Role of gut metabolism of adrenal corticosteroids and hypertension: clues gut-cleansing antibiotics give us.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing mechanistic reasoning and preclinical animal studies.
PubMed 30681907 · doi:10.1152/physiolgenomics.00115.2018
What was done
This narrative review summarizes mechanisms and preclinical findings linking gut bacterial metabolism of endogenous glucocorticoids (corticosterone and cortisol) to systemic hypertension. The authors review biochemical pathways as well as animal studies employing gut-cleansing antibiotics and fecal microbiota transfers from hypertensive animals or humans into recipient rodents.
What was found
The abstract reports no quantitative values or effect sizes. It describes a mechanistic sequence where gut-derived steroid metabolites inhibit 11β-hydroxysteroid dehydrogenase (11β-HSD) types 1 and 2, enabling glucocorticoids to activate mineralocorticoid receptors and increase vascular resistance and sodium retention. It also notes that antibiotic-mediated gut cleansing transiently reverses hypertension in animal models and that fecal transfers from hypertensive animals or humans transfer the hypertensive phenotype to recipient mice.
Why it matters
The paper outlines a microbial-endocrine axis that could explain non-classical drivers of blood pressure elevation through altered steroid metabolism and enzyme inhibition.
Limits
The abstract reports no quantitative outcomes, sample sizes, or original human clinical trial data. Evidence is predominantly mechanistic or derived from preclinical animal models, limiting direct clinical translation.
Cited by
- supports Gut microbes metabolize cortisol into byproducts that alter renal potassium-sodium ratios, increasing fluid retention and raising blood pressure.