Abstract
Alcoholic liver disease (ALD) is one of the leading causes of morbidity among adults with alcohol use disorder (AUD) worldwide. Its clinical course ranges from steatosis to alcoholic hepatitis, progressing to more severe forms of liver damage, such as cirrhosis and hepatocellular carcinoma. The pathogenesis of ALD is complex and diverse elements are involved in its development, including environmental factors, genetic predisposition, the immune response, and the gut-liver axis interaction. Chronic alcohol consumption induces changes in gut microbiota that are associated with a loss of intestinal barrier function and inflammatory responses which reinforce a liver damage progression triggered by alcohol. Alcohol metabolites such as acetaldehyde, lipid peroxidation-derived aldehyde malondialdehyde (MDA), and protein-adducts act as liver-damaging hepatotoxins and potentiate systemic inflammation. Additionally, ethanol causes direct damage to the central nervous system (CNS) by crossing the blood-brain barrier (BBB), provoking oxidative stress contributing to neuroinflammation. Overall, these processes have been associated with susceptibility to depression, anxiety, and alcohol craving in ALD. Recent evidence has shown that probiotics can reverse alcohol-induced changes of the microbiota and prevent ALD progression by restoring gut microbial composition. However, the impact of probiotics on alcohol consumption behavior has been less explored. Probiotics have been used to treat various conditions by restoring microbiota and decreasing systemic and CNS inflammation. The results of some studies suggest that probiotics might improve mental function in Alzheimer’s, autism spectrum disorder, and attenuated morphine analgesic tolerance. In this sense, it has been observed that gut microbiota composition alterations, as well as its modulation using probiotics, elicit changes in neurotransmitter signals in the brain, especially in the dopamine reward circuit. Consequently, it is not difficult to imagine that a probiotics-based complementary treatment to ALD might reduce disease progression mediated by lower alcohol consumption. This review aims to present an update of the pathophysiologic mechanism underlying the microbiota-gut-liver-brain axis in ALD, as well as to provide evidence supporting probiotic use as a complementary therapy to address alcohol consumption disorder and its consequences on liver damage.
Highlights
Alcohol consumption is the third most important cause of health impairment worldwide, with 5.3% of all annual deaths due to its excessive use
Prebiotics has emerged as a complementary therapy
Prebiotics was described in 1995 as “a non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, improving host health” (Gibson and Roberfroid, 1995)
Summary
Alcohol consumption is the third most important cause of health impairment worldwide, with 5.3% of all annual deaths due to its excessive use. 43% of the population over 15 years of age consumed alcohol in the last 12 months, indicating an early life risk of death and disability due to this cause (World-HealthOrganization, 2018). Chronic alcohol consumption is one of the main risk factors of liver injury (Rocco et al, 2014), with alcoholic liver disease (ALD) as one of the leading causes of morbidity among adults with alcohol use disorder (AUD). The liver damage induced by alcohol consumption includes the following clinical impacts: steatosis, steatohepatitis, alcoholic hepatitis, fibrosis, and cirrhosis, each considered a relevant public health burden (World-HealthOrganization, 2018). AUD has a significant socioeconomic impact on the population, with an elevated mortality rate from alcohol cirrhosis associated with increased alcohol consumption rates. It is estimated that alcohol consumption and ALD incidence will continue to increase in the coming decades, inextricably linked to psychosocial issues that our society is facing
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