Trimethylamine N-oxide reduction is related to probiotic strain specificity: A systematic review

Cardiovascular diseases (CVDs) represent the leading cause of death in individuals worldwide. Gut microbiota‐derived metabolite trimethylamine N-oxide (TMAO) can be metabolized from phosphatidylcholine, choline, and l-carnitine and may play an important role in CVD etiology. Thus, this systematic review aimed to evaluate the effect of probiotics to mitigate TMAO concentrations by gut microbiota modulation. A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol from databases: PubMed, Web of Sciences, CENTRAL, and Scopus. Controlled intervention studies published until January 3, 2022, with a population at cardiovascular risk were included. The risk of bias was assessed by RoB 2.0 and SYRCLE's for humans and animals' studies, respectively. The search in the database returned 5389 studies, of which 8 matched all criteria to final qualitative analysis. Four studies were controlled trials with humans (total population = 115) and 4 were animal model studies. The body of evidence on the use of probiotics to reduce TMAO concentrations shows that only a few strains have this beneficial effect. This review can conclude that Lactobacillus rhamnosus GG were the most efficient strains in reducing the plasma TMAO level in both humans and animals. In addition, it is worth mentioning the promising character of Lactobacillus plantarum ZDY04, Lactobacillus amylovorus LAM 1345, Lactiplantibacillus plantarum LP1145, and Enterobacter aerogenes ZDY01 for having had the same effect in animals.