The Therapeutic Implications of the Gut Microbiome and Probiotics in Patients with NAFLD

Overview

Journal Diseases

Date 2019 Mar 3

PMID 30823570

Citations 28

Authors

Brandon J Perumpail

Andrew A Li

Nimy John

Sandy Sallam

Neha D Shah

Waiyee Kwong

George Cholankeril

Donghee Kim

Aijaz Ahmed

Affiliations

Soon will be listed here.

Abstract

Recent breakthrough in our understanding pertaining to the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has pointed to dysregulation or derangement of the gut microbiome, also known as dysbiosis. This has led to growing interest in probiotic supplementation as a potential treatment method for NAFLD due to its ability to retard and/or reverse dysbiosis and restore normal gut flora. A thorough review of medical literature was completed from inception through July 10, 2018 on the PubMed database by searching for key terms such as NAFLD, probiotics, dysbiosis, synbiotics, and nonalcoholic steatohepatitis (NASH). All studies reviewed indicate that probiotics had a beneficial effect in patients with NAFLD and its subset NASH. Results varied between studies, but there was evidence demonstrating improvement in liver enzymes, hepatic inflammation, hepatic steatosis, and hepatic fibrosis. No major adverse effects were noted. Currently, there are no guidelines addressing the use of probiotics in the setting of NAFLD. In conclusion, probiotics appear to be a promising option in the treatment of NAFLD. Future research is necessary to assess the efficacy of probiotics in patients with NAFLD.

Citing Articles

Therapeutic Strategies to Modulate Gut Microbial Health: Approaches for Chronic Metabolic Disorder Management.

Rondanelli M, Borromeo S, Cavioni A, Gasparri C, Gattone I, Genovese E Metabolites. 2025; 15(2).

PMID: 39997751 PMC: 11857149. DOI: 10.3390/metabo15020127.

Synergistic Effects of Probiotics and Lifestyle Interventions on Intestinal Microbiota Composition and Clinical Outcomes in Obese Adults.

Florencio G, Xavier A, Natal A, Sadoyama L, Roder D, Menezes R Metabolites. 2025; 15(2).

PMID: 39997695 PMC: 11857521. DOI: 10.3390/metabo15020070.

Yinchenhao Decoction Protects Against Acute Liver Injury in Mice With Biliary Acute Pancreatitis by Regulating the Gut Microflora-Bile Acids-Liver Axis.

Zhao X, Wu X, Hu Q, Yao J, Yang Y, Wan M Gastroenterol Res Pract. 2024; 2024:8882667.

PMID: 38966598 PMC: 11223911. DOI: 10.1155/2024/8882667.

Potential of Chlorogenic Acid in the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Animal Studies and Clinical Trials-A Narrative Review.

Ziolkiewicz A, Nizinski P, Soja J, Oniszczuk T, Combrzynski M, Kondracka A Metabolites. 2024; 14(6).

PMID: 38921480 PMC: 11205996. DOI: 10.3390/metabo14060346.

Targeting Non-Alcoholic Fatty Liver Disease with Hawthorn Ethanol Extract (HEE): A Comprehensive Examination of Hepatic Lipid Reduction and Gut Microbiota Modulation.

Wang T, Wang D, Ding Y, Xu H, Sun Y, Hou J Nutrients. 2024; 16(9).

PMID: 38732582 PMC: 11085873. DOI: 10.3390/nu16091335.

References

Li Z, Yang S, Lin H, Huang J, Watkins P, Moser A . Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease. Hepatology. 2003; 37(2):343-50. DOI: 10.1053/jhep.2003.50048. View

Videla L, Rodrigo R, Orellana M, Fernandez V, Tapia G, Quinones L . Oxidative stress-related parameters in the liver of non-alcoholic fatty liver disease patients. Clin Sci (Lond). 2003; 106(3):261-8. DOI: 10.1042/CS20030285. View

Raucy J, Lasker J, Ozaki K, Zoleta V . Regulation of CYP2E1 by ethanol and palmitic acid and CYP4A11 by clofibrate in primary cultures of human hepatocytes. Toxicol Sci. 2004; 79(2):233-41. DOI: 10.1093/toxsci/kfh126. View

Backhed F, Ding H, Wang T, Hooper L, Koh G, Nagy A . The gut microbiota as an environmental factor that regulates fat storage. Proc Natl Acad Sci U S A. 2004; 101(44):15718-23. PMC: 524219. DOI: 10.1073/pnas.0407076101. View

Loguercio C, Federico A, Tuccillo C, Terracciano F, DAuria M, De Simone C . Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol. 2005; 39(6):540-3. DOI: 10.1097/01.mcg.0000165671.25272.0f. View

Szabo G, Velayudham A, Romics Jr L, Mandrekar P . Modulation of non-alcoholic steatohepatitis by pattern recognition receptors in mice: the role of toll-like receptors 2 and 4. Alcohol Clin Exp Res. 2005; 29(11 Suppl):140S-145S. DOI: 10.1097/01.alc.0000189287.83544.33. View

Begriche K, Igoudjil A, Pessayre D, Fromenty B . Mitochondrial dysfunction in NASH: causes, consequences and possible means to prevent it. Mitochondrion. 2006; 6(1):1-28. DOI: 10.1016/j.mito.2005.10.004. View

Bai J, Cederbaum A . Adenovirus-mediated expression of CYP2E1 produces liver toxicity in mice. Toxicol Sci. 2006; 91(2):365-71. DOI: 10.1093/toxsci/kfj165. View

Arrieta M, Bistritz L, Meddings J . Alterations in intestinal permeability. Gut. 2006; 55(10):1512-20. PMC: 1856434. DOI: 10.1136/gut.2005.085373. View

10.

Backhed F, Manchester J, Semenkovich C, Gordon J . Mechanisms underlying the resistance to diet-induced obesity in germ-free mice. Proc Natl Acad Sci U S A. 2007; 104(3):979-84. PMC: 1764762. DOI: 10.1073/pnas.0605374104. View

11.

Tarantino G, Conca P, Basile V, Gentile A, Capone D, Polichetti G . A prospective study of acute drug-induced liver injury in patients suffering from non-alcoholic fatty liver disease. Hepatol Res. 2007; 37(6):410-5. DOI: 10.1111/j.1872-034X.2007.00072.x. View

12.

Osabe M, Sugatani J, Fukuyama T, Ikushiro S, Ikari A, Miwa M . Expression of hepatic UDP-glucuronosyltransferase 1A1 and 1A6 correlated with increased expression of the nuclear constitutive androstane receptor and peroxisome proliferator-activated receptor alpha in male rats fed a high-fat and high-sucrose diet. Drug Metab Dispos. 2007; 36(2):294-302. DOI: 10.1124/dmd.107.017731. View

13.

Velayudham A, Dolganiuc A, Ellis M, Petrasek J, Kodys K, Mandrekar P . VSL#3 probiotic treatment attenuates fibrosis without changes in steatohepatitis in a diet-induced nonalcoholic steatohepatitis model in mice. Hepatology. 2008; 49(3):989-97. PMC: 3756672. DOI: 10.1002/hep.22711. View

14.

Louis P, Young P, Holtrop G, Flint H . Diversity of human colonic butyrate-producing bacteria revealed by analysis of the butyryl-CoA:acetate CoA-transferase gene. Environ Microbiol. 2009; 12(2):304-14. DOI: 10.1111/j.1462-2920.2009.02066.x. View

15.

Vijay-Kumar M, Aitken J, Carvalho F, Cullender T, Mwangi S, Srinivasan S . Metabolic syndrome and altered gut microbiota in mice lacking Toll-like receptor 5. Science. 2010; 328(5975):228-31. PMC: 4714868. DOI: 10.1126/science.1179721. View

16.

Kawai T, Akira S . The role of pattern-recognition receptors in innate immunity: update on Toll-like receptors. Nat Immunol. 2010; 11(5):373-84. DOI: 10.1038/ni.1863. View

17.

Aubert J, Begriche K, Knockaert L, Robin M, Fromenty B . Increased expression of cytochrome P450 2E1 in nonalcoholic fatty liver disease: mechanisms and pathophysiological role. Clin Res Hepatol Gastroenterol. 2011; 35(10):630-7. DOI: 10.1016/j.clinre.2011.04.015. View

18.

Aller R, de Luis D, Izaola O, Conde R, Gonzalez Sagrado M, Primo D . Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. Eur Rev Med Pharmacol Sci. 2011; 15(9):1090-5. View

19.

Brill M, Diepstraten J, van Rongen A, van Kralingen S, van den Anker J, Knibbe C . Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet. 2012; 51(5):277-304. DOI: 10.2165/11599410-000000000-00000. View

20.

Chalasani N, Younossi Z, Lavine J, Diehl A, Brunt E, Cusi K . The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology. Gastroenterology. 2012; 142(7):1592-609. DOI: 10.1053/j.gastro.2012.04.001. View