Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Front Endocrinol (Lausanne). 2021 Apr 9;12:612946. doi: 10.3389/fendo.2021.612946. eCollection 2021.
The progression of metabolic dysfunction associated fatty liver disease (MAFLD) leads to steatohepatitis, liver fibrosis and hepatocellular carcinoma. Thus far, there have been no FDA-approved medications for MAFLD. Bariatric surgery (BS) has been found to improve insulin resistance, steatohepatitis and liver fibrosis but is not recommended for treating MAFLD due to its invasiveness. Recent studies suggest the improved glucose metabolism after BS is a result of, at least partly, alterations to the gut microbiota and its associated metabolites, including short chain fatty acids and bile acids. It makes sense the improved steatohepatitis and fibrosis after BS are also induced by the gut microbiota that involves in host metabolic modulation, for example, through altering bile acids composition. Given that the gut-liver axis is a path that may harbor unexplored mechanisms behind MAFLD, we review current literatures about disentangling the metabolic benefits of MAFLD after BS, with a focus on gut microbiota. Some useful research tools including the rodent BS model, the multiomics approach, and the human microbiota associated (HMA) mice are presented and discussed. We believe, by taking advantage of these modern translational tools, researchers will uncover microbiota related pathways to serve as potential therapeutic targets for treating MAFLD.
代谢功能障碍相关脂肪性肝病（MAFLD）的进展可导致脂肪性肝炎、肝纤维化和肝细胞癌。迄今为止，还没有获得 FDA 批准用于 MAFLD 的药物。减重手术（BS）已被发现可改善胰岛素抵抗、脂肪性肝炎和肝纤维化，但由于其侵袭性，不推荐用于治疗 MAFLD。最近的研究表明，BS 后改善的葡萄糖代谢至少部分是由于肠道微生物群及其相关代谢物（包括短链脂肪酸和胆汁酸）的改变。BS 后改善的脂肪性肝炎和纤维化也是由参与宿主代谢调节的肠道微生物群引起的，例如通过改变胆汁酸组成，这是有道理的。鉴于肠-肝轴是一个可能隐藏着 MAFLD 背后未被探索的机制的途径，我们综述了目前关于解析 BS 后 MAFLD 的代谢益处的文献，重点是肠道微生物群。介绍并讨论了一些有用的研究工具，包括啮齿动物 BS 模型、多组学方法和人类微生物群相关（HMA）小鼠。我们相信，利用这些现代转化工具，研究人员将揭示与微生物群相关的途径，作为治疗 MAFLD 的潜在治疗靶点。
