Linking intestinal homeostasis and liver disease

Bernd Schnabl
Current Opinion in Gastroenterology 2013, 29 (3): 264-70

PURPOSE OF REVIEW: Interactions of the gut microbiome with the host are important in health and disease. Microbial translocation releases bacterial products that play a key role in progression of chronic liver disease by promoting hepatic injury and inflammation. Although this has long been recognized, we are just beginning to understand the circumstances under which the gut becomes leaky and to discover bacterial metabolites that promote liver disease. In this review, we will summarize recent findings from the last 2 years.

RECENT FINDINGS: Chronic liver disease is associated with an altered microbiome with both qualitative (dysbiosis) and quantitative (overgrowth) differences. This can be viewed as a loss of the symbiotic relationship between the microflora and the host. An imbalanced intestinal homeostasis results in a breach of the gut barrier and subsequent microbial translocation. However, the contribution of the intestinal microflora is beyond simple microbial translocation as a pathogenic factor. Bacterial metabolites resulting from an imbalanced homeostasis and dysbiosis play also a crucial role in liver disease.

SUMMARY: A combination between an initiating liver insult and a disturbance of the gut-host symbiosis synergize in progression of liver disease.

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