Probiotics as a complementary therapeutic approach in nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is currently recognized as one of the most common causes of chronic liver disease. It involves a spectrum of conditions that include pure steatosis without inflammation, steatohepatitis, fibrosis and cirrhosis. The key factor in the pathophysiology of NAFLD is insulin resistance that determines lipid accumulation in the hepatocytes and, thus, oxidative stress, which is followed by inflammatory response. However, NAFLD pathogenesis is still largely unknown and has been extensively investigated. Although life style modification with the aim of losing weight has been advocated to treat this disorder, its effectiveness is limited; additionally, there is no specific pharmacologic treatment until nowadays. Recent evidence suggests that the gut microbiota may play a role in the development of insulin resistance, hepatic steatosis, necroinflammation and fibrosis. Differences in gut microbiota between NAFLD patients and lean individuals as well as presence of small intestinal bacterial overgrowth in NAFLD subjects have been demonstrated. Furthermore, some data indicate that the immunoregulatory effects of probiotics may be beneficial in NAFLD treatment as they modulate the intestinal microbiota; improve epithelial barrier function and strengthen the intestinal wall decreasing its permeability; reduce bacterial translocation and endotoxemia; improve intestinal inflammation; and reduce oxidative and inflammatory liver damage. In this article, we review the clinical trials on the use of probiotics in the treatment of NAFLD and discuss the effects of these agents and their efficacy as an emerging therapeutic resource to treat NAFLD patients.

Gut microbiota-associated bile acid deconjugation accelerates hepatic steatosis in ob/ob mice

“…Features of NAFLD include nonalcoholic hepatic steatosis (NASH), steatohepatitis, fibrosis and cirrhosis (Ferolla et al . ). NAFLD is defined as hepatic fat infiltration in more than 5% of all hepatocytes.…”

Intestinal microbiome and NAFLD: molecular insights and therapeutic perspectives

“…So far, the underlying mechanism behind the development and progression of NAFLD has not been fully elucidated. Historically, ''two-hit'' hypothesis was used to explain the pathogenesis of NAFLD [5]. However, this view was considered to be too simplistic to summarize the synergy of multiple stimulating factors in the occurrence of NAFLD.…”

The Effect of Probiotic and/or Prebiotic on Liver Function Tests in Patients with Nonalcoholic Fatty Liver Disease: A Double Blind Randomized Clinical Trial

“…Considering the lack of complete pharmaceutical formulations, probiotics may be seen as a complementary therapeutic approach for NAFLD (17). The present study aimed at evaluating the effect of probiotics and prebiotics alone and in combination on liver function tests in patients with NAFLD.…”