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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2023; 13(01): 001-016
DOI: 10.1055/s-0043-1768145
Review Article

Review: Microbial Therapeutics for Liver Disease

Cyriac Abby Philips 
1   Clinical and Translational Hepatology and Monarch Liver Laboratory, The Liver Institute, Center for Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
,
Philip Augustine
2   Gastroenterology and Advanced GI Endoscopy, Center for Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
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Abstract

The human gut contains many microorganisms, including bacteria, fungi, viruses, and archaea. Patients with liver disorders have altered intestinal flora and disrupted gut barriers. The role of the gut microbiota in the pathophysiology of many liver disorders is apparent from preclinical models and clinical studies. High-quality studies showed that people with acute or chronic liver disorders of various etiologies, such as non–alcohol- and alcohol-related liver disease, chronic hepatitis virus infection, chronic cholestatic liver disease, and liver cirrhosis and related complications, have less diverse gut flora and associated perturbed microbial functional metabolism. In this review, we discuss unique therapeutic strategies for various liver diseases that involve manipulating the gut microbiota using various methods. We provide a summary of the most recent information on untargeted methods for treating liver illnesses, such as probiotics, prebiotics, and postbiotics, fecal microbiota transplantation, and precision microbiome-centered treatments (e.g., engineered microbes). Recent research suggests that altering the gut microbiota in various ways might slow the onset of liver disease and lessen the associated clinical complications. Growing evidence suggests that antimicrobial therapy with rifaximin can beneficially alter the gut microbiome to reduce hepatic encephalopathy, portal hypertension, and systemic inflammation in decompensated cirrhosis. At the same time, a healthy donor stool transplant improves transplant-free survival in severe alcohol-associated hepatitis, prevents hepatic encephalopathy, and reduces incident and intercurrent infections and multidrug resistance in decompensated cirrhosis.

Keywords

gut microbiome - NAFLD - sepsis - hepatic encephalopathy - hepatocellular carcinoma - HBV - HCV - DILI

Author Contributions

C.A.P.: conceptualization, writing - original draft, writing - review and editing. P.A.: supervision, writing - review and editing.




Publication History

Received: 19 January 2023

Accepted: 02 March 2023

Article published online:
22 September 2023

© 2023. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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