New challenges in cholangiocarcinoma candidates for elective surgery: harnessing the microbiome dysbiosis

BACKGROUND

The gut microbiota, composed by several species of microorganisms, works to preserve the liver-gut homeostasis and plays an important role during digestion and absorption of nutrients, and in the immune response of the host. In this review, we analyzed the influence of microbiota in patients with cholangiocarcinoma (CCA) who were candidates for elective surgery.

METHODS

A literature review was conducted to identify papers that provided empiric evidence to support that the altered microbiota composition (dysbiosis) is related also to CCA development.

RESULTS

Bacteria such as Helicobacter pylori, Helicobacter hepaticus, and Opisthorchis viverrini increase the risk of CCA. The most abundant genera were Enterococcus, Streptococcus, Bacteroides, Klebsiella, and Pyramidobacter in CCA's biliary microbiota. Additionally, levels of Bacteroides, Geobacillus, Meiothermus, and Anoxybacillus genera were significantly higher. An enrichment of Bifidobacteriaceae, Enterobacteriaceae, and Enterococcaceae families has also been observed in CCA tumor tissue. Microbiota is related to postoperative outcomes in abdominal surgery. The combination of caloric restriction diets in liver cancer or CCA increases the effect of the chemotherapy treatment.

CONCLUSION

The correct use of nutrition for microbiota modulation according to each patient's needs could be a therapeutic tool in combination with elective surgery and chemotherapy to diminish side effects and improve prognosis. Further investigations are needed to fully understand the mechanisms by which they are related.

Opisthorchiasis-Induced Cholangiocarcinoma: How Innate Immunity May Cause Cancer

Innate, inflammatory responses towards persistent Opisthorchis viverrini (OV) infection are likely to contribute to the development of cholangiocarcinoma (CCA), a liver cancer that is rare in the West but prevalent in Greater Mekong Subregion countries in Southeast Asia. Infection results in the infiltration of innate immune cells into the bile ducts and subsequent activation of inflammatory immune responses that fail to clear OV but instead may damage local tissues within the bile ducts. Not all patients infected with OV develop CCA, and so tumourigenesis may be dependent on multiple factors including the magnitude of the inflammatory response that is activated in infected individuals. The purpose of this review is to summarize how innate immune responses may promote tumourigenesis following OV infection and if such responses can be used to predict CCA onset in OV-infected individuals. It also hypothesizes on the role that Helicobacterspp., which are associated with liver fluke infections, may play in activation of the innate the immune system to promote tissue damage and persistent inflammation leading to CCA.

Chronic Opisthorchis viverrini Infection Changes the Liver Microbiome and Promotes Helicobacter Growth

Adults of Opisthorchis viverrini reside in the biliary system, inducing inflammation of bile ducts and cholangitis, leading to hepatobiliary disease (HBD) including cholangiocarcinoma. O. viverrini infection also has major implications for the bacterial community in bile ducts and liver. To investigate this in chronic O. viverrini infection (≥ 8 months p.i.), bacterial genomic DNA from livers of hamsters and from worms was investigated using culture techniques, PCR for Helicobacter spp. and high-throughput next-generation sequencing targeting the V3-V4 hypervariable regions of prokaryotic 16S rRNA gene. Of a total of 855,046 DNA sequence reads, 417,953 were useable after filtering. Metagenomic analyses assigned these to 93 operational taxonomic units (OTUs) consisting of 80 OTUs of bacteria, including 6 phyla and 42 genera. In the chronic O. viverrini-infected group, bacterial community composition and diversity were significantly increased compared to controls. Sequences of Fusobacterium spp. were the most common (13.81%), followed by Streptococcus luteciae (10.76%), Escherichia coli (10.18%), and Bifidobacterium spp. (0.58%). In addition, Helicobacter pylori (0.17% of sequences) was also identified in the liver of chronic O. viverrini infections, but not in normal liver. The presence of H. pylori was confirmed by PCR and by use of an antibody against bacterial antigen, supporting the metagenomics data. The identities of bacteria cultured for enrichment suggested that chronic O. viverrini infection changes the liver microbiome and promotes Helicobacter spp. growth. There may be synergy between O. viverrini and the liver microbiome in enhancing immune response-mediated hepatobiliary diseases.

Biliary Microbiota, Gallstone Disease and Infection with Opisthorchis felineus

Background

There is increasing interest in the microbiome of the hepatobiliary system. This study investigated the influence of infection with the fish-borne liver fluke, Opisthorchis felineus on the biliary microbiome of residents of the Tomsk region of western Siberia.

Methodology/Principal Findings

Samples of bile were provided by 56 study participants, half of who were infected with O. felineus, and all of who were diagnosed with gallstone disease. The microbiota of the bile was investigated using high throughput, Illumina-based sequencing targeting the prokaryotic 16S rRNA gene. About 2,797, discrete phylotypes of prokaryotes were detected. At the level of phylum, bile from participants with opisthorchiasis showed greater numbers of Synergistetes, Spirochaetes, Planctomycetes, TM7 and Verrucomicrobia. Numbers of > 20 phylotypes differed in bile of the O. felineus-infected compared to non-infected participants, including presence of species of the genera Mycoplana, Cellulosimicrobium, Microlunatus and Phycicoccus, and the Archaeans genus, Halogeometricum, and increased numbers of Selenomonas, Bacteroides, Rothia, Leptotrichia, Lactobacillus, Treponema and Klebsiella.

Conclusions/Significance

Overall, infection with the liver fluke O. felineus modified the biliary microbiome, increasing abundance of bacterial and archaeal phylotypes.

The microbiota of the alimentary tract and other sites of the body influences human health. Contrary to popular belief, the bile within the liver is not sterile, and may host a microbiome consisting of diverse species of microbes. The spectrum of microbial species and their numbers within the biliary system may be influenced by disease including infection with pathogens such as parasitic worms and with gallstone disease, liver cancer and other ailments. Here we examined the microbes in the bile of patients from western Siberia, Russia who were concurrently infected with a food-borne parasitic worm, the liver fluke Opisthorchis felineus. Infection with this liver fluke is common in western Siberia, as a consequence of dietary preference for undercooked or smoked fresh-water fishes that often carry the larva of the liver fluke. Using high throughput sequencing targeting a conserved bacterial gene and statistical analyses, numerous bacterial species were identified in the bile of the patients. Infection with the liver fluke modified the biliary microbiome, resulting in abundant and diverse species of bacteria and Archaea.

[THE ENVIRONMENTAL BASES AND MECHANISM FOR NATURAL OPISTHORCHIASIS FOCUS PULSATION IN THE COMBINED FOCUS OF OPISTHORCHIASIS AND TULAREMIA]

A cyclic change in the epizootic activity of a tularemia activity underlies the mechanism of natural opisthorchiasis focus pulsation in the combined focus of opisthorchiasis and tularemia in the ecosystem of the Konda River. This is due to mass breeding and depression in the water vole (Arvicola terrestris) population. The mass breeding is predetermined by high population reproduction constants. The rodents' potential fecundity occurs with the high capacity of lands, which is caused by the hydrological regime of rivers. The size depression is predetermined by the epizootics of tularemia. The water vole is a host of the pathogens of opisthorchiasis and tularemia. So the mass rodent breeding in the combined infection and invasion focus causes an increase in the number of real invasion sources. The epizootic of tularemia is responsible for elimination of these invasion sources and for decreases in the flow of invasion material, the infection rate of Codiella and hence the amount of their produced cercarae, the extensive and intensive indicators of fish contamination, and the intensity of an epizootic process in the opisthorchiasis focus.

[Mechanisms for the formation of a combination of the natural foci of trematodiases and tularemia in the floodplain-river ecosystem of the Konda River in different periods of epizootic activity of an infection focus]

The basis of the mechanism responsible for the formation of a combination of the natural foci of trematodiases and tularemia in the infection foci in the interepizootic periods is their association with the morphological structure of the floodplain-river landscape of the Konda River. The landscape's facias and holes, which are common to the foci, are integrated, by predetermining the territorial combination. The formation of a closed trinomial Francisella tularensis parasite system integrating these foci serves as a basis for the mechanism of the formation of a combination of the natural foci of trematodiases and tularemia on transition of the latter from the interepizootic state to epizooty. The absence of host populations linking the foci of methorchiasis (M. xanthosomus), bilharziasis, and tularemia determines their combination both in the interepizootic periods and at the level of the landscape morphological structure. The basis for the mechanism of the formation of a combination of the natural foci of trematodiases and tularemia in the periods of diffuse epizooties in the infection foci is the formation of an open binomial F. tularensis parasite system and the infestation of the co-members of F. tularensis trematode parasite systems. By penetrating into them, the pathogen forces the F. tularensis parasite system to enter the trematode parasite systems, causing their complete (opisthorchiases, methorchiases) or partial (bilharziasis) coincidence. Thus, these foci are combined at the level of parasitocenoses of the parasite systems of infections and infestations, by giving rise to pseudosystem combined foci. The natural foci of B. polonica and F. tularensis are combined at the level of parasitocenosis of the coacting hemipopulation of trematode parthenitas, F. tularensis subpopulations and intermediate host population, by forming an autoecious population-combination bilharziasis-tularemia focus. The formation of territorial-combination, autoecious population-combination, and pseudosystem-combination foci of trematodiases and tularemia in different periods of the epizootic activity of an infection focus is determined by the functional organization of the parasite system of a tularemia focus and the biocenotic (functional) structure of natural foci of infestations.

[The pathomorphosis of opisthorchiasis]

Based on the data available in the literature and their own findings, the authors have come to the conclusion that the clinical picture of opisthorchiasis has undergone profound changes in the past decades, which may be regarded as a manifestation of induced and reduced pathomorphism. Uninduced pathomorphism appears as decreased invasion rates and as acute forms. Induced pathomorphism shows up in reduced invasion or by timely liquidation of invasion. The etiological and pathogenetic role of Helicobacter pylori in the development of the gastroduodenal pathology in patients with opisthorchiasis is considered as a manifestation of false pathomorphism.

[Characteristics of the immunity in typhoid infection associated with opisthorchiasis]

Typhoid infection developing in persons with opisthorchiasis is characterized by the appearance of pronounced systemic immunity, that ensures a more favorable clinical course of this infection and promotes a decrease in the occurrence of diarrheal phenomena and bacteremia. At the same time, in typhoid patients, simultaneously affected by opisthorchiasis, a more intensive release of the infective agent into the environment is observed. This seemingly demonstrates the presence of disturbances in the local protective mechanisms regulating the process of the release of bacteria on the level of the gastrointestinal tract.

[Pathogenetic and immunological characteristics of different forms of the Salmonella typhi carrier state]

Infectious granulomas with macrophages containing Salmonella typhi have been detected in the immune organs of the intestine of typhoid patients by means of morphological investigation techniques, immunofluorescent and electron microscopy. This suggests that typhoid granulomas form the basis of S. typhi primary carriership complicated by the relapses of this infection in cases of weakened cell-mediated immunity, which is proved by a decrease in the level of T-lymphocytes and by increased leukocyte migration index in relapses of typhoid fever and in S. typhi primary carriership. At the same time, the formation of S. typhi secondary carriership occurs in the process of the colonization of the altered organs and tissues of the body by S. typhi. This secondary carriership differs from the primary one by a number of pathogenetic signs. The detailed characterization of these two forms of S. typhi carriership is presented.