio Andreelli, Eugeni Belda, Julius Kieswich, Kanta Chechi, Francesc Puig-Castellvi, Mickael Chevalier, Emmanuelle Le Chatelier, Michael T Olanipekun, Lesley Hoyles, Renato Alves, Gerard Helft, Richard Isnard, Lars Køber, Luis Pedro Coelho, Christine Rouault, Dominique Gauguier, Jens Peter Gøtze, Edi Prifti, Philippe Froguel, Jean-Daniel Zucker, Fredrik Bäckhed, Henrik Vestergaard, Torben Hansen, Jean-Michel Oppert, Matthias Blüher, Jens Nielsen, Jeroen Raes, Peer Bork, Muhammad M Yaqoob, Michael Stumvoll, Oluf Pedersen, S Dusko Ehrlich, Karine Clément, Marc-Emmanuel Dumas

Journal: Nature communications 2023;14(1):5843

PMID: 37730687

Abstract

The host-microbiota co-metabolite trimethylamine N-oxide (TMAO) is linked to increased cardiovascular risk but how its circulating levels are regulated remains unclear. We applied "explainable" machine learning, univariate, multivariate and mediation analyses of fasting plasma TMAO concentration and a multitude of phenotypes in 1,741 adult Europeans of the MetaCardis study. Here we show that next to age, kidney function is the primary variable predicting circulating TMAO, with microbiota composition and diet playing minor, albeit significant, roles. Mediation analysis suggests a causal relationship between TMAO and kidney function that we corroborate in preclinical models where TMAO exposure increases kidney scarring. Consistent with our findings, patients receiving glucose-lowering drugs with reno-protective properties have significantly lower circulating TMAO when compared to propensity-score matched control individuals. Our analyses uncover a bidirectional relationship between kidney function and TMAO that can potentially be modified by reno-protective anti-diabetic drugs and suggest a clinically actionable intervention for decreasing TMAO-associated excess cardiovascular risk.

© 2023. Springer Nature Limited.

Address: Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. [email protected].; Section of Genomic & Environmental Medicine, National Heart & Lung Institute, Imperial College London, London, UK. [email protected].; Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France.; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Paris, France.; Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.; The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.; Environmental Research Group, MRC Centre for Environment and Health, School of Public Health, Imperial College London, 86 Wood Lane, London, W12 0BZ, UK.; Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany.; Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin and the Max-Delbrück Center, Berlin, Germany.; Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany.; Charité University Hospital, Berlin, Germany.; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France.; Danone Research, Palaiseau, France.; Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.; Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium.; Center for Microbiology, VIB, Leuven, Belgium.; Institute of Medical Microbiology and Hygiene and Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.; Institute of Molecular Biology (IMB), Mainz, Germany.; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Paris, France.; Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France.; Sorbonne Université, IRD, Unité de Modélisation Mathématique et Informatique des Systèmes Complexes, UMMISCO, F-93143, Bondy, France.; Diabetic Kidney Disease Centre, Renal Unit, Barts Health National Health Service Trust, The Royal London Hospital, London, UK.; Centre for Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.; Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.; Section of Genomic & Environmental Medicine, National Heart & Lung Institute, Imperial College London, London, UK.; European Genomics Institute for Diabetes, EGENODIA, INSERM U1283, CNRS UMR8199, Institut Pasteur de Lille, Lille University Hospital, University of Lille, Lille, France.; Metagenopolis, INRA, AgroParisTech, Université Paris-Saclay, Paris, France.; Department of Biosciences, School of Science and Technology, Nottingham Trent University, Nottingham, UK.; Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany.; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Paris, France.; Institute of Cardiometabolism and Nutrition, ICAN, INSERM, 1166, Paris, France.; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.; INSERM UMR 1124, Université de Paris, 45 rue des Saint-Pères, 75006, Paris, France.; McGill Genome Centre, McGill University, 740 Doctor Penfield Avenue, Montreal, QC, H3A 0G1, Canada.; Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.; European Genomics Institute for Diabetes, EGENODIA, INSERM U1283, CNRS UMR8199, Institut Pasteur de Lille, Lille University Hospital, University of Lille, Lille, France.; Section of Genetics and Genomics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, W12 0NN, UK.; The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Department of Medicine, Bornholms Hospital, Rønne, Denmark.; Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.; Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden.; Laboratory of Molecular Bacteriology, Department of Microbiology and Immunology, Rega Institute, KU Leuven, Leuven, Belgium.; Center for Microbiology, VIB, Leuven, Belgium.; Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany.; Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany.; Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany.; Yonsei Frontier Lab (YFL), Yonsei University, Seoul, 03722, South Korea.; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Center for Clinical Metabolic Research, Gentofte University Hospital, Copenhagen, Denmark.; Department of Clinical and Movement Neurosciences, University College London, London, NW3 2PF, UK.; Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France. [email protected].; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Paris, France. [email protected].; Section of Biomolecular Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. [email protected].; Section of Genomic & Environmental Medicine, National Heart & Lung Institute, Imperial College London, London, UK. [email protected].; European Genomics Institute for Diabetes, EGENODIA, INSERM U1283, CNRS UMR8199, Institut Pasteur de Lille, Lille University Hospital, University of Lille, Lille, France. [email protected].; McGill Genome Centre, McGill University, 740 Doctor Penfield Avenue, Montreal, QC, H3A 0G1, Canada. [email protected].
Bant logo

© Copyright 2026, Nutrition Evidence

NED wishes to thank the following organisations for their support:

We use cookies to improve your experience and analyze site traffic with Google Analytics. By continuing to use our site, you agree to our use of cookies. Learn more.