The Link between Gut Microbiota and Hepatic Encephalopathy

Abstract

Hepatic encephalopathy (HE) is a serious complication of cirrhosis that causes neuropsychiatric problems, such as cognitive dysfunction and movement disorders. The link between the microbiota and the host plays a key role in the pathogenesis of HE. The link between the gut microbiome and disease can be positively utilized not only in the diagnosis area of HE but also in the treatment area. Probiotics and prebiotics aim to resolve gut dysbiosis and increase beneficial microbial taxa, while fecal microbiota transplantation aims to address gut dysbiosis through transplantation (FMT) of the gut microbiome from healthy donors. Antibiotics, such as rifaximin, aim to improve cognitive function and hyperammonemia by targeting harmful taxa. Current treatment regimens for HE have achieved some success in treatment by targeting the gut microbiota, however, are still accompanied by limitations and problems. A focused approach should be placed on the establishment of personalized trial designs and therapies for the improvement of future care. This narrative review identifies factors negatively influencing the gut–hepatic–brain axis leading to HE in cirrhosis and explores their relationship with the gut microbiome. We also focused on the evaluation of reported clinical studies on the management and improvement of HE patients with a particular focus on microbiome-targeted therapy.

Gut Dysbiosis and Blood-Brain Barrier Alteration in Hepatic Encephalopathy: From Gut to Brain

“…The intestinal microbiome seems to be of central importance in the progression of HE [106,107]. The decreased expression of tight junction proteins and the increased BBB permeabilization have been addressed in the brain of germ-free mice compared with normal gut flora [108].…”

Hepatische Enzephalopathie Teil 2: Therapie

“…Wirkung gegen intestinale grampositive und gramnegative Organismen, was sowohl Aerobier als auch Anaerobier einschließt. Klare Aussagen zu einer möglichen positiven Beeinflussung des Darmmikrobioms unter Rifaximin beim Menschen sind aufgrund der begrenzten Datenlage bei HE nicht möglich [16]. Für den primären Einsatz von Rifaximin bei einer oHE gibt es keine Leitlinienempfehlung und keine Arzneimittelzulassung in Europa und den USA [1,2].…”

Identifying microbe-disease association based on graph convolutional attention network: Case study of liver cirrhosis and epilepsy

“…Gut microbiota plays an important role in regulating host physiological processes (e.g., immunity and metabolism), and its ecological disorders are closely related to the brain, liver and other organs ( Gonzalez-Ochoa et al, 2017 ; Tooley, 2020 ; Gabanyi et al, 2022 ). Recently, increasing medical studies reported that the gut-liver-brain axis plays a fundamental role in the pathogenesis of various diseases ( Won et al, 2022 ), which is the bidirectional relationship between the gut and its microbiota, the liver, and the brain. Besides, gut microbiota exert their actions at different levels of the gut-liver-brain axis, impacting disease progression via changing gut-liver-brain axis communication ( Fuenzalida et al, 2021 ).…”