Imidazole: A molecule produced by gut bacteria causes atherosclerosis

Revolution in medicine: A molecule produced by gut bacteria causes atherosclerosis, responsible for millions of deaths

The discovery, made thanks to an experiment involving hundreds of bank employees in Spain, opens the door to new treatments beyond reducing cholesterol

Paper: Imidazole propionate is a driver and therapeutic target in atherosclerosis 2025

Atherosclerosis is the main underlying cause of cardiovascular diseases. Its prevention is based on the detection and treatment of traditional cardiovascular risk factors1. However, individuals at risk for early vascular disease often remain unidentified2. Recent research has identified new molecules in the pathophysiology of atherosclerosis3, highlighting the need for alternative disease biomarkers and therapeutic targets to improve early diagnosis and therapy efficacy. Here, we observed that imidazole propionate (ImP), produced by microorganisms, is associated with the extent of atherosclerosis in mice and in two independent human cohorts. Furthermore, ImP administration to atherosclerosis-prone mice fed with chow diet was sufficient to induce atherosclerosis without altering the lipid profile, and was linked to activation of both systemic and local innate and adaptive immunity and inflammation. Specifically, we found that ImP caused atherosclerosis through the imidazoline-1 receptor (I1R, also known as nischarin) in myeloid cells. Blocking this ImP–I1R axis inhibited the development of atherosclerosis induced by ImP or high-cholesterol diet in mice. Identification of the strong association of ImP with active atherosclerosis and the contribution of the ImP–I1R axis to disease progression opens new avenues for improving the early diagnosis and personalized therapy of atherosclerosis.

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Wow, this is genuinely exciting, they say there is a causal relationship between that bacteria and atherosclerosis.

Sancho stresses that the work has been made possible thanks to the collaboration of thousands of volunteer employees of Banco Santander in Madrid, but also thanks to grants of €1 million from the “la Caixa” Foundation, €150,000 from the European Research Council and €100,000 from the State Research Agency.

If that’s all it took in terms of funding, that’s also pretty impressive too!

Another factor in atherosclerosis:

Researchers have discovered that gut bacteria produce a molecule that not only induces but also causes atherosclerosis, the accumulation of fat and cholesterol in the arteries that can lead to heart attacks and strokes. This unexpected link between microbes and cardiovascular disease — the leading cause of death in humanity — is a paradigm shift. The work was published Wednesday in the journal Nature, a showcase for the world’s best science.

another microbiome paper:

Open access paper:

Tanshinone regulated gut microbiota and TMAO to improve high-fat diet induced atherosclerosis in APOE−/− mice

Conclusion

Tanshinone has the potential to ameliorate atherosclerosis induced by a high-fat diet by promoting the proliferation of lactobacillus, reducing the abundance of lachnospiraceae, enhancing lipid metabolism, and diminishing the production of TMAO.

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Tanshinone does not seem to be readily available but the plant extract Danshen (used in TCM) from which it is derived is available as a supplement Danshen 500mg and often recommended for cancer in TCM. However, Danshen only contains 0.02% to 0.32% of Tanshinone Danshen global quality.

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In mice.

No, see above.

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What they used in the study is AGN192403, have not done enough reading to see if there is a known human dose.

These results demonstrate that the administration of AGN192403, which inhibits the ImP–I1R axis, prevents atherosclerosis linked to immune cell activation without affecting cholesterol concentration in plasma, suggesting a novel approach for atherosclerosis therapy.
Imidazole propionate is a driver and therapeutic target in atherosclerosis | Nature

It’s fairly “old” and has been studied for quite a while with regards to being a

Protective effects of rilmenidine and AGN 192403 on oxidative cytotoxicity and mitochondrial inhibitor-induced cytotoxicity in astrocytes

https://www.sciencedirect.com/science/article/abs/pii/S0891584902010419?via%3Dihub

My guess is that it should be fairly inexpensive.

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Supplemental magnesium and ginsenoside compound K for lowering imidazole propionate?

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240 participants at high risk of Mg deficiency

Not in healthy individuals who may already have normal levels on Magnesium. Fixing a Mg deficiency indicates what?

I’m more interested in how that would affect imidazole propionate in a healthy group.

This is from the Linus Pauling Institute:

“94.3% of the US population do not meet the daily requirement for vitamin D, 88.5% for vitamin E, 52.2% for magnesium, 44.1% for calcium, 43.0% for vitamin A, and 38.9% for vitamin C.”

https://lpi.oregonstate.edu/mic/micronutrient-inadequacies/overview

The magnesium study above does say that additional work is needed to determine “whether Mg treatment specifically changes the production of ImP by microbiota.”

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Keep in mind, for those taking SGLT2i, these drugs are magnesium sparing, so it’s kess likely that such users are magnesium deficient.

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From the El Pais article:

The new study shows that blood levels of imidazole propionate are lower in people with diets rich in vegetables, fruits, whole grains, fish, tea, and low-fat dairy products.

Elements of the Japanese diet. Could be Mediterranean as well, without the tea.

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Also intermittent fasting might help…
https://www.sciencedirect.com/science/article/abs/pii/S0014482724003525

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It seems to me that another and more direct path may exist to reduce imidazole propionate. Via ChatGPT:

Koh et al. (Nature, 2018), identify several Clostridial species as likely producers of imidazole propionate, including:

  • Clostridium bolteae
  • Clostridium symbiosum
  • Eggerthella lenta (a non-Clostridial Actinobacteria, but often associated)
  • Dorea longicatena
  • Ruminococcus gnavus

These microbes convert histidine → urocanate → imidazole propionate through anaerobic fermentation pathways.

It further appears that dysbiosis - involving the overgrowth or imbalance of the above Clostridial species can lead to increased imidazole propionate production

  1. Histidine Metabolism Pathway These microbes metabolize dietary histidine into urocanate, then into imidazole propionate (ImP) under anaerobic conditions.

  2. Dysbiosis Context In healthy individuals, histidine may pass through the gut without significant microbial conversion.In dysbiosis (especially when Clostridial species and Eggerthella lenta are overrepresented), more histidine gets diverted into the ImP pathway.

  3. Clinical Implications

  • Elevated ImP levels have been observed in individuals with type 2 diabetes and obesity.

  • ImP interferes with insulin signaling via activation of mTORC1 and p38Îł pathways.

  • Dysbiosis may lower microbial diversity, reducing checks on overactive histidine fermenters.

I make no claims any of us would find it easy, but I think this raises the question(s) of defining:

  • An optimal microbiome and
  • Interventions to shift sub-optimal microbiomes toward optimal ones.

Diet could help. Possible antibiotic interventions might include:

Bacterium Common Susceptible Antibiotics Resistance Notes
Clostridium bolteae Metronidazole, Vancomycin, Rifaximin May resist β-lactams, especially in biofilm form
Clostridium symbiosum Metronidazole, Clindamycin, Rifaximin Similar to other Clostridia; variable
Eggerthella lenta Metronidazole, Linezolid, Rifaximin Frequently resistant to β-lactams (e.g. penicillins, cephalosporins)
Dorea longicatena Vancomycin, Rifaximin, Clindamycin (variable) Less well-characterized; possible resistance to ampicillin
Ruminococcus gnavus Rifaximin, Metronidazole Often resistant to aminoglycosides and some cephalosporins

Market price seems to be around $20/mg. E.g. → https://www.tocris.com/products/agn-192403-hydrochloride_1072

Who’s going to be the first volunteer? I’m curious, but my last coronary calcification score was zero, so the risk/reward doesn’t work out for me.

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I work on this pathway daily as I have an acoustic neuroma. Some compounds that work the same way that I take are berberine, astaxanthin, fucoidan.

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Agmatine is an imidazoline I2 receptor agonist. I’ve been using with some slight benefit for neuropathy and sciatica pain. I also have familial hypercholesterolemia, but have not noticed this making a dent as yet.

Responding to Yogo25:

The original article speaks of the imidazole I1R receptor and blocking the I1R receptor eliminates the damage caused by imidazole. Even if the imidazole I2 and I1R receptors are similar, wouldn’t using a I2 receptor agonist make the problem worse, by causing problems even without any imidazole production in the gut ?

You’re absolutely correct. Wishful thinking on my part and ignoring that detail. It also is reported to act on I1 receptor as well, but I have not seen any studies on the effects of this action specifically.