Abstract
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease worldwide, affecting both adults and children and will result, in the near future, as the leading cause of end-stage liver disease. Indeed, its prevalence is rapidly increasing, and NAFLD is becoming a major public health concern. For this reason, great efforts are needed to identify its pathogenetic factors and new therapeutic approaches. In the past decade, enormous advances understanding the gut–liver axis―the complex network of cross-talking between the gut, microbiome and liver through the portal circulation―have elucidated its role as one of the main actors in the pathogenesis of NAFLD. Indeed, evidence shows that gut microbiota is involved in the development and progression of liver steatosis, inflammation and fibrosis seen in the context of NAFLD, as well as in the process of hepatocarcinogenesis. As a result, gut microbiota is currently emerging as a non-invasive biomarker for the diagnosis of disease and for the assessment of its severity. Additionally, to its enormous diagnostic potential, gut microbiota is currently studied as a therapeutic target in NAFLD: several different approaches targeting the gut homeostasis such as antibiotics, prebiotics, probiotics, symbiotics, adsorbents, bariatric surgery and fecal microbiota transplantation are emerging as promising therapeutic options.
Highlights
Published: 17 June 2021The human gut microbiota comprises the trillions of microorganisms from 500 to 1000 different species that reside in our gastrointestinal (GI) tract, of which bacteria constitute the vast majority [1,2]
Boursier et al examined the gut microbiota taxonomic composition of patients with biopsy proven Nonalcoholic fatty liver disease (NAFLD) and different degrees of fibrosis: The results showed how Bacteroidetes abundance was significantly higher in nonalcoholic steatohepatitis (NASH), whereas Prevotella abundance was lower; Ruminococcus abundance was significantly higher in F ≥ 2 patients [39]
Numerous evidence has implicated the intestinal microbiome in the development and progression of hepatocellular steatosis, inflammation and fibrosis seen in the context of NAFLD, as well as in hepatocarcinogenesis
Summary
The human gut microbiota comprises the trillions of microorganisms from 500 to 1000 different species that reside in our gastrointestinal (GI) tract, of which bacteria constitute the vast majority [1,2] This large community of microbes establishes a symbiotic relationship with the host and is able to perform various functions that significantly influence its physiology and pathology. The gut microbiota has recognized to play many important roles in the mammalian body such as dietary nutrient metabolism and energy extraction, immune system education and tolerance development and the prevention of pathogen colonization [3,4,5] For this reason, disturbance of its homeostasis may be involved in the development of several different diseases. Authors have started to talk about the existence of a “gut–liver axis” [18,19]
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