The Role of Gut Microbiome-Targeted Therapy in Nonalcoholic Fatty Liver Disease
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FATTY LIVER DISEASE (V AJMERA, SECTION EDITOR)
The Role of Gut Microbiome-Targeted Therapy in Nonalcoholic Fatty Liver Disease Chencheng Xie 1 & Dina Halegoua-DeMarzio 1 Accepted: 16 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the role and progress of microbiome-targeting therapies in nonalcoholic fatty liver disease (NAFLD). This review summarizes recent clinical trials of probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) and analyzes the potential clinical impact of reverse dysbiosis in NAFLD. Recent Findings Though results might be mixed, the recent randomized clinical trials and systemic reviews indicate probiotics, prebiotics, and synbiotics are promising therapies that improve transaminitis and hepatic steatosis. The scarcity of FMT clinical trials limits the power to conclude the direct impact of FMT on NAFLD. Summary Given the rapidly growing prevalence of NAFLD and the lack of effective pharmacological intervention, there is an urgent need for the development of novel therapeutic strategies. Despite the advancements in and promising results of gut microbiome (GM) restoring remedies, further studies are needed to assess their beneficial efficacy, safety, and sustainability to develop novel pharmacologic approaches to NAFLD. Keywords Gut microbiome . Nonalcoholic fatty liver disease . Probiotic . Prebiotic . Synbiotic . Fecal microbiota transplantation
Introduction Nonalcoholic fatty liver disease (NAFLD) is characterized by excessive fat accumulation in the hepatocyte. The presentation of NAFLD can vary due to a broad disease spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) that can not only progress to cirrhosis but is also a major risk factor for hepatocellular carcinoma [1–5]. The increasing prevalence of NAFLD correlates with metabolic syndrome, obesity, and insulin resistance, and affects 25% of the population globally [6]. Despite the sharp increase in prevalence, lifestyle and diet modifications remain the mainstay therapeutic strategies for NAFLD patients with there being a lack of definitive pharmacological treatments. It is widely accepted that the pathophysiology of NAFLD is linked to insulin resistance, dyslipidemia, obesity, metabolic syndrome, This article is part of the Topical Collection on Fatty Liver Disease * Dina Halegoua-DeMarzio [email protected] 1
Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, 132 South 10th Street, #450, Philadelphia, PA 19107, USA
intrahepatic inflammation, and oxidative stress. Multiple factors contribute to NAFLD onset and progression including environment, diet, and genetic tendencies that can alter biochemical metabolism and immunological hemostasis [7–9]. Recent studies linking obesity and diabetes mellitus to alteration in the gut microbiome (GM) have also brought attention to its potential link to the development of NAFLD. The host provides environment and nutrients for
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