Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China.
Aliment Pharmacol Ther. 2022 Jan;55(1):49-63. doi: 10.1111/apt.16676. Epub 2021 Oct 29.
Intestinal failure-associated liver disease (IFALD) increases mortality of patients with intestinal failure (IF), but lacks effective prevention or treatment approaches. Bile acids, gut microbiota and the host have close and complex interactions, which play a central role in modulating host immune and metabolic homeostasis. Increasing evidence suggests that derangement of the bile acid-gut microbiota (BA-GM) axis contributes to the development of IFALD.
To review the BA-GM axis in the pathogenesis and clinical applications of IFALD, and to explore future directions for effective disease management.
We conducted a literature search on bile acid and gut microbiota in IF and liver diseases.
The BA-GM axis demonstrates a unique IF signature manifesting as an increase in primary-to-secondary bile acids ratio, disturbed enterohepatic circulation, blunted bile acid signalling pathways, gut microbial dysbiosis, and altered microbial metabolic outputs. Bile acids and gut microbiota shape the compositional and functional alterations of each other in IF; collaboratively, they promote immune dysfunction and metabolic aberration in the liver. Diagnostic markers and treatments targeting the BA-GM axis showed promising potential in the management of IFALD.
Bile acids and gut microbiota play a central role in the development of IFALD and make attractive biomarkers as well as therapeutic targets. A multitarget, individualised therapy aiming at different parts of the BA-GM axis may provide optimal clinical benefits and requires future investigation.
肠衰竭相关肝病（IFALD）增加了肠衰竭（IF）患者的死亡率，但缺乏有效的预防或治疗方法。胆汁酸、肠道微生物群和宿主之间存在密切而复杂的相互作用，它们在调节宿主免疫和代谢稳态方面起着核心作用。越来越多的证据表明，胆汁酸-肠道微生物群（BA-GM）轴的失调导致 IFALD 的发展。
综述 BA-GM 轴在 IFALD 的发病机制和临床应用中的作用，并探讨有效疾病管理的未来方向。
我们对胆汁酸和肠道微生物群在 IF 和肝脏疾病中的作用进行了文献检索。
BA-GM 轴表现出独特的 IF 特征，表现为初级胆汁酸与次级胆汁酸比值增加、肠肝循环紊乱、胆汁酸信号通路减弱、肠道微生物群失调和微生物代谢产物改变。胆汁酸和肠道微生物群在 IF 中相互塑造彼此的组成和功能；它们共同促进肝脏的免疫功能障碍和代谢异常。针对 BA-GM 轴的诊断标志物和治疗方法在 IFALD 的管理中显示出有希望的潜力。
胆汁酸和肠道微生物群在 IFALD 的发展中起着核心作用，它们作为有吸引力的生物标志物和治疗靶点。针对 BA-GM 轴不同部分的多靶点、个体化治疗可能提供最佳的临床获益，需要进一步研究。
