Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk

• Published in: The New England journal of medicine Vol. 368; no. 17; pp. 1575 - 1584
• Main Authors: Tang, W.H. Wilson, Wang, Zeneng, Levison, Bruce S, Koeth, Robert A, Britt, Earl B, Fu, Xiaoming, Wu, Yuping, Hazen, Stanley L
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 25.04.2013
• Subjects: Acute coronary syndromes; Administration, Oral; Aged; Angiography; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Betaine; Betaine - blood; Biological and medical sciences; Blood diseases; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cerebral infarction; Choline; Choline - administration & dosage; Choline - blood; Coronary artery; Eggs; Female; General aspects; Heart attacks; Heart diseases; Humans; Intestinal microflora; Intestine; Intestines - metabolism; Intestines - microbiology; Intubation; Kaplan-Meier Estimate; Laboratories; Lecithin; Liquid chromatography; Male; Mass spectroscopy; Medical sciences; Metabolism; Metabolites; Metagenome - drug effects; Metagenome - physiology; Methylamines - blood; Methylamines - urine; Microbiota; Microorganisms; Middle Aged; Myocardial infarction; Phosphatidylcholine; Phosphatidylcholines - administration & dosage; Phosphatidylcholines - metabolism; Plasma; Plasma levels; Prospective Studies; Risk Factors; Trimethylamine; Trimethylamine-N-oxide; Cleveland Ohio; United States > US; Medicine; Digestive system; Risk factor; Gut; Cardiovascular risk; Phosphatidylcholine; Cardiovascular disease; Metabolism
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1109400

The production of trimethylamine-N-oxide (TMAO) from dietary phosphatidylcholine was found to be dependent on metabolism by the intestinal microbiota. Increased TMAO levels were associated with an increased risk of incident major adverse cardiac events. The phospholipid phosphatidylcholine (lecithin) is the major dietary source of choline, a semiessential nutrient that is part of the B-complex vitamin family. 1 , 2 Choline has various metabolic roles, ranging from its essential involvement in lipid metabolism and cell-membrane structure to its role as a precursor for the synthesis of the neurotransmitter acetylcholine. Choline and some of its metabolites, such as betaine, can also serve as a source of methyl groups that are required for proper metabolism of certain amino acids, such as homocysteine and methionine. 3 There is a growing awareness that intestinal microbial organisms, collectively termed microbiota, participate in the . . .