Nitrate-Responsive Oral Microbiome Modulates Nitric Oxide Homeostasis and Blood Pressure in Humans
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View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Online Research @ Cardiff This is an Open Access document downloaded from ORCA, Cardiff University's institutional repository: http://orca.cf.ac.uk/111622/ This is the author’s version of a work that was submitted to / accepted for publication. Citation for final published version: Vanhatalo, Anni, Blackwell, Jamie, L'Heureux, Joanna, Williams, David, Smith, Ann, van der Giezen, Mark, Winyard, Paul, Kelly, James and Jones, Andrew 2018. Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans. Free Radical Biology and Medicine 124 , pp. 21-30. 10.1016/j.freeradbiomed.2018.05.078 file Publishers page: https://doi.org/10.1016/j.freeradbiomed.2018.05.07... <https://doi.org/10.1016/j.freeradbiomed.2018.05.078> Please note: Changes made as a result of publishing processes such as copy-editing, formatting and page numbers may not be reflected in this version. For the definitive version of this publication, please refer to the published source. You are advised to consult the publisher’s version if you wish to cite this paper. This version is being made available in accordance with publisher policies. See http://orca.cf.ac.uk/policies.html for usage policies. Copyright and moral rights for publications made available in ORCA are retained by the copyright holders. 1 Nitrate-responsive oral microbiome modulates nitric oxide 2 homeostasis and blood pressure in humans 3 4 Anni Vanhatalo1, Jamie R. Blackwell1, Joanna L’Heureux1, David W. Williams2, Ann 5 Smith3, Mark van der Giezen1, Paul G. Winyard4, James Kelly1, Andrew M. Jones1 6 7 1 College of Life and Environmental Sciences, University of Exeter, Exeter EX1 1TE, UK; 2 8 School of Dentistry and 3 Division of Population Medicine, Cardiff University, Cardiff CF14 9 4XY UK; 4 University of Exeter Medical School, University of Exeter, Exeter EX1 1TE, UK. 10 11 Running Head: Dietary nitrate and oral microbiome 12 13 14 Correspondence: 15 Anni Vanhatalo, Ph.D. 16 E-mail: [email protected] 17 Tel: 01392 722886 18 Fax: 01392 264726 19 1 20 Abstract 21 Imbalances in the oral microbial community have been associated with reduced 22 cardiovascular and metabolic health. A possible mechanism linking the oral microbiota to - - 23 health is the nitrate (NO3 )-nitrite (NO2 )-nitric oxide (NO) pathway, which relies on oral - - - 24 bacteria to reduce NO3 to NO2 . NO (generated from both NO2 and L-arginine) regulates 25 vascular endothelial function and therefore blood pressure (BP). By sequencing bacterial 16S 26 rRNA genes we examined the relationships between the oral microbiome and physiological 27 indices of NO bioavailability and possible changes in these variables following 10 days of - 28 NO3 (12 mmol/d) and placebo supplementation in young (18-22 yrs) and old (70-79 yrs) - 29 normotensive humans (n=18). NO3 supplementation altered the salivary microbiome 30 compared to placebo by increasing the relative abundance of Proteobacteria (+225%) and - 31 decreasing the relative abundance of Bacteroidetes (-46%; P<0.05). After NO3 32 supplementation the relative abundances of Rothia (+127%) and Neisseria (+351%) were 33 greater, and Prevotella (-60%) and Veillonella (-65%) were lower than in the placebo - - 34 condition (all P<0.05). NO3 supplementation increased plasma concentration of NO2 and 35 reduced systemic blood pressure in old (70-79 yrs), but not young (18-22 yrs), participants. 36 High abundances of Rothia and Neisseria and low abundances of Prevotella and Veillonella - - 37 were correlated with greater increases in plasma [NO2 ] in response to NO3 supplementation. 38 The current findings indicate that the oral microbiome is malleable to change with increased - 39 dietary intake of inorganic NO3 , and that diet-induced changes in the oral microbial 40 community are related to indices of NO homeostasis and vascular health in vivo. 41 42 Keywords: Ageing; cardiovascular health; oral nitrate reduction; nitrite; 16S rRNA 43 sequencing; host-microbe symbiosis; prebiotic. 44 2 45 Introduction 46 - 47 Inorganic nitrate (NO3 ) is a natural part of the human diet that is found in high - 48 concentrations in many vegetables. NO3 itself is biologically inert and human cells are - 49 believed to lack NO3 -reductase capability. However, commensal bacteria in the oral cavity - 50 can use nitrate as a terminal electron acceptor for ATP synthesis, reducing NO3 to nitrite - - 51 (NO2 ; which can be vasoactive in low-oxygen and low-pH conditions) and this NO2 can be - 52 further reduced to the potent vasodilator, nitric oxide (NO) (Dejam et al. 2004). The NO3 - - - 53 NO2 -NO reduction pathway underpins the discovery that dietary NO3 supplementation - 54 through consumption of NO3 salts (Larsen et al. 2006) or vegetable products such as beetroot 55 juice (Kelly et al. 2013a; Webb et al. 2008) reduces blood pressure (BP) in healthy young and 56 old humans. 57 - - 58 The importance of a functioning oral microbiome for the NO3 - NO2 -NO reduction pathway 59 is highlighted in cases where use of antibacterial mouthwash markedly blunts the increase in - 60 plasma and saliva NO2 concentrations and associated decrease in BP following ingestion of a - 61 standardised NO3 dose (Govoni et al. 2008; Kapil et al. 2013; McDonagh et al. 2015). 62 Epidemiological studies also indicate that dysbiosis of the oral microbial community is 63 associated with poor cardiovascular health (Briskey et al. 2016). Conversely, a diet rich in - 64 vegetables, which contain high concentrations of inorganic NO3 , significantly protects 65 against both coronary heart disease and stroke (Bondonno et al. 2017; Hung et al. 2004; 66 Joshipura et al. 2009). Ageing has been associated with reduced salivary flow rate (‘dry 67 mouth’) and altered oral bacterial colonisation (Percival et al. 1991; Xu et al. 2015), but it is - 68 not known whether the abundances of NO3 reducing oral bacteria decline with age. Dietary - - 69 NO3 intake, and the abundance of NO3 -reducing oral bacteria, therefore represent routes to 3 70 lower blood pressure and maintain and improve cardiovascular health across the human 71 lifespan. 72 - - 73 It is possible that dietary NO3 as a prebiotic treatment might promote proliferation of NO3 - 74 reducing bacteria. In a rodent model, a NO3 -rich diet over 7 days increased abundance of - 75 oral bacteria (Streptococcus and Haemophilus) that contain NO3 reductase genes (Hyde et al. - 76 2014a). In saliva samples of hypercholesterolaemic humans, 6 weeks of NO3 77 supplementation with beetroot juice significantly increased the abundance of Neisseria - 78 flavescens and tended to increase Rothia mucilaginosa which are known NO3 reducers - 79 (Velmurugan et al. 2016). These studies indicate that increased dietary NO3 intake may alter - 80 the oral microbiome in a way which enhances an individual’s ability to reduce ingested NO3 , - 81 resulting in greater plasma NO2 concentration and a greater reduction in systemic blood 82 pressure. However, characterisation of potential changes in the oral microbiome of healthy - 83 young and old humans in response to NO3 supplementation is lacking. 84 85 In the present study, we used 16S rRNA gene sequencing to investigate whether abundances - 86 of NO3 -reducing bacteria on the surface of the human tongue modulate an individual’s - 87 response to NO3 supplementation in young (18-22 years) and old (70-79 years) normotensive - 88 adults. We hypothesised that at baseline, abundances of known NO3 -reducing bacteria 89 (including Neisseria, Prevotella, Rothia, Veillonella and Actinomycetales) would be greater 90 in young compared to old participants, and that high abundances of these bacteria at baseline - 91 would be associated with higher plasma NO2 concentrations, and greater changes in blood - 92 pressure and arterial stiffness in response to NO3 supplementation. Secondly, we investigated - 93 whether 10 days of regular dietary NO3 ingestion altered the oral microbiome compared with 94 placebo supplementation. It was hypothesised that oral microbiomes would be different 4 - 95 between placebo and NO3 conditions, and specifically that the relative abundances of - - 96 bacteria capable of NO3 reduction would be greater after NO3 compared to placebo 97 supplementation. 98 99 Methods 100 101 Ethical approval 102 The study was approved by the institutional Ethics Committee (Sport and Health Sciences, 103 University of Exeter) and conducted in accordance with the code of the ethical principles of 104 the World Medical Association (Declaration of Helsinki). All participants gave their written, 105 informed consent before the commencement of the study, once the experimental procedures, 106 associated risks, and potential benefits of participation had been explained. 107 108 Study participants 109 Nine old adults including six females (mean ± SD, age 75 ± 3 yrs, age range 70-79 yrs, height 110 162 ± 6 cm, body mass 61.8 ± 14.0 kg) and three males (age 73 ± 5 yrs, age range 70-78 yrs, 111 height 172 ± 4 cm, body mass 77.7 ± 11.6 kg) and nine young adults including five females 112 (age 20 ± 1 yrs, age range 19-22 yrs, height 168 ± 7 cm, body mass 67.9 ± 10.3 kg) and four 113 males (age 20 ± 2 yrs, age range 18-22 yrs, height 180 ± 4 cm, body mass 73.4 ± 12.9 kg) 114 volunteered to participate in this study (Table 1). All participants were of Caucasian 115 ethnicity. The nine old adults represented a subsample of a larger cohort tested for a Dunhill 116 Medical Trust funded project (R269/1112) from which the microbiome of the tongue and 117 saliva were retrospectively analysed. Participants were screened prior to participation to 118 ensure suitability for the study. All participants were ostensibly healthy and were not taking 119 medication or dietary supplements. None of the participants were tobacco smokers and all 5 120 reported having no oral diseases.