Abstract
Microbiota is defined as the collection of microorganisms within the gastrointestinal ecosystem. These microbes are strongly implicated in the stimulation of immune responses. An unbalanced microbiota, termed dysbiosis, is related to the development of several liver diseases. The bidirectional relationship between the gut, its microbiota and the liver is referred to as the gut–liver axis. The translocation of bacterial products from the intestine to the liver induces inflammation in different cell types such as Kupffer cells, and a fibrotic response in hepatic stellate cells, resulting in deleterious effects on hepatocytes. Moreover, ischemia-reperfusion injury, a consequence of liver surgery, alters the microbiota profile, affecting inflammation, the immune response and even liver regeneration. Microbiota also seems to play an important role in post-operative outcomes (i.e., liver transplantation or liver resection). Nonetheless, studies to determine changes in the gut microbial populations produced during and after surgery, and affecting liver function and regeneration are scarce. In the present review we analyze and discuss the preclinical and clinical studies reported in the literature focused on the evaluation of alterations in microbiota and its products as well as their effects on post-operative outcomes in hepatic surgery.
Highlights
Liver Vascular Biology Research Group, Barcelona Hepatic Hemodynamic Laboratory IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08036 Barcelona, Spain
Is an inherent part of the surgical process in hepatic resections and Liver transplantation (LT) [6], the numerous studies reported in the literature have mainly focused on procedures directed at the liver itself to reduce the injurious effects of reactive oxygen species (ROS) through the administration of antioxidants [7], to reduce neutrophil accumulation through treatment with antibodies anti-P-selectin or antiintercellular adhesion molecule 1 [8,9] or to regulate the activity or levels of some cytokines involved in the inflammatory process, such as tumor necrosis factor (TNF)
These are other studies based on the following treatments in liver surgery: lipid emulsion or carbohydrate supplementation just after partial hepatectomy (PH) maintain ATP levels, reduces liver damage and increases liver regeneration [166]; the treatment of omega-3 fatty acids three days before liver surgery and one after surgery protects liver against inflammation and damage associated with PH [167]; the treatment with branched-chain amino acids (BCAAs) prior to surgery improves liver regeneration and decreases liver damage [168,169]; the treatment with dexpanthenol immediately before surgery decreases I/R injury [170]
Summary
Some studies suggest that alterations in the gut microbiota might be responsible for the post-operative outcomes in different pathologies, which require the presence of a relationship between the intestine and the liver Such is the case with the clinical surgical procedures of hepatic resections and LT [14,15]. If the intestinal barrier is affected, products present in the gut can reach the liver, including some that are toxic to the organism resulting in hepatic inflammation and the consequent development from simple steatosis to non-alcoholic steatohepatitis (NASH) [25,26] This progression has been related with cytotoxicity resulting from the increases in fecal bile acids (BAs) and primary/secondary BA ratio, plasma and liver BA levels and plasma lipopolysaccharides (LPS) [25,27,28].
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