Data availability
All data supporting the findings in this study are available within the paper and its supplementary information. 16S RNA gene sequencing data generated in this study have been deposited in the NCBI’s Sequence Read Archive (SRA) under accession number PRJNA1250224. Metabolomics data generated in this study have been deposited in MetaboLights and are accessible through the accession number MTBLS12426. Source data is available for Figs. 2–7 and Supplementary Figs. 4–9, 11, 13–17, 20–28 in the associated source data file. Source data are provided with this paper.
References
-
Libby, P. The changing landscape of atherosclerosis. Nature 592, 524–533 (2021).
-
Libby, P. et al. Atherosclerosis. Nat. Rev. Dis. Prim. 5, 56 (2019).
-
Kong, P. et al. Inflammation and atherosclerosis: signaling pathways and therapeutic intervention. Signal Transduct. Target Ther. 7, 131 (2022).
-
Zhu, Q. et al. Microenvironment-responsive coating for vascular stents to regulate coagulation-inflammation interaction and promote vascular recovery. Bioact. Mater. 48, 443–457 (2025).
-
Chunawala, Z. S. et al. Mortality in patients hospitalized with acute myocardial infarction without standard modifiable risk factors: the aric study community surveillance. J. Am. Heart Assoc. 12, e027851 (2023).
-
Figtree, G. A. & Vernon, S. T. Coronary artery disease patients without standard modifiable risk factors (SMuRFs)- a forgotten group calling out for new discoveries. Cardiovasc Res 117, e76–e78 (2021).
-
Ma, S. R. et al. Berberine treats atherosclerosis via a vitamine-like effect down-regulating Choline-TMA-TMAO production pathway in gut microbiota. Signal Transduct. Target Ther. 7, 207 (2022).
-
Wang, Z. et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature 472, 57–63 (2011).
-
Koeth, R. A. et al. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat. Med 19, 576–585 (2013).
-
Seldin, M.M. et al. Trimethylamine N-Oxide Promotes Vascular Inflammation Through Signaling of Mitogen-Activated Protein Kinase and Nuclear Factor-κB. J. Am. Heart Assoc. 5, 10.1161/JAHA.115.002767 (2016).
-
Bennett, B. J. et al. Trimethylamine-N-oxide, a metabolite associated with atherosclerosis, exhibits complex genetic and dietary regulation. Cell Metab. 17, 49–60 (2013).
-
Craciun, S., Marks, J. A. & Balskus, E. P. Characterization of choline trimethylamine-lyase expands the chemistry of glycyl radical enzymes. ACS Chem. Biol. 9, 1408–1413 (2014).
-
Ross, F. C. et al. The interplay between diet and the gut microbiome: implications for health and disease. Nat. Rev. Microbiol 22, 671–686 (2024).
-
Yoo, W. et al. High-fat diet-induced colonocyte dysfunction escalates microbiota-derived trimethylamine N-oxide. Science 373, 813–818 (2021).
-
Wang, Z. et al. Impact of chronic dietary red meat, white meat, or non-meat protein on trimethylamine N-oxide metabolism and renal excretion in healthy men and women. Eur. Heart J. 40, 583–594 (2019).
-
Koeth, R. A. et al. l-Carnitine in omnivorous diets induces an atherogenic gut microbial pathway in humans. J. Clin. Invest 129, 373–387 (2019).
-
Kong, L. et al. Trimethylamine N-oxide impairs β-cell function and glucose tolerance. Nat. Commun. 15, 2526 (2024).
-
Dave, N. et al. Dietary choline intake is necessary to prevent systems-wide organ pathology and reduce Alzheimer’s disease hallmarks. Aging Cell 22, e13775 (2023).
-
Yu, D. et al. Higher dietary choline intake is associated with lower risk of nonalcoholic fatty liver in normal-weight Chinese women. J. Nutr. 144, 2034–2040 (2014).
-
Moretti, A. et al. Choline: an essential nutrient for skeletal muscle. Nutrients. 12, 10.3390/nu12072144 (2020).
-
Motika, M. S., Zhang, J. & Cashman, J. R. Flavin-containing monooxygenase 3 and human disease. Expert Opin. Drug Metab. Toxicol. 3, 831–845 (2007).
-
Roberts, A. B. et al. Development of a gut microbe-targeted nonlethal therapeutic to inhibit thrombosis potential. Nat. Med 24, 1407–1417 (2018).
-
Saadh, M. J. et al. Therapeutic potential of lipid-lowering probiotics on the atherosclerosis development. Eur. J. Pharm. 971, 176527 (2024).
-
Liu, W. et al. The Metabolite Indole-3-Acetic Acid of Bacteroides Ovatus Improves Atherosclerosis by Restoring the Polarisation Balance of M1/M2 Macrophages and Inhibiting Inflammation. Adv. Sci. (Weinh.) 12, e2413010 (2025).
-
Cao, F. et al. Artificial-enzymes-armed Bifidobacterium longum probiotics for alleviating intestinal inflammation and microbiota dysbiosis. Nat. Nanotechnol. 18, 617–627 (2023).
-
Lu, Y. et al. Gut microbe-derived metabolite indole-3-carboxaldehyde alleviates atherosclerosis. Signal Transduct. Target Ther. 8, 378 (2023).
-
Wang, K. et al. Mucoadhesive probiotic-based oral microcarriers with prolonged intestinal retention for inflammatory bowel disease therapy. Nano Today. 50, 10.1126/sciadv.abp8798 (2023).
-
Ma, B. et al. Targeting theranostics of atherosclerosis by dual-responsive nanoplatform via photoacoustic imaging and three-in-one integrated lipid management. Adv Mater, e2206129 10.1002/adma.202206129 (2022).
-
Dai, L. et al. A pH/ROS Cascade-Responsive Charge-Reversal Nanosystem with Self-Amplified Drug Release for Synergistic Oxidation-Chemotherapy. Adv. Sci. (Weinh.) 6, 1801807 (2019).
-
Saravanakumar, G., Kim, J. & Kim, W. J. Reactive-Oxygen-Species-Responsive Drug Delivery Systems: Promises and Challenges. Adv. Sci. (Weinh.) 4, 1600124 (2017).
-
Heavey, M. K. et al. Targeted delivery of the probiotic Saccharomyces boulardii to the extracellular matrix enhances gut residence time and recovery in murine colitis. Nat. Commun. 15, 3784 (2024).
-
Wang, M. et al. Trimethylamine N-oxide is associated with long-term mortality risk: the multi-ethnic study of atherosclerosis. Eur. Heart J. 44, 1608–1618 (2023).
-
Adolph, T. E. & Tilg, H. Western diets and chronic diseases. Nat. Med 30, 2133–2147 (2024).
-
Ma, B. et al. Biomimetic Targeting Nanoplatform for Atherosclerosis Theranostics Via Photoacoustic Diagnosis and “Hand-In-Hand” Immunoregulation. Advanced Functional Materials, 111009 (2023).
-
Ma, B. et al. Reactive Oxygen Species Responsive Theranostic Nanoplatform for Two-Photon Aggregation-Induced Emission Imaging and Therapy of Acute and Chronic Inflammation. ACS Nano, 10.1016/j.isci.2024.111009 (2020).
-
Wang, Y. et al. A thrombin-triggered self-regulating anticoagulant strategy combined with anti-inflammatory capacity for blood-contacting implants. Sci. Adv. 8, eabm3378 (2022).
-
Luo, Y. et al. Precise oral delivery systems for probiotics: A review. J. Control Release 352, 371–384 (2022).
-
Guo, P. et al. Engineered probiotic ameliorates ulcerative colitis by restoring gut microbiota and redox homeostasis. Cell Host Microbe 32, 1502–1518.e9 (2024).
-
Otani, T. & Furuse, M. Tight junction structure and function revisited. Trends Cell Biol. 30, 805–817 (2020).
-
Benson, T. W. et al. Gut microbiota-derived trimethylamine n-oxide contributes to abdominal aortic aneurysm through inflammatory and apoptotic mechanisms. Circulation 147, 1079–1096 (2023).
-
Suntornsaratoon, P. et al. Lactobacillus rhamnosus gg stimulates dietary tryptophan-dependent production of barrier-protecting methylnicotinamide. Cell Mol. Gastroenterol. Hepatol. 18, 101346 (2024).
-
Miao, J. et al. Flavin-containing monooxygenase 3 as a potential player in diabetes-associated atherosclerosis. Nat. Commun. 6, 6498 (2015).
-
Chen, M. L. et al. Resveratrol Attenuates Trimethylamine-N-Oxide (TMAO)-Induced Atherosclerosis by Regulating TMAO Synthesis and Bile Acid Metabolism via Remodeling of the Gut Microbiota. mBio 7, e02210-15 (2016).
-
Ding, H. et al. Protocatechuic acid alleviates TMAO-aggravated atherosclerosis via mitigating inflammation, regulating lipid metabolism, and reshaping gut microbiota. Food Funct. 15, 881–893 (2024).
-
Lin, X. et al. Isolation of potentially novel species expands the genomic and functional diversity of Lachnospiraceae. Imeta 3, e174 (2024).
-
Grisham, M. B. Oxidants and free radicals in inflammatory bowel disease. Lancet 344, 859–861 (1994).
-
Petersen, C. et al. T cell-mediated regulation of the microbiota protects against obesity. Science. 365, eaat9351 (2019).
-
Liu, F. et al. Millet shell polyphenols prevent atherosclerosis by protecting the gut barrier and remodeling the gut microbiota in ApoE(−/−) mice. Food Funct. 12, 7298–7309 (2021).
-
Yang, J. et al. Oscillospira – a candidate for the next-generation probiotics. Gut Microbes 13, 1987783 (2021).
-
Li, C. et al. Gut microbiome and metabolome profiling in Framingham heart study reveals cholesterol-metabolizing bacteria. Cell 187, 1834–1852.e19 (2024).
-
Liu, H. et al. Alterations in the gut microbiome and metabolism with coronary artery disease severity. Microbiome 7, 68 (2019).
-
Kasahara, K. et al. Interactions between Roseburia intestinalis and diet modulate atherogenesis in a murine model. Nat. Microbiol 3, 1461–1471 (2018).
-
Gaillard, T., Schuster, D. & Osei, K. Differential impact of serum glucose, triglycerides, and high-density lipoprotein cholesterol on cardiovascular risk factor burden in nondiabetic, obese African American women: implications for the prevalence of metabolic syndrome. Metabolism 59, 1115–1123 (2010).
-
Costa, M. C. et al. Trigonelline and curcumin alone, but not in combination, counteract oxidative stress and inflammation and increase glycation product detoxification in the liver and kidney of mice with high-fat diet-induced obesity. J. Nutr. Biochem 76, 108303 (2020).
-
Casale, M. et al. Topical Ectoine: A promising molecule in the upper airways inflammation-a systematic review. Biomed. Res Int 2019, 7150942 (2019).
-
Kadam, P. et al. Recent advances in production and applications of ectoine, a compatible solute of industrial relevance. Bioresour. Technol. 393, 130016 (2024).
-
Vangaveti, V., Baune, B. T. & Kennedy, R. L. Hydroxyoctadecadienoic acids: novel regulators of macrophage differentiation and atherogenesis. Ther. Adv. Endocrinol. Metab. 1, 51–60 (2010).
-
Duan, J. et al. Senescence-associated 13-HODE production promotes age-related liver steatosis by directly inhibiting catalase activity. Nat. Commun. 14, 8151 (2023).
-
Levan, S. R. et al. Elevated faecal 12,13-diHOME concentration in neonates at high risk for asthma is produced by gut bacteria and impedes immune tolerance. Nat. Microbiol 4, 1851–1861 (2019).
-
Kumar, N. et al. 15-Lipoxygenase metabolites of α-linolenic acid, [13-(S)-HPOTrE and 13-(S)-HOTrE], mediate anti-inflammatory effects by inactivating NLRP3 inflammasome. Sci. Rep 6, 31649 (2016).
Acknowledgements
This research was financially supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project (grant number 2023ZD0503904 to W.Z.), National Natural Science Foundation of China (grant number 32201128 to B.M., grant number 82270262 to W.Z., grant number 32301100 to Yanan Wang), Zhejiang TCM Science and Technology Program TCM modernization special project, China (grant number 2022ZX012 to G.F.), Natural Science Funds of Zhejiang Province, China (grant number ZCLY24H1801 to B.M.). The schematic figures were created with BioRender.com. We thank Xiaoli Hong from the Core Facilities, Zhejiang University School of Medicine, for their technical support.
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Chen, Z., Zhu, Q., Xu, H. et al. Nano-functionalized probiotic treats atherosclerosis via inhibiting intestinal microbiota-TMA-TMAO axis. Nat Commun (2025). https://doi.org/10.1038/s41467-025-66448-7
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DOI: https://doi.org/10.1038/s41467-025-66448-7
