Роль кишечной микробиоты в развитии артериальной гипертензии: механизмы и терапевтические мишени

Кишечная микробиота не только опосредует влияние на организм ряда факторов риска сердечно-сосудистых заболеваний, но и может играть активную роль в регуляции артериального давления (АД) за счет изменения проницаемости кишечного эпителиального барьера и продукции вазоактивных метаболитов. При этом изучение молекулярных механизмов, лежащих в основе влияния кишечной микробиоты на уровень АД, находится на начальном этапе. В обзоре проведен анализ научной литературы, посвященной роли кишечной микробиоты в развитии артериальной гипертензии (АГ), описаны ключевые механизмы прогипертензивного действия метаболитов кишечной микробиоты и представлены данные о новых подходах к лечению АГ, основанных на воздействии на состав и функцию кишечной микрофлоры. На уровень АД влияют молекулы, концентрация которых в крови прямо или опосредованно связана с активностью кишечной микрофлоры. Эти биоактивные молекулы могут быть разделены на две группы — образующиеся клетками иммунной системы человека в результате стимуляции со стороны микробиоты и образующиеся ферментативным путем в результате метаболической активности самой микробиоты. К первой группе относятся молекулярные механизмы, связанные с активацией иммунитета и системной воспалительной реакцией, а ко второй — короткоцепочечные жирные кислоты, триметиламин-N-оксид, желчные кислоты, уремические токсины и биогенные амины. АГ сопровождается специфическими изменениями состава кишечной микробиоты, причем в последние годы исследователями установлены причинно-следственные отношения между определенными энтеротипами и развитием АГ. Более того, сформировавшаяся АГ сама по себе является причиной изменений профиля кишечного микробиома. Более глубокое понимание молекулярных механизмов, опосредующих влияние микробиоты на АД, может послужить основой для разработки новых подходов к лечению АГ.

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