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Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk

  • Weifei Zhu
  • , Jill C. Gregory
  • , Elin Org
  • , Jennifer A. Buffa
  • , Nilaksh Gupta
  • , Zeneng Wang
  • , Lin Li
  • , Xiaoming Fu
  • , Yuping Wu
  • , Margarete Mehrabian
  • , R. Balfour Sartor
  • , Thomas M. McIntyre
  • , Roy L. Silverstein
  • , W.H. Wilson Tang
  • , Joseph A. Didonato
  • , J. Mark Brown
  • , Aldons J. Lusis
  • , Stanley L. Hazen
  • Cleveland Clinic Foundation
  • David Geffen School of Medicine at UCLA
  • University of North Carolina
  • Medical College of Wisconsin

Research output: Contribution to journalArticlepeer-review

1800 Scopus citations

Abstract

Normal platelet function is critical to blood hemostasis and maintenance of a closed circulatory system. Heightened platelet reactivity, however, is associated with cardiometabolic diseases and enhanced potential for thrombotic events. We now show gut microbes, through generation of trimethylamine N-oxide (TMAO), directly contribute to platelet hyperreactivity and enhanced thrombosis potential. Plasma TMAO levels in subjects (n > 4,000) independently predicted incident (3 years) thrombosis (heart attack, stroke) risk. Direct exposure of platelets to TMAO enhanced sub-maximal stimulus-dependent platelet activation from multiple agonists through augmented Ca2+ release from intracellular stores. Animal model studies employing dietary choline or TMAO, germ-free mice, and microbial transplantation collectively confirm a role for gut microbiota and TMAO in modulating platelet hyperresponsiveness and thrombosis potential and identify microbial taxa associated with plasma TMAO and thrombosis potential. Collectively, the present results reveal a previously unrecognized mechanistic link between specific dietary nutrients, gut microbes, platelet function, and thrombosis risk.
Original languageEnglish
Pages (from-to)111-124
Number of pages14
JournalCell
Volume165
Issue number1
DOIs
StatePublished - Mar 24 2016

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