Microbial Translocation in Chronic Liver Diseases

Abstract

<jats:p>The intestinal microflora is not only involved in the digestion of nutrients, but also in local immunity, forming a barrier against pathogenic microorganisms. The derangement of the gut microflora may lead to microbial translocation, defined as the passage of viable microorganisms or bacterial products (i.e., LPS, lipopeptides) from the intestinal lumen to the mesenteric lymph nodes and other extraintestinal sites. The most recent evidence suggests that microbial translocation (MT) may occur not only in cirrhosis, but also in the early stage of several liver diseases, including alcoholic hepatopathy and nonalcoholic fatty liver disease. Different mechanisms, such as small intestinal bacterial overgrowth, increased permeability of intestinal mucosa, and impaired immunity, may favor MT. Furthermore, MT has been implicated in the pathogenesis of the complications of cirrhosis, which are a significant cause of morbidity and mortality in cirrhotic subjects. Therapeutic strategies aiming at modulating the gut microflora and reducing MT have focused on antibiotic-based options, such as selective intestinal decontamination, and nonantibiotic-based options, such as prokinetics and probiotics. In particular, probiotics may represent an attractive strategy, even though the promising results of experimental models and limited clinical studies need to be confirmed in larger randomized trials.</jats:p>

Macrophage Activation and the Tumor Necrosis Factor Cascade in Hepatitis C Disease Progression Among HIV-Infected Women Participating in the Women's Interagency HIV Study

“…This is in contrast to an early cross sectional study that showed that elevated LPS was independently associated with cirrhosis 10 as well as several studies examining sCD14 levels (including our own) which reported that elevated levels of sCD14 were associated with a increased risk of liver disease progression in patients with and without HIV 9,10,44,45 . The difference in outcomes is perhaps due to difference in study design, population, or the endpoints defining liver disease progression, or related to the low proportion of patients in the current study that reported hazardous alcohol consumption.…”

Selective bowel decontamination improves the survival of 90% hepatectomy in rats

“…Such results are consistent with previous studies [1,21,22]. Second, from the perspective of the intestinal bacterial flora, overgrowth has been shown to frequently occur during severe trauma or large operation [4,23] or liver diseases [24]. And apical exposure to LPS could increase epithelial permeability in the intestine [25], involving disruption of tight junction [26,27].…”

Protective effect of ursodeoxycholic acid, resveratrol, andN-acetylcysteine on nonalcoholic fatty liver disease in rats

“…In agreement with our results, the UDCA + NAC combination had the least lowering potential regarding TNF-a level and was not as effective as UDCA alone (Belonovskaia et al, 2013). It should be mentioned that cultures of samples from portal blood, peripheral blood, and perihepatic lymph nodes in our model were negative in all groups, proving that expression of hepatic TNF-a was not due to bacterial translocation but due to MCDD (Pinzone et al, 2012).…”