Gut-liver axis and probiotics: Their role in non-alcoholic fatty liver disease |
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Authors: | Giulia Paolella Claudia Mandato Luca Pierri Marco Poeta Martina Di Stasi Pietro Vajro |
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Institution: | Giulia Paolella, Luca Pierri, Marco Poeta, Martina Di Stasi, Pietro Vajro, Department of Medicine and Surgery, University of Salerno, 84081 Baronissi (Salerno), ItalyClaudia Mandato, Pediatrics of AORN Santobono-Pausilipon, 80123 Naples, ItalyPietro Vajro, ELFID European Laboratory for the Investigation of Food Induced Disease, 80138 Napoli, Italy |
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Abstract: | The incidence of obesity and its related conditions, including non-alcoholic fatty liver disease (NAFLD), has dramatically increased in all age groups worldwide. Given the health consequences of these conditions, and the subsequent economic burden on healthcare systems, their prevention and treatment have become major priorities. Because standard dietary and lifestyle changes and pathogenically-oriented therapies (e.g., antioxidants, oral hypoglycemic agents, and lipid-lowering agents) often fail due to poor compliance and/or lack of efficacy, novel approaches directed toward other pathomechanisms are needed. Here we present several lines of evidence indicating that, by increasing energy extraction in some dysbiosis conditions or small intestinal bacterial overgrowth, specific gut microbiota and/or a “low bacterial richness” may play a role in obesity, metabolic syndrome, and fatty liver. Under conditions involving a damaged intestinal barrier (“leaky gut”), the gut-liver axis may enhance the natural interactions between intestinal bacteria/bacterial products and hepatic receptors (e.g., toll-like receptors), thus promoting the following cascade of events: oxidative stress, insulin-resistance, hepatic inflammation, and fibrosis. We also discuss the possible modulation of gut microbiota by probiotics, as attempted in NAFLD animal model studies and in several pilot pediatric and adult human studies. Globally, this approach appears to be a promising and innovative add-on therapeutic tool for NAFLD in the context of multi-target therapy. |
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Keywords: | Probiotics Gut-liver axis Intestinal microbiota Barrier function Small intestinal bacterial overgrowth Bacterial translocation Non-alcoholic fatty liver disease |
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