5. Conclusions
hepatic steatosis, metabolic syndrome, hyperoxic, microbiome dysfunction
HYPOXIC, METABOLIC SYNDROME, PATHOLOGY, HEPATIC STEATOSIS
Despite significant interindividual variation and a small number of patients with MS and baseline elevated TMAO in the study, it was noted that a hypoxic conditioning course in the mode of intermittent hypoxic–hyperoxic exposures at rest leads to a downward trend in blood TMAO, which was accompanied by a more significant reduction in cardiometabolic and hepatic indicators of MS than in the placebo group. Patients with baseline elevated values of this metabolite in the IHHE course showed a significant reduction in TMAO but a smaller degree of reduction of total cholesterol, low-density lipoproteins, and hepatic steatosis than in the subgroup of patients with baseline normal TMAO values. IHHE can potentially be considered as an effective and safe (well-tolerated) technique to improve cardiometabolic health, presumably through normalization of the gut microbiome, the barrier function of the intestinal wall, and hepatic metabolism.More research is needed to objectify the role of microbiome dysfunction and TMAO in the development and progression of metabolic syndrome components and hepatic and cardiovascular pathology, as well as to identify the cellular and molecular mechanisms of interval hypoxic exposures to TMAO levels as an indicator of the “microbiome-lipid metabolism-oxidative stress-cardiovascular risk factors” interplay. The aspect of individualization of IHHE regimens with regard to the optimal combination of procedure variables to achieve the best physiological and structural adaptations deserves special attention.