Review article: can bugs be drugs? The potential of probiotics and prebiotics as treatment for non‐alcoholic fatty liver disease

Aug 3, 2019Alimentary pharmacology & therapeutics

The potential of probiotics and prebiotics as treatments for non-alcoholic fatty liver disease

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Animal studies and emerging human studies indicate that probiotics and prebiotics may positively influence non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

Common probiotics like Lactobacillus, Bifidobacterium, and Streptococci may show promising results in treating NAFLD-NASH.
Short chain fatty acid (SCFA) butyrate-producing bacteria are associated with positive effects on NAFLD-NASH mechanisms.
Prebiotics may have beneficial impacts on various processes related to NAFLD-NASH.
Understanding of the mechanisms involved in microbiota modulation for NAFLD-NASH remains limited.
Changes in intestinal microbiota composition post-treatment are seldom measured.
Large clinical trials with comparative endpoints are currently lacking in this area.

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BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver condition. A major current research effort is ongoing to find potential strategies to treat NAFLD-non-alcoholic steatohepatitis (NASH), with special attention to the gut microbiota. Multiple animal studies and pilot clinical trials are assessing different gut microbiota modulating strategies such as faecal microbiota transplantation, antibiotics, probiotics, prebiotics and synbiotics.

AIM: To review the role of microbiota in NAFLD-NASH and determine whether pro- and prebiotics have potential as treatment METHODS: Information was obtained from critically reviewing literature on PubMed on targeting the gut microbiota in NAFLD. Search terms included NAFLD, NASH, non-alcoholic fatty liver disease, steatohepatitis; combined with microbiome, microbiota, gut bacteria, probiotics and prebiotics.

RESULTS: Animal studies and the first emerging studies in humans show promising results for both the common probiotics Lactobacillus, Bifidobacterium and Streptococci as for short chain fatty acid (SCFA) butyrate-producing bacteria. Also, prebiotics have positive effects on different mechanisms underlying NAFLD-NASH.

CONCLUSIONS: The most promising strategies thus far developed to alter the microbiome in NAFLD-NASH are probiotics and prebiotics. However, pre- and probiotic treatment of NAFLD-NASH is relatively new and still under development. Actual understanding of the involved mechanisms is lacking and changes in the intestinal microbiota composition after treatment are rarely measured. Furthermore, large clinical trials with comparative endpoints are unavailable. Personalised treatment based on metagenomics gut microbiota analysis will probably be part of the future diagnosis and treatment of NAFLD-NASH.

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Review article: can bugs be drugs? The potential of probiotics and prebiotics as treatment for non‐alcoholic fatty liver disease

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