Organelle-specific mechanisms and AI-guided stratification in gut-renal-vascular axis modulation
4 affiliations
- 1Medical Examination Center, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, 430015 Hubei China
- 2Department of Nephrology, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, 430064 Hubei China
- 3Wuhan University of Science and Technology, Wuhan, 430064 China
- 4Department of Nephrology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 450084 Hubei China
Abstract
Background: Gut-derived uremic toxins, notably indoxyl sulfate (IS), p-cresyl sulfate (PCS), and trimethylamine N-oxide (TMAO), contribute to multi-organ damage via the gut-renal-vascular axis, exacerbating chronic kidney disease (CKD) and cardiovascular pathologies. The global CKD prevalence exceeds 850 million, yet the evidence remains fragmented. Consequently, this fragmentation highlights a gap in developing integrated, mechanism-targeted strategies.
Objective: This narrative review proposes an integrative framework linking subcellular organelle damage to metabolite-driven epigenetic reprogramming within the gut-renal-vascular axis. We synthesize current evidence not as a definitive efficacy assessment, but to construct and substantiate a novel paradigm for precision stratification and intervention, highlighting the gut-derived metabolites IS, PCS, and TMAO as archetypes of this multi-scale pathophysiology.
Methods: A structured literature search of PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov (inception to May 2025) was conducted. Forty-eight studies were included for thematic synthesis. To enhance transparency, a documented study selection process was followed. Tools for risk-of-bias assessment were used descriptively to contextualize the evidence, acknowledging the interpretive nature of a narrative synthesis.
Results: The synthesis included 48 studies, encompassing approximately 15,000 participants. A descriptive summary of a subset of interventional studies suggests that some interventions may be associated with reduced composite outcome risks (e.g., one trial reported a risk ratio of 0.85). These findings indicate substantial heterogeneity in study designs and populations. Mechanistic literature frequently implicates the attenuation of NLRP3 inflammasome activation and epigenetic reprogramming as potential pathways underlying intervention effects.
Conclusions: This narrative review discusses evidence suggesting that precision-guided combined interventions may represent a potential strategy for mitigating multi-organ damage in CKM cohorts. However, the significant heterogeneity across studies necessitates a cautious, individualized approach when interpreting this evidence for clinical practice.
Graphical abstract:
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BibTeX
@article{chen2026organellespecific,
title = {{Organelle-specific mechanisms and AI-guided stratification in gut-renal-vascular axis modulation}},
author = {Jin Chen and Xuebin Cao and Shihong Xiong and Songlin Li and Kelun Wang and Wenqi Zhen and Xinyue Wang and Ke Cheng and Shanshan Yang and Yuxin Wang and Jian Chen and Na Gong},
journal = {Clinical Epigenetics},
year = {2026},
month = jul,
doi = {10.1186/s13148-026-02209-7},
url = {https://doi.org/10.1186/s13148-026-02209-7},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Organelle-specific mechanisms and AI-guided stratification in gut-renal-vascular axis modulation
AU - Jin Chen
AU - Xuebin Cao
AU - Shihong Xiong
AU - Songlin Li
AU - Kelun Wang
AU - Wenqi Zhen
AU - Xinyue Wang
AU - Ke Cheng
AU - Shanshan Yang
AU - Yuxin Wang
AU - Jian Chen
AU - Na Gong
PY - 2026
DA - 2026/07/30
JO - Clinical Epigenetics
DO - 10.1186/s13148-026-02209-7
UR - https://doi.org/10.1186/s13148-026-02209-7
AB - Background: Gut-derived uremic toxins, notably indoxyl sulfate (IS), p-cresyl sulfate (PCS), and trimethylamine N-oxide (TMAO), contribute to multi-organ damage via the gut-renal-vascular axis, exacerbating chronic kidney disease (CKD) and cardiovascular pathologies. The global CKD prevalence exceeds 850 million, yet the evidence remains fragmented. Consequently, this fragmentation highlights a gap in developing integrated, mechanism-targeted strategies. Objective: This narrative review proposes an integrative framework linking subcellular organelle damage to metabolite-driven epigenetic reprogramming within the gut-renal-vascular axis. We synthesize current evidence not as a definitive efficacy assessment, but to construct and substantiate a novel paradigm for precision stratification and intervention, highlighting the gut-derived metabolites IS, PCS, and TMAO as archetypes of this multi-scale pathophysiology. Methods: A structured literature search of PubMed, Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov (inception to May 2025) was conducted. Forty-eight studies were included for thematic synthesis. To enhance transparency, a documented study selection process was followed. Tools for risk-of-bias assessment were used descriptively to contextualize the evidence, acknowledging the interpretive nature of a narrative synthesis. Results: The synthesis included 48 studies, encompassing approximately 15,000 participants. A descriptive summary of a subset of interventional studies suggests that some interventions may be associated with reduced composite outcome risks (e.g., one trial reported a risk ratio of 0.85). These findings indicate substantial heterogeneity in study designs and populations. Mechanistic literature frequently implicates the attenuation of NLRP3 inflammasome activation and epigenetic reprogramming as potential pathways underlying intervention effects. Conclusions: This narrative review discusses evidence suggesting that precision-guided combined interventions may represent a potential strategy for mitigating multi-organ damage in CKM cohorts. However, the significant heterogeneity across studies necessitates a cautious, individualized approach when interpreting this evidence for clinical practice. Graphical abstract:
SN - 1868-7075
SN - 1868-7083
ER -