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Wang Y, Zheng L, Zhou Z, Yao D, Huang Y, Liu B, Duan Y, Li Y. Review article: insights into the bile acid-gut microbiota axis in intestinal failure-associated liver disease-redefining the treatment approach. Aliment Pharmacol Ther 2022; 55:49-63. [PMID: 34713470 DOI: 10.1111/apt.16676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/04/2021] [Accepted: 10/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intestinal failure-associated liver disease (IFALD) increases mortality of patients with intestinal failure (IF), but lacks effective prevention or treatment approaches. Bile acids, gut microbiota and the host have close and complex interactions, which play a central role in modulating host immune and metabolic homeostasis. Increasing evidence suggests that derangement of the bile acid-gut microbiota (BA-GM) axis contributes to the development of IFALD. AIMS To review the BA-GM axis in the pathogenesis and clinical applications of IFALD, and to explore future directions for effective disease management. METHODS We conducted a literature search on bile acid and gut microbiota in IF and liver diseases. RESULTS The BA-GM axis demonstrates a unique IF signature manifesting as an increase in primary-to-secondary bile acids ratio, disturbed enterohepatic circulation, blunted bile acid signalling pathways, gut microbial dysbiosis, and altered microbial metabolic outputs. Bile acids and gut microbiota shape the compositional and functional alterations of each other in IF; collaboratively, they promote immune dysfunction and metabolic aberration in the liver. Diagnostic markers and treatments targeting the BA-GM axis showed promising potential in the management of IFALD. CONCLUSIONS Bile acids and gut microbiota play a central role in the development of IFALD and make attractive biomarkers as well as therapeutic targets. A multitarget, individualised therapy aiming at different parts of the BA-GM axis may provide optimal clinical benefits and requires future investigation.
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Affiliation(s)
- Yaoxuan Wang
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Lei Zheng
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Zhiyuan Zhou
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Danhua Yao
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Yuhua Huang
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Bin Liu
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Yantao Duan
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
| | - Yousheng Li
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
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Grave PK, Thomsen SV, Clark PS, Madsen GI, Qvist N, Ellebæk MB. Segmental reversal of distal small intestine in short bowel syndrome: a study on the influence on postoperative weight and intestinal topography in piglets. Pediatr Surg Int 2018; 34:671-677. [PMID: 29666926 DOI: 10.1007/s00383-018-4269-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE The objective of the present study was to investigate the effect of segmental reversal of the distal 20 cm of the small intestine in piglets with induced SBS compared to controls with SBS alone. Primary endpoint was postoperative weight change over a period of 1 month. Secondary endpoints were the influence on cell proliferation and mucosal architecture shown by histological analysis. METHODS Sixteen piglets underwent a 60% resection of the distal small intestine and were randomized into two groups. Group 1 short bowel syndrome alone (SBS) (n = 8) and group 2 with reversal of a distal small intestinal segment (SBS-RS) (n = 8). Body weight was measured daily and the pigs were euthanized after 1 month. Crypt depths, villus heights and muscle layers thicknesses were measured. For the evaluation of microvilli of the brush border of the epithelium and cell proliferation, immunohistochemical staining with Villin and Ki-67 was performed. RESULTS No statistically significant differences were observed concerning weight gain. Mean ± SD weight gain was 2.31 ± 2.85 kg for SBS-RS and 2.03 ± 1.27 kg for SBS (p = 0.8). In the proximal jejunal segment a significant increase in villus heights was found in the SBS group and increase in the thickness of the circular and longitudinal muscle layers in the SBS-RS group. In the distal ileal segment the longitudinal muscle layer thicknesses were increased in the SBS group. Otherwise, no significant changes were found. CONCLUSION Reversal of a 20-cm distal segment showed no effect on weight gain, but there were some significant histological changes of unknown clinical significance.
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Affiliation(s)
- Pernille Kock Grave
- Surgical Department A, Odense University Hospital, JB Winsløwsvej 4, 5000, Odense C, Denmark
| | | | - Pia Susanne Clark
- Department of Pathology, Odense University Hospital, JB Winsløwsvej 7, 5000, Odense C, Denmark
| | - Gunvor Iben Madsen
- Department of Pathology, Odense University Hospital, JB Winsløwsvej 7, 5000, Odense C, Denmark
| | - Niels Qvist
- Surgical Department A, Odense University Hospital, JB Winsløwsvej 4, 5000, Odense C, Denmark. .,Danish Centre for Regenerative Medicine, Odense University Hospital, JB Winsløwsvej 4, 5000, Odense C, Denmark.
| | - Mark Bremholm Ellebæk
- Surgical Department A, Odense University Hospital, JB Winsløwsvej 4, 5000, Odense C, Denmark
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Lee CH, Chen JY, Li ML, Chou MC, Lo HC. Oral Antibiotics Attenuate Bowel Segment Reversal–Induced Alterations in Subpopulation and Function of Peripheral Blood Leukocytes, Thymocytes, and Splenocytes in Massive Bowel-Resected Rats. JPEN J Parenter Enteral Nutr 2008; 33:90-101. [DOI: 10.1177/0148607108322397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chien-Hsing Lee
- From the Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan; Department of Nutritional Science, Fu Jen Catholic University, Hsin Chuang City, Taipei, Taiwan
| | - Jing-Yi Chen
- From the Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan; Department of Nutritional Science, Fu Jen Catholic University, Hsin Chuang City, Taipei, Taiwan
| | - Mei-Ling Li
- From the Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan; Department of Nutritional Science, Fu Jen Catholic University, Hsin Chuang City, Taipei, Taiwan
| | - Ming-Chih Chou
- From the Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan; Department of Nutritional Science, Fu Jen Catholic University, Hsin Chuang City, Taipei, Taiwan
| | - Hui-Chen Lo
- From the Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education and Research, Changhua Christian Hospital, Changhua, Taiwan; Department of Nutritional Science, Fu Jen Catholic University, Hsin Chuang City, Taipei, Taiwan
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