In addition, the gut microbiota that produce imidazole propionate (ImP) such as Streptococcus mutans, Clostridium symbiotic and Eubacterium eligen have also been found to be enriched in patients with heart failure.123 ImP impacts insulin signaling at the insulin receptor substrate level by activating p38γ MAPK, thereby promoting p62 phosphorylation and subsequently inducing rapamycin complex 1 (mTORC1) signaling; these mechanisms are associated with cardiac fibrosis, hypertrophy, and heart failure.124. This evidence concerns the gene INSR and heart failure.