Published online Dec 5, 2025. doi: 10.4331/wjbc.v16.i4.112221
Revised: August 3, 2025
Accepted: October 21, 2025
Published online: December 5, 2025
Processing time: 136 Days and 10.6 Hours
Chemotherapy-induced cardiotoxicity is a significant complication in cancer therapy, limiting treatment efficacy and worsening patient outcomes. Recent studies have implicated the gut microbiome and its key metabolites, such as short-chain fatty acids (SCFAs) and trimethylamine-N-oxide (TMAO), in mediating inflammation, oxidative stress, and cardiac damage. The gut-heart axis is incre
To systematically review existing evidence on the role of gut microbiome alter
A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2013 and December 2024. Studies were included if they examined chemotherapy-induced cardiotoxicity in relation to gut microbiota composition, microbial metabolites (e.g., SCFAs, TMAO), or microbiome-targeted interventions. Selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction focused on microbiota alterations, mechanistic pathways, cardiac outcomes, and quality assessments using standardized risk-of-bias tools.
Eighteen studies met the inclusion criteria. Chemotherapy was consistently associated with gut dysbiosis characterized by reduced SCFA-producing bacteria and increased TMAO-producing strains. This imbalance contributed to gut barrier disruption, systemic inflammation, and oxidative stress, all of which promote myocardial damage. SCFA depletion weakened anti-inflammatory responses, while elevated TMAO levels exacerbated cardiac fibrosis and dysfunction. Preclinical studies showed promising cardioprotective effects from probiotics, prebiotics, dietary interventions, and fecal microbiota transplantation, though human data remain limited.
Gut microbiome dysregulation plays a crucial role in the development of chemotherapy-induced cardiotoxicity. Altered microbial composition and metabolite production trigger systemic inflammation and cardiac injury. Microbiome-targeted therapies represent a promising preventive and therapeutic approach in cardio-oncology, warranting further clinical validation through well-designed trials.
Core Tip: This systematic review highlights the emerging role of the gut microbiome in chemotherapy-induced cardiotoxicity, focusing on how dysbiosis disrupts microbial metabolite balance, particularly short-chain fatty acids and trimethylamine-N-oxide, to drive inflammation, oxidative stress, and cardiac damage. The review synthesizes mechanistic insights and evaluates microbiome-targeted interventions such as probiotics, prebiotics, and fecal microbiota transplantation. It emphasizes the gut-heart axis as a novel therapeutic target in cardio-oncology and underscores the need for standardized clinical trials to translate these findings into personalized medicine.