Modulation of the intestinal microbiota as a new strategy for the prevention and treatment of comorbid chronic cardiovascular diseases and colorectal cancer in one patient. Review

To date, the etiological causes of adverse outcomes associated with cardiovascular diseases and concomitant colorectal cancer in one patient, especially over 60 years of age, are multifactorial: from undiagnosed timely above-mentioned pathological conditions to poor adherence to treatment. It is a multi-level approach that is the future guarantee of reducing the burden on public health as a result of these most common nosologies.

The aim of the work is to evaluate discussions between different experts with an analysis of fundamental and clinical studies based on world literature in the search for new prospects for the treatment of patients with cardiovascular pathology and comorbid colorectal cancer based on the composition and function of the intestinal microbiota.

A literature search was conducted in the PubMed electronic database using the keywords: intestinal microbiota, cardio-oncology, oncosurgery, colorectal cancer, cardiovascular diseases. Additional sources were identified through literature cross-referencing. Search period: 2023.

The gut microbiome is a potential marker for better risk stratification of cardiovascular diseases, colorectal cancer, and prediction of shortand long-term major adverse cardiovascular and cancer events. To develop clear recommendations and conclusions, additional research is required.

1. Shimizu Y. Gut microbiota in common elderly diseases affecting activities of daily living. World J Gastroenterol 2018;24(42):4750–8; DOI: 10.3748/wjg.v24.i42.4750

2. Nouri R., Hasani A., Asgharzadeh M. et al. Roles of gut microbiota in colorectal carcinogenesis providing a perspective for early diagnosis and treatment. Curr Pharm Biotechnol 2022;23(13):1569–80. DOI: 10.2174/1389201023666220307112413

3. Alasiri G.A. Effect of gut microbiota on colorectal cancer progression and treatment. Saudi Med J 2022;43(12):1289–99. DOI: 10.15537/smj.2022.43.12.20220367

4. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70(1):7–30. DOI: 10.3322/caac.21590

5. Kim H., Park I.J., Han Y. et al. Cardiovascular morbidities in postoperative colorectal cancer patients. Sci Rep 2021;11(1):21359. DOI: 10.1038/s41598-021-00735-3

6. Alam M.J., Puppala V., Uppulapu S.K. et al. Human microbiome and cardiovascular diseases. Prog Mol Biol Transl Sci 2022;192(1):231–79. DOI: 10.1016/bs.pmbts.2022.07.012

7. Shelton C.D., Byndloss M.X. Gut epithelial metabolism as a key driver of intestinal dysbiosis associated with noncommunicable diseases. Infect Immun 2020;88(7):e00939–19. DOI: 10.1128/IAI.00939-19

8. Soerjomataram I., Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070. Nat Rev Clin Oncol 2021;18(10):663–72. DOI: 10.1038/s41571-021-00514-z

9. Siegel R.L., Miller K.D., Wagle N.S., Jemal A. Cancer statistics, 2023. CA A Cancer J Clin 2023;73(1);17–48. DOI: 10.3322/caac.21763

10. Huo R.X., Wang Y.J., Hou S.B. et al. Gut mucosal microbiota profiles linked to colorectal cancer recurrence. World J Gastroenterol 2022;28(18):1946–64. DOI: 10.3748/wjg.v28.i18.1946

11. Xia C., Cai Y., Ren S., Xia C. Role of microbes in colorectal cancer therapy: cross-talk between the microbiome and tumor microenvironment. Front Pharmacol 2022;13:1051330. DOI: 10.3389/fphar.2022.1051330

12. Fong W., Li Q., Yu J. Gut microbiota modulation: a novel strategy for prevention and treatment of colorectal cancer. Oncogene 2020;39(26):4925–43. DOI: 10.1038/s41388-020-1341-1

13. Fabbri A., Bracci L. Immunomodulatory properties of CNF1 toxin from E. coli: implications for colorectal carcinogenesis. Am J Cancer Res 2022;12(2):651–60.

14. Wong S.H., Yu J. Gut microbiota in colorectal cancer: mechanisms of action and clinical applications. Nat Rev Gastroenterol Hepatol 2019;16(11):690–704. DOI: 10.1038/s41575-019-0209-8

15. Shi Y., Cui H., Wang F. et al. Role of gut microbiota in postoperative complications and prognosis of gastrointestinal surgery: a narrative review. Medicine (Baltimore) 2022;101(29):e29826. DOI: 10.1097/MD.0000000000029826

16. Lucafò M., Curci D., Franzin M. et al. Inflammatory bowel disease and risk of colorectal cancer: an overview from pathophysiology to pharmacological prevention. Front Pharmacol 2021;12:772101. DOI: 10.3389/fphar.2021.772101

17. Popov J., Caputi V., Nandeesha N. et al. Microbiota-immune interactions in ulcerative colitis and colitis associated cancer and emerging microbiota-based therapies. Int J Mol Sci 2021;22. DOI: 10.3390/ijms222111365

18. Yu L.C. Microbiota dysbiosis and barrier dysfunction in inflammatory bowel disease and colorectal cancers: exploring a common ground hypothesis. J Biomed Sci 2018;25(1):79. DOI: 10.1186/s12929-018-0483-8

19. Yang Y., Gharaibeh R.Z., Newsome R.C., Jobin C. Amending microbiota by targeting intestinal inflammation with TNF blockade attenuates development of colorectal cancer. Nat Cancer 2020;1(7):723–34. DOI: 10.1038/s43018-020-0078-7

20. Zamani S., Taslimi R., Sarabi A. et al. Enterotoxigenic Bacteroides fragilis: a possible etiological candidate for bacterially-induced colorectal precancerous and cancerous lesions. Front Cell Infect Microbiol 2019;9:449. DOI: 10.3389/fcimb.2019.00449

21. Quaglio A.E.V., Grillo T.G., De Oliveira E.C.S. et al. Gut microbiota, inflammatory bowel disease and colorectal cancer. World J Gastroenterol 2022;28(30):4053–60. DOI: 10.3748/wjg.v28.i30.4053

22. Jin M., Shang F., Wu J. et al. Tumor-associated microbiota in proximal and distal colorectal cancer and their relationships with clinical outcomes. Front Microbiol 2021;12:727937. DOI: 10.3389/fmicb.2021.727937

23. Appunni S., Rubens M., Ramamoorthy V. et al. Emerging evidence on the effects of dietary factors on the gut microbiome in colorectal cancer. Front Nutr 2021;8:718389. DOI: 10.3389/fnut.2021.718389

24. Keller D.S., Windsor A., Cohen R., Chand M. Colorectal cancer in inflammatory bowel disease: review of the evidence. Tech Coloproctol 2019;23(1):3–13. DOI: 10.1007/s10151-019-1926-2

25. Olén O., Erichsen R., Sachs M.C. et al. Colorectal cancer in ulcerative colitis: a Scandinavian population-based cohort study. Lancet 2020;395(10218):123–31. DOI: 10.1016/S0140-6736(19)32545-0

26. Wang L., Yu K.C., Hou Y.Q. et al. Gut microbiome in tumorigenesis and therapy of colorectal cancer. J Cell Physiol 2023;238(1);94–108; DOI: 10.1002/jcp.30917

27. Roth G.A., Mensah G.A., Johnson C.O. et al. Global burden of cardiovascular diseases and risk factors, 1990–2019 update from the GBD 2019 study. J Am Coll Cardiol 2020;76(25):2982–3021. DOI: 10.1016/j.jacc.2020.11.010

28. Garg Y., Kanwar N., Chopra S. et al. Microbiome medicine: microbiota in development and management of cardiovascular diseases. Endocr Metab Immune Disord Drug Targets 2022;22(14):1344–56. DOI: 10.2174/1871530322666220624161712

29. Peng J., Xiao X., Hu M., Zhang X. Interaction between gut microbiome and cardiovascular disease. Life Sci 2018;214:153–7. DOI: 10.1016/j.lfs.2018.10.063

30. Tang W.H.W., Li D.Y., Hazen S.L. Dietary metabolism, the gut microbiome, and heart failure. Nat Rev Cardiol 2019;16(3):137–54. DOI: 10.1038/s41569-018-0108-7

31. Lu Y., Zhang Y., Zhao X. et al. Microbiota-derived short-chain fatty acids: implications for cardiovascular and metabolic disease. Front Cardiovasc Med 2022;9:900381. DOI: 10.3389/fcvm.2022.900381

32. Zhou X., Jin M., Liu L. et al. Trimethylamine N-oxide and cardiovascular outcomes in patients with chronic heart failure after myocardial infarction. ESC Heart Failure 2020;7(1):188–93. DOI: 10.1002/ehf2.12552

33. Sanchez-Gimenez R., Ahmed-Khodja W., Molina Y. et al. Gut microbiota-derived metabolites and cardiovascular disease risk: a systematic review of prospective cohort studies. Nutrients 2022;14(13):2654. DOI: 10.3390/nu14132654

34. Li J., Zhao F., Wang Y. et al. Gut microbiota dysbiosis contributes to the development of hypertension. Microbiome 2017;5(1):14. DOI: 10.1186/s40168-016-0222-x

35. Zhen J., Zhou Z., He M. et al. The gut microbial metabolite trimethylamine N-oxide and cardiovascular diseases. Front Endocrinol (Lausanne) 2023;14:1085041. DOI: 10.3389/fendo.2023.1085041

36. Oniszczuk A., Oniszczuk T., Gancarz M., Szymańska J. Role of gut microbiota, probiotics and prebiotics in the cardiovascular diseases. Molecules 2021;26(4):1172. DOI: 10.3390/molecules26041172

37. Sanchez-Rodriguez E., Egea-Zorrilla A., Plaza-Díaz J. et al. The gut microbiota and its implication in the development of atherosclerosis and related cardiovascular diseases. Nutrients 2020;12(3):605. DOI: 10.3390/nu12030605

38. Manolis A.A., Manolis T.A., Melita H., Manolis A.S. Gut microbiota and cardiovascular disease: symbiosis versus dysbiosis. Curr Med Chem 2022;29(23):4050–77. DOI: 10.2174/0929867328666211213112949

39. Jin L., Shi X., Yang J. et al. Gut microbes in cardiovascular diseases and their potential therapeutic application. Protein Cell 2021;12(5):346–59. DOI: 10.1007/s13238-020-00785-9