Review: Microbial Therapeutics for Liver Disease

Abstract

AbstractThe 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.