Oral and gut microbiome alterations in heart failure: Epidemiology, pathogenesis and response to advanced heart failure therapies

Melana Yuzefpolskaya, Bruno Bohn, Annamaria Ladanyi, Alexander Khoruts, Paolo C. Colombo, Ryan T. Demmer

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Despite significant advances in therapies, heart failure (HF) remains a progressive disease that, once advanced, is associated with significant death and disability. Cardiac replacement therapies with left ventricular assist device (LVAD) and heart transplantation (HT) are the only treatment options for advanced HF, while lifesaving they can also be lifespan limiting due to the associated complications. Systemic inflammation is mechanistically important in HF pathophysiology and progression. However, directly targeting inflammation in HF has not been beneficial thus far. These failed attempts at therapeutics might be related to our limited understanding of the factors that cause inflammation in HF, and, therefore, to our inability to investigate these triggers in interventional studies. Observational studies have consistently demonstrated associations between alterations in the digestive (gut and oral) microbiome, inflammation and HF risk and progression. Additionally, recent data indicate that these microbial perturbations persist following LVAD and HT, along with residual inflammation and oxidative stress. Furthermore, there is rising recognition of the critical contribution of the microbiome to the metabolism of immunosuppressive drugs after HT. Cumulatively, these findings might posit a mechanistic link between microbiome alterations, systemic inflammation, and adverse outcomes in HF patients before and after cardiac replacement therapies. This review (1) provides an update on available data linking changes in digestive tract microbiota, inflammation, and oxidative stress, to HF pathogenesis and progression; (2) describes evolution of these relationships following LVAD and HT; and (3) outlines present and future intervention strategies that can manipulate the microbiome and possibly modify HF disease trajectory.

Original languageEnglish (US)
Pages (from-to)291-300
Number of pages10
JournalJournal of Heart and Lung Transplantation
Issue number3
StatePublished - Mar 2023

Bibliographical note

Funding Information:
This research has been supported by funds Susan and Lowell McAdam Research Grant at New York-Presbyterian Hospital/Columbia University .

Publisher Copyright:
© 2022 International Society for Heart and Lung Transplantation


  • gut microbiome
  • heart failure
  • heart transplantation
  • inflammation
  • left ventricular assist device
  • oral microbiome

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, Non-U.S. Gov't


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