Microbiome Prevents Sudden Death Through Occult Cardiac Sub-micrometastasis in Mice

Sudden cardiac deaths (SCDs) pose a formidable clinical challenge, and their underlying risk mechanisms are poorly understood. Using a gnotobiotic germ-free mouse model, we fortuitously discovered SCD incidences resulting from occult cardiac metastases. Female germ-free C57BL/6 mice (n=22) were raised in isolation and injected with mammary Py230 cells. Significantly higher SCD probabilities (36.3%) were observed in germ-free mice compared to gut-colonized groups (0%). Extensive examinations revealed no physical anomalies but demonstrated occult cardiac sub-micrometastasis in three out of four sudden death cases. Further analysis supported the role of occult cardiac sub-micrometastasis as the leading cause of SCDs. Remaining germ-free mice exhibited minimal primary tumors but high levels of cardiac metastases and morbidity. The gnotobiotic SCD model represents a crucial milestone in our understanding of the complex interplay between the gut microbiota and the development of occult oncological processes that ultimately culminate in SCDs and warrants further investigation into their mechanisms. ### Competing Interest Statement The authors have declared no competing interest.