{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:48:31Z","timestamp":1791607711167,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K23HL16497"],"award-info":[{"award-number":["K23HL16497"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HL168166"],"award-info":[{"award-number":["HL168166"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["23CDA1049093"],"award-info":[{"award-number":["23CDA1049093"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comprehensive Physiology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gut dysbiosis and gut\u2010derived metabolites have been linked to pulmonary arterial hypertension. However, associations between specific microbes, and corresponding metabolites, with pulmonary arterial hypertension disease severity is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a prospective cohort study of patients with pulmonary arterial hypertension undergoing right heart catheterization, with pulmonary artery blood subject to nuclear magnetic resonance metabolomics, and simultaneous stool sample shotgun metagenomics. Validation of metabolite levels with disease severity was done in an independent cohort of pulmonary arterial hypertension patients with blood samples from right heart catheterization testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The presence of\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      species in the gut microbiome of pulmonary arterial hypertension patients was associated with less severe pulmonary hemodynamics and echocardiographic right ventricular dysfunction. Higher threonine levels were associated with more favorable pulmonary hemodynamic characteristics in both prospective and independent validation cohorts of pulmonary arterial hypertension patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Detectable\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      species in the gut microbiome of pulmonary arterial hypertension patients are associated with more favorable pulmonary hemodynamic and right ventricular characteristics. Circulating gut\u2010derived metabolites may also be involved. Further investigation into the relationship between gut microbial\n                      <jats:italic>Lactobacillus<\/jats:italic>\n                      , circulating metabolites, disease severity, and clinical outcomes in pulmonary arterial hypertension may be warranted.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cph4.70161","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:13:01Z","timestamp":1777421581000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>Lactobacillus<\/i>\n                    Is Associated With Disease in Pulmonary Arterial Hypertension: A Prospective Cohort Study"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7109-2692","authenticated-orcid":false,"given":"Arun","family":"Jose","sequence":"first","affiliation":[{"name":"Department of Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senu","family":"Apewokin","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Ollberding","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Trannguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9059-0635","authenticated-orcid":false,"given":"Sasha Z.","family":"Prisco","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thenappan","family":"Thenappan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Department of Medicine University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2755-5845","authenticated-orcid":false,"given":"Anna R.","family":"Hemnes","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-1707","authenticated-orcid":false,"given":"Jean M.","family":"Elwing","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.12.019"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.65088"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/bty560"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2025.105686"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btad728"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aad2602"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3390\/biom15101447"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00617-2022"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2020.1822729"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00033.2022"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2021-0414OC"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pul2.12051"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.119.14294"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01324-2024"},{"key":"e_1_2_13_16_1","unstructured":"Mallick H. 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