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• W4353056855 abstract "The gut microbiome consists of more than a thousand different microbes and their associated genes and microbial metabolites. It influences various host metabolic pathways and is therefore important for homeostasis. In recent years, its influence on health and disease has been extensively researched. In case of a microbiome disequilibrium, called dysbiosis, the gut microbiome is associated with several diseases. Consequent chronic inflammation may lead to or promote inflammatory bowel disease, obesity, diabetes mellitus, atherosclerosis, alcoholic and non-alcoholic liver disease, cirrhosis, hepatocellular carcinoma, and other diseases. The pathogenesis of the three most common retinal vascular diseases, diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion, may also be influenced by an altered microbiome and associated risk factors such as diabetes mellitus, atherosclerosis, hypertension, and obesity. Direct cause–effect relationships remain less well understood. A potential prevention or treatment modality for these diseases could be targeting and modulating the individual's gut microbiome. The gut microbiome consists of more than a thousand different microbes and their associated genes and microbial metabolites. It influences various host metabolic pathways and is therefore important for homeostasis. In recent years, its influence on health and disease has been extensively researched. In case of a microbiome disequilibrium, called dysbiosis, the gut microbiome is associated with several diseases. Consequent chronic inflammation may lead to or promote inflammatory bowel disease, obesity, diabetes mellitus, atherosclerosis, alcoholic and non-alcoholic liver disease, cirrhosis, hepatocellular carcinoma, and other diseases. The pathogenesis of the three most common retinal vascular diseases, diabetic retinopathy, retinal vein occlusion, and retinal artery occlusion, may also be influenced by an altered microbiome and associated risk factors such as diabetes mellitus, atherosclerosis, hypertension, and obesity. Direct cause–effect relationships remain less well understood. A potential prevention or treatment modality for these diseases could be targeting and modulating the individual's gut microbiome. Retinal vascular diseases (RVDs) refer to a range of diseases affecting the blood vessels in the eyes and represent a major part of ophthalmic disease burden in the general population. Diabetic retinopathy (DR) is the most common RVD, followed by retinal vein occlusion (RVO) and retinal artery occlusion (RAO).1Jampol L.M. Glassman A.R. Sun J. Evaluation and care of patients with diabetic retinopathy.N Engl J Med. 2020; 382: 1629-1637Crossref PubMed Scopus (98) Google Scholar,2Leasher J.L. Bourne R.R.A. Flaxman S.R. Jonas J.B. Keeffe J. Naidoo K. Pesudovs K. Price H. White R.A. Wong T.Y. Resnikoff S. Taylor H.R. Vision Loss Expert Group of the Global Burden of Disease StudyGlobal estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010.Diabetes Care. 2016; 39: 1643-1649Crossref PubMed Scopus (368) Google Scholar Due to the large number of affected patients and the immense disease burden, it is of medical and economic interest to find measures of improving treatment and ultimately preventing these diseases. Although the three entities DR, RVO, and RAO have different pathophysiologic characteristics, they share common risk factors such as atherosclerosis, arterial hypertension, dyslipidemia, and obesity.3Lin K.Y. Hsih W.H. Lin Y.B. Wen C.Y. Chang T.J. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy.J Diabetes Investig. 2021; 12: 1322-1325Crossref PubMed Scopus (70) Google Scholar, 4The Eye Disease Case-control Study GroupRisk factors for branch retinal vein occlusion.Am J Ophthalmol. 1993; 116: 286-296Abstract Full Text PDF PubMed Scopus (276) Google Scholar, 5Scott I.U. Campochiaro P.A. Newman N.J. Biousse V. Retinal vascular occlusions.Lancet. 2020; 396: 1927-1940Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar In recent years, extensive research has been done to understand the gut microbiome and its impact on health and disease. It influences metabolic processes and the immune system of its host through microbial-derived metabolites. Our gut microbiome consists of microbes including bacteria, archaea, viruses, and eukaryotes, and their microbial products and genes. It comprises more than a thousand different species of bacteria and carries about 150 times more genes than found in the entire human genome. This leads to the assumption that this “essential organ” is of utmost importance for homeostasis and health.6Wang B. Yao M. Lv L. Ling Z. Li L. The human microbiota in health and disease.Engineering. 2017; 3: 71-82Crossref Scopus (471) Google Scholar With the introduction of modern high-throughput sequencing techniques, such as 16S rRNA gene sequencing and whole-metagenome shotgun sequencing, the taxonomic composition of the gut microbiome has been described. On the phylum level, Bacteroidetes, Firmicutes, Proteobacteria, Actinobacteria, Fusobacteria, and Verrucomicrobia represent the main part of the human gut microbiome.7Rinninella E. Raoul P. Cintoni M. Franceschi F. Miggiano G.A.D. Gasbarrini A. Mele M.C. What is the healthy gut microbiota composition? a changing ecosystem across age, environment, diet, and diseases.Microorganisms. 2019; 7: 14Crossref PubMed Scopus (1400) Google Scholar Associations between an imbalance in the gut microbiome's composition, called dysbiosis, and various diseases such as inflammatory bowel disease, obesity, diabetes mellitus (DM), atherosclerosis, alcoholic and non-alcoholic liver disease, cirrhosis, and hepatocellular carcinoma have been found.6Wang B. Yao M. Lv L. Ling Z. Li L. The human microbiota in health and disease.Engineering. 2017; 3: 71-82Crossref Scopus (471) Google Scholar Under dysbiotic conditions, the equilibrium shifts toward bacteria with pathogenic characteristics. This may lead to the breakdown of the intestinal epithelial barrier and subsequently to translocation of microbes and their products into the systemic circulation. These microbial products may have various effects on tissue and cells in all organs of the body, including the eye. Certain microbial products such as lipopolysaccharides (LPS) lead to inflammation. By contrast, production of microbial metabolites with protective effects, such as short-chain fatty acids (SCFAs) or bile acids (BAs), may be inhibited in case of gut dysbiosis. Furthermore, epigenetic programming through histone acetylation and deacetylation by commensal bacteria, which promotes or represses the expression of certain genes, may have an influence on pathogenesis through overactivation of the immune system leading to chronic low-grade inflammation.8Nayyar A. Gindina S. Barron A. Hu Y. Danias J. Do epigenetic changes caused by commensal microbiota contribute to development of ocular disease? a review of evidence.Hum Genomics. 2020; 14: 11Crossref PubMed Scopus (21) Google Scholar Associations between an altered gut microbiome and the pathogenesis of ophthalmic diseases as well as their risk factors have been suggested.9Karlsson F.H. Fåk F. Nookaew I. Tremaroli V. Fagerberg B. Petranovic D. Bäckhed F. Nielsen J. Symptomatic atherosclerosis is associated with an altered gut metagenome.Nat Commun. 2012; 3: 1245Crossref PubMed Scopus (858) Google Scholar, 10Avery E.G. Bartolomaeus H. Maifeld A. Marko L. Wiig H. Wilck N. Rosshart S.P. Forslund S.K. Müller D.N. The gut microbiome in hypertension: recent advances and future perspectives.Circ Res. 2021; 128: 934-950Crossref PubMed Scopus (56) Google Scholar, 11John G.K. Mullin G.E. The gut microbiome and obesity.Curr Oncol Rep. 2016; 18: 45Crossref PubMed Scopus (198) Google Scholar, 12Zysset-Burri D.C. Morandi S. Herzog E.L. Berger L.E. Zinkernagel M.S. The role of the gut microbiome in eye diseases.Prog Retin Eye Res. 2022; 92: 101117Crossref PubMed Scopus (4) Google Scholar, 13Zinkernagel M.S. Zysset-Burri D.C. Keller I. Berger L.E. Leichtle A.B. Largiadèr C.R. Fiedler G.M. Wolf S. Association of the intestinal microbiome with the development of neovascular age-related macular degeneration.Sci Rep. 2017; 7: 40826Crossref PubMed Scopus (125) Google Scholar, 14Zysset-Burri D.C. Keller I. Berger L.E. Largiadèr C.R. Wittwer M. Wolf S. Zinkernagel M.S. Associations of the intestinal microbiome with the complement system in neovascular age-related macular degeneration.NPJ Genom Med. 2020; 5: 34Crossref PubMed Scopus (31) Google Scholar, 15Napolitano P. Filippelli M. Davinelli S. Bartollino S. dell'Omo R. Costagliola C. Influence of gut microbiota on eye diseases: an overview.Ann Med. 2021; 53: 750-761Crossref PubMed Scopus (22) Google Scholar The connection between the gut microbiome and the retina has been termed the “gut-retina axis” (Figure 1).16Nadeem U. Xie B. Movahedan A. D'Souza M. Barba H. Deng N. Leone V.A. Chang E. Sulakhe D. Skondra D. High throughput RNA sequencing of germ-free mouse retina reveals metabolic pathways involved in the gut-retina axis.bioRxiv. 2020; ([Preprint] doi:)10.1101/2020.10.01.318949Google Scholar Although the role of the gut microbiome in the pathogenesis of some diseases, such as DR and RAO, has been investigated in recently published studies, its influence on other diseases such as RVO remain less understood.17Zysset-Burri D.C. Keller I. Berger L.E. Neyer P.J. Steuer C. Wolf S. Zinkernagel M.S. Retinal artery occlusion is associated with compositional and functional shifts in the gut microbiome and altered trimethylamine-N-oxide levels.Sci Rep. 2019; 9: 15303Crossref PubMed Scopus (13) Google Scholar,18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar This review aims to summarize the current knowledge linking the gut microbiome to the most common retinal vascular diseases. The pathophysiology of the three main RVDs are elucidated in the first part. In the second part, associations between these RVDs, their risk factors, and the gut microbiome are discussed. In the last part, the microbial metabolites are presented. The following paragraphs depict the three most common RVDs including their epidemiology and pathophysiology. DR is the most common retinal vascular disease and a major ocular complication of DM. The pathophysiology of DR is dominated by microvascular pathology. The microvascular retinal damage arises due to non- or inadequately controlled blood glucose levels. Although patients usually do not notice any symptoms in the early stages, later stages of the disease are often more devastating and can ultimately end in complete blindness, making it a very insidious disease. This is troublesome alone due to the epidemiologic numbers of patients affected by DM. Today, there are roughly 285 million people affected by DM worldwide of which one-third suffers from DR.19Lee R. Wong T.Y. Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss.Eye Vis (Lond). 2015; 2: 17Crossref PubMed Scopus (902) Google Scholar The most important aspect of treatment is early screening for DR in diabetic patients as well as control and regulation of blood glucose levels, anticipating hyperglycemia because it has a direct effect on DR.20Aiello L.P. DCCT/EDIC Research GroupDiabetic retinopathy and other ocular findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.Diabetes Care. 2013; 37: 17-23Crossref Scopus (152) Google Scholar Early stages are characterized by vascular retinal changes such as dot and blot hemorrhages, cotton-wool spots, venous beading, and intraretinal microvascular anomalies (Figure 2A). Patients often only notice a deterioration of vision if macular edema develops. Macular edema is characterized by retinal thickening and accumulation of intraretinal fluid in the central macula, due to breakdown of the blood-retinal barrier.21Ford J.A. Lois N. Royle P. Clar C. Shyangdan D. Waugh N. Current treatments in diabetic macular oedema: systematic review and meta-analysis.BMJ Open. 2013; 3: e002269Crossref PubMed Scopus (87) Google Scholar In advanced disease stages, retinal hypoxia can lead to formation of new blood vessels, which can lead to various complications such as vitreous hemorrhage, glaucoma, and retinal detachment. This stage is called proliferative DR. There is a loss of retinal vessel autoregulation, basement membrane thickening, loss of pericytes, progressive nonperfusion of capillaries, and subsequent ischemia.22Ogura S. Kurata K. Hattori Y. Takase H. Ishiguro-Oonuma T. Hwang Y. Ahn S. Park I. Ikeda W. Kusuhara S. Fukushima Y. Nara H. Sakai H. Fujiwara T. Matsushita J. Ema M. Hirashima M. Minami T. Shibuya M. Takakura N. Kim P. Miyata T. Ogura Y. Uemura A. Sustained inflammation after pericyte depletion induces irreversible blood-retina barrier breakdown.JCI Insight. 2017; 2: e90905Crossref PubMed Scopus (94) Google Scholar The periarterial capillary-free zone is much larger in individuals suffering from DR.23Li H. Ding X. Lu L. Yang J. Ma J. Morphometry of the normal retinal periarteral capillary-free zone and changes during severe nonproliferative diabetic retinopathy.Clin Hemorheol Microcirc. 2019; 72: 169-178Crossref PubMed Scopus (3) Google Scholar This can lead to release of proangiogenic peptides such as vascular endothelial growth factor (VEGF), which is responsible for the formation of neovascularizations.24Lechner J. O'Leary O.E. Stitt A.W. The pathology associated with diabetic retinopathy.Vis Res. 2017; 139: 7-14Crossref PubMed Scopus (257) Google Scholar End-stage disease (proliferative DR) is associated with repeated hemorrhages from these incompetent vessels and fibrosis of the retinal surface leading to tractional retinal detachments.25Stitt A.W. Curtis T.M. Chen M. Medina R.J. McKay G.J. Jenkins A. Gardiner T.A. Lyons T.J. Hammes H.P. Simó R. Lois N. The progress in understanding and treatment of diabetic retinopathy.Prog Retin Eye Res. 2016; 51: 156-186Crossref PubMed Scopus (640) Google Scholar Treatment includes retinal laser photocoagulation of ischemic areas and altered vasculature as well as intravitreal anti-VEGF injections, steroid injections, and vitreoretinal surgery. Risk factors for DR are identical to those for DM and comprise a positive family history, age [younger for type 1 DM and older for type 2 DM (T2D)], ethnicity, sedentary lifestyle, obesity, and diet. Due to the large and continuously growing number of patients affected with DM and DR, and accumulating evidence of associations with the gut microbiome, targeting these diseases by microbiome-altering interventions are of great interest.18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar The second most common RVD is RVO. It is defined as a vascular insult of the retina based on impeded venous outflow, usually due to embolism in the venous vasculature (Figure 2B). Depending on the affected area (central retinal vein versus smaller branch retinal vein), impact on vision and complications differ. Smaller RVOs can even go unnoticed by the patient if only a peripheral area of retinal tissue is affected. Globally, about 28 million people suffer from the consequences of RVO.26Song P. Xu Y. Zha M. Zhang Y. Rudan I. Global epidemiology of retinal vein occlusion: a systematic review and meta-analysis of prevalence, incidence, and risk factors.J Glob Health. 2019; 9: 010427Crossref PubMed Scopus (132) Google Scholar The most common complication of RVO is macular edema usually causing a reduction in visual acuity.27Rogers S. McIntosh R.L. Cheung N. Lim L. Wang J.J. Mitchell P. Kowalski J.W. Nguyen H. Wong T.Y. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia.Ophthalmology. 2010; 117: 313-319.e1Abstract Full Text Full Text PDF PubMed Scopus (801) Google Scholar Development of macular edema is the consequence of increased vascular permeability due to vascular congestion and up-regulation of VEGF. Other complications are optic neuropathy, macular ischemia, vitreous hemorrhage, and retinal ischemia due to nonperfusion of retinal tissue. The latter can lead to choroidal neovascularization with potentially devastating visual outcomes.28Rehak M. Wiedemann P. Retinal vein thrombosis: pathogenesis and management.J Thromb Haemost. 2010; 8: 1886-1894Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar Because ischemic retinal areas are hard to identify upon ophthalmoscopy, they are best examined with fluorescein angiography, delineating areas of capillary nonperfusion. Fluorescein angiography also enables the detection of subclinical neovascularization. The mainstay of treatment are intravitreal anti-VEGF and steroid injections, and retinal laser photocoagulation. Risk factors are arterial hypertension, dyslipidemia, obesity, atherosclerosis, and smoking.5Scott I.U. Campochiaro P.A. Newman N.J. Biousse V. Retinal vascular occlusions.Lancet. 2020; 396: 1927-1940Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar,28Rehak M. Wiedemann P. Retinal vein thrombosis: pathogenesis and management.J Thromb Haemost. 2010; 8: 1886-1894Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar Interestingly, DM itself is an important risk factor for RVO and seems to be associated with the gut microbiome29Wang Y. Wu S. Wen F. Cao Q. Diabetes mellitus as a risk factor for retinal vein occlusion: a meta-analysis.Medicine (Baltimore). 2020; 99: e19319Crossref PubMed Scopus (17) Google Scholar,30Qin J. Li Y. Cai Z. Li S. Zhu J. Zhang F. et al.A metagenome-wide association study of gut microbiota in type 2 diabetes.Nature. 2012; 490: 55-60Crossref PubMed Scopus (4362) Google Scholar The third most common RVD is RAO with a worldwide annual incidence of about 1 to 15 per 100,000 people.31Feltgen N. Neubauer A. Jurklies B. Schmoor C. Schmidt D. Wanke J. Maier-Lenz H. Schumacher M. EAGLE-Study GroupMulticenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. EAGLE Study report no. 1.Graefes Arch Clin Exp Ophthalmol. 2006; 244: 950-956Crossref PubMed Scopus (94) Google Scholar RAO occurs due to occlusion of an arterial vessel supplying the retina. Due to the very high metabolic demand of the retina and absence of vascular bypasses, RAO usually leads to severe visual impairment within a few hours. Because of nonperfusion of retinal arteries and arterioles, and consequent retinal hypoxemia, nerve fiber swelling and breakdown of the metabolic visual cycle occurs, ultimately leading to cell death (Figure 2C). Whereas most RAO are caused by large vessel disease (macroangiopathy) such as embolization from atherosclerotic plaques, cases due to small vessel disease (microangiopathic) also exist. An inflammatory cause must be separated from a noninflammatory, purely embolic cause. Vasculitis such as giant cell arteritis can cause occlusion of arterial vessels as in RAO. Furthermore, a hypercoagulable state must be excluded. This could point to other diseases affecting the coagulation cascades or malignancies.32Hayreh S.S. Acute retinal arterial occlusive disorders.Prog Retin Eye Res. 2011; 30: 359-394Crossref PubMed Scopus (238) Google Scholar No formal treatment for patients who have suffered from a RAO is available. If the onset of symptoms is less than 4.5 hours ago, intravascular thrombolysis is a treatment option.5Scott I.U. Campochiaro P.A. Newman N.J. Biousse V. Retinal vascular occlusions.Lancet. 2020; 396: 1927-1940Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar In summary, in most of the cases of RAO, the disease can be considered as an ischemic stroke.33Sacco R.L. Kasner S.E. Broderick J.P. Caplan L.R. Connors J.J. Culebras A. Elkind M.S. George M.G. Hamdan A.D. Higashida R.T. Hoh B.L. Janis L.S. Kase C.S. Kleindorfer D.O. Lee J.M. Moseley M.E. Peterson E.D. Turan T.N. Valderrama A.L. Vinters H.V. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 2064-2089Crossref PubMed Scopus (2042) Google Scholar Patients at risk for vascular insults are also candidates for potential RAO. Inversely, in the weeks following a RAO, patients are at elevated risk for a stroke.34Callizo J. Feltgen N. Pantenburg S. Wolf A. Neubauer A.S. Jurklies B. Wachter R. Schmoor C. Schumacher M. Junker B. Pielen A. Cardiovascular risk factors in central retinal artery occlusion: results of a prospective and standardized medical examination.Ophthalmology. 2015; 122: 1881-1888Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Risk factors are atherosclerosis, hypertension, DM, obesity, dyslipidemia, and thrombus-eliciting circumstances or events, such as atrial fibrillation, whereby these risk factors seem to be influenced by the gut microbiome.5Scott I.U. Campochiaro P.A. Newman N.J. Biousse V. Retinal vascular occlusions.Lancet. 2020; 396: 1927-1940Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar,11John G.K. Mullin G.E. The gut microbiome and obesity.Curr Oncol Rep. 2016; 18: 45Crossref PubMed Scopus (198) Google Scholar,28Rehak M. Wiedemann P. Retinal vein thrombosis: pathogenesis and management.J Thromb Haemost. 2010; 8: 1886-1894Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar The direct relationship between the gut microbiome and RVDs has not been studied comprehensively. To date, there are only a few articles addressing the influence of the gut microbiome on DR and RAO17Zysset-Burri D.C. Keller I. Berger L.E. Neyer P.J. Steuer C. Wolf S. Zinkernagel M.S. Retinal artery occlusion is associated with compositional and functional shifts in the gut microbiome and altered trimethylamine-N-oxide levels.Sci Rep. 2019; 9: 15303Crossref PubMed Scopus (13) Google Scholar,18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar,35Ye P. Zhang X. Xu Y. Xu J. Song X. Yao K. Alterations of the gut microbiome and metabolome in patients with proliferative diabetic retinopathy.Front Microbiol. 2021; 12: 667632Crossref PubMed Scopus (20) Google Scholar,36Bai J. Wan Z. Zhang Y. Wang T. Xue Y. Peng Q. Composition and diversity of gut microbiota in diabetic retinopathy.Front Microbiol. 2022; 13: 926926Crossref PubMed Scopus (7) Google Scholar and no articles investigating the influence of the gut microbiome on RVO. The link between the gut microbiome and RVDs may be explained by risk factors that partially overlap between the different entities. Most of these risk factors and their associations with the gut microbiome have already been the subject of extensive research. In the following paragraphs, we review the associated changes of the gut microbiome in RAO and DR, and clarify how the risk factors for RVDs are connected with the gut microbiome. In RAO, compositional and functional shifts in the gut microbiome were reported. Using whole-metagenome shotgun sequencing, the gut microbiome of 29 patients with nonarteritic RAO was compared with that of 30 healthy controls. The class Actinobacteria and the species Bifidobacterium adolescentis, Bifidobacterium bifidum, Bacteroides stercosis, and Faecalibacterium prausnitzii were enriched in RAO patients, whereas the family Lachnospiraceae, and the genera Odoribacter and Parasutterella were enriched in controls.17Zysset-Burri D.C. Keller I. Berger L.E. Neyer P.J. Steuer C. Wolf S. Zinkernagel M.S. Retinal artery occlusion is associated with compositional and functional shifts in the gut microbiome and altered trimethylamine-N-oxide levels.Sci Rep. 2019; 9: 15303Crossref PubMed Scopus (13) Google Scholar In addition to these taxonomic differences, there were differences in functional features of the gut microbiome. The mevalonate pathway and methylerythritol phosphate pathway, both involved in cholesterol metabolism, were enriched in RAO patients. Interestingly, the identified compositional and functional alterations of the gut microbiome were closely associated with atherosclerosis. In patients with symptomatic atherosclerosis, a higher abundance of Collinsella (belonging to the class of Actinobacteria) was found. DNA found in atherosclerotic plaques mainly originates from Actinobacteria. Furthermore, an enriched mevalonate pathway, also known as the target of statins, represents an important pathway in the pathogenesis of atherosclerosis. DM is a metabolic disease characterized by impaired glucose tolerance. Its most common variant is T2D, affecting about 90% of all diabetic patients. There is evidence that in diabetic individuals compared with healthy controls, compositional and functional changes occur in the gut microbiome.30Qin J. Li Y. Cai Z. Li S. Zhu J. Zhang F. et al.A metagenome-wide association study of gut microbiota in type 2 diabetes.Nature. 2012; 490: 55-60Crossref PubMed Scopus (4362) Google Scholar The abundances of Escherichia coli, Clostridium species, Bacteroides caccae, and Eggerthella lenta were higher, whereas the abundances of Eubacterium rectale, Clostridiales sp. SS3/4, Faecalibacterium prausnitzii, and Roseburia intestinalis were lower in T2D patients compared with healthy controls.30Qin J. Li Y. Cai Z. Li S. Zhu J. Zhang F. et al.A metagenome-wide association study of gut microbiota in type 2 diabetes.Nature. 2012; 490: 55-60Crossref PubMed Scopus (4362) Google Scholar Furthermore, several microbial pathways and metabolites were identified that may lead to the progression of diabetes. Gut bacteria–derived NOD1 ligands, acting as signal molecules between the gut and extraintestinal organs, modulate insulin trafficking in pancreatic beta cells.37Zhang Q. Pan Y. Zeng B. Zheng X. Wang H. Shen X. Li H. Jiang Q. Zhao J. Meng Z.-X. Li P. Chen Z. Wei H. Liu Z. Intestinal lysozyme liberates Nod1 ligands from microbes to direct insulin trafficking in pancreatic beta cells.Cell Res. 2019; 29: 516-532Crossref PubMed Scopus (35) Google Scholar Indeed, treatment with fecal microbiota transplantation showed promising results in DM. In recently diagnosed type 1 DM patients receiving allogenic fecal microbiota transplantations from healthy donors, a decline in endogenous insulin production was observed.38de Groot P. Nikolic T. Pellegrini S. Sordi V. Imangaliyev S. Rampanelli E. Hanssen N. Attaye I. Bakker G. Duinkerken G. Joosten A. Prodan A. Levin E. Levels H. Potter van Loon B. van Bon A. Brouwer C. van Dam S. Simsek S. van Raalte D. Stam F. Gerdes V. Hoogma R. Diekman M. Gerding M. Rustemeijer C. de Bakker B. Hoekstra J. Zwinderman A. Bergman J. Holleman F. Piemonti L. De Vos W. Roep B. Nieuwdorp M. Faecal microbiota transplantation halts progression of human new-onset type 1 diabetes in a randomised controlled trial.Gut. 2021; 70: 92-105Crossref PubMed Scopus (136) Google Scholar Although there are vast similarities in the gut microbiome composition changes in patients with DM and DR, the latter has been associated with lower bacterial diversity and specific compositional changes.18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar,35Ye P. Zhang X. Xu Y. Xu J. Song X. Yao K. Alterations of the gut microbiome and metabolome in patients with proliferative diabetic retinopathy.Front Microbiol. 2021; 12: 667632Crossref PubMed Scopus (20) Google Scholar At the phylum level, Bacteroidetes were more abundant in diabetic patients with DR compared with patients with only DM.18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar Other bacteria such as the genera Blautia and Lactobacillus were more abundant in patients with DM, but without DR.18Huang Y. Wang Z. Ma H. Ji S. Chen Z. Cui Z. Chen J. Tang S. Dysbiosis and implication of the gut microbiota in diabetic retinopathy.Front Cell Infect Microbiol. 2021; 11: 646348Crossref PubMed Scopus (53) Google Scholar In another study, increased abundance of Burkholderiaceae and Burkholderiales_unclassified were found in patients with DR, whereas significantly less abundances in 22 families including Streptococcaceae, Coriobacteriaceae, and Veillonellaceae were noted.35Ye P. Zhang X. Xu Y. Xu J. Song X. Yao K. Alterations of the gut microbiome and metabolome in patients with proliferative diabetic retinopathy.Front Microbiol. 2021; 12: 667632Crossref PubMed Scopus (20) Google Scholar Furthermore, significant differences in lipid, amino, and nucleotide metabolism were observed in DR patients.35Ye P. Zhang X. Xu Y. Xu J. Song X. Yao K. Alterations of the gut microbiome and metabolome in patients with proliferative diabetic retinopathy.Front Microbiol. 2021; 12: 667632Crossref PubMed Scopus (20) Google Scholar In addition, known mediators for DR development, such as arachidonic acid, hydroxyeicosatetraenoic acids, and leukotriene, were increased in fecal samples of patients with DR.35Ye P. Zhang X. Xu Y. Xu J. Song X. Yao K. Alterations of the gut microbiome and metabolome in pat" @default.
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• W4353056855 title "Microbiome and Retinal Vascular Diseases" @default.
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• W4353056855 doi "https://doi.org/10.1016/j.ajpath.2023.02.017" @default.
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