Probiotic Lactic Acid Bacteria with Nitric Oxide Synthase Activity: A Promising Approach for Cardiovascular Health

Abstract Lactic acid bacteria (LAB) are widely recognized for their probiotic properties and potential health benefits. In humans cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, necessitating the exploration of natural preventive strategies (World Health Organization, 2023). Recent investigations have highlighted the potential of probiotic LAB, particularly L. plantarum in promoting cardiovascular health through multiple mechanisms, including modulation of the gut microbiota, reduction of serum cholesterol levels, anti-inflammatory effects, antioxidant activity, antihypertensive action, glucose regulation, and nitric oxide (NO) production via nitric oxide synthase (NOS) activity. L. plantarum scavenges reactive oxygen species and enhances the activity of antioxidant enzymes like superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), thereby mitigating oxidative stress and endothelial dysfunction. It also exerts lipid-lowering effects by producing bile salt hydrolase (BSH), modulating lipid metabolism via AMPK and PPARα pathways, and synthesizing conjugated linoleic acid (CLA). Furthermore, it contributes to blood pressure regulation through angiotensin-converting enzyme (ACE) inhibitory activity and γ-aminobutyric acid (GABA) production. The interaction of LAB with the gut microbiota enhances glucose uptake and reduces systemic inflammation—key factors in managing diabetes-related cardiovascular risks. Specific LAB strains, such as L. plantarum, Lactobacillus fermentum, and Lactobacillus rhamnosus have demonstrated resilience during gastrointestinal transit and the ability to exert beneficial immunomodulatory effects. In addition to their physiological benefits, LAB strains are also widely used in the fermentation of dairy, cereal, vegetable, and meat-based foods, enhancing their functional properties and serving as accessible dietary strategies to improve cardiovascular outcomes. This review explores the promising role of LAB as probiotics for cardiovascular health and outlines directions for future research