Fotis Dimitrios, Liu Junli, Dalamaga Maria
Gastroenterology Department, General Hospital of Trikala, 56 Karditsis, 42100, Trikala, Greece.
Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Diabetes Institute, Shanghai, China.
Metabol Open. 2022 Mar 14;14:100178. doi: 10.1016/j.metop.2022.100178. eCollection 2022 Jun.
The entire spectrum of nonalcoholic fatty liver disease (NAFLD) ranging from fatty liver to cirrhosis has been considered as the result of specific metabolic pathways and mediators, gut barrier function alterations and inflammatory responses. Previous studies have associated intestinal microbiota with NAFLD pathogenesis, focusing mostly on bacteria. In a recent study by Demir et al. in the , researchers characterized the fecal mycobiome of patients with NAFLD and controls. NAFLD severity was linked to a specific fecal mycobiome signature, particularly in patients without obesity, highlighting previously undescribed aspects of the non obese phenotype of NAFLD. There has recently been a growing interest in the pathophysiology and progression of non obese NAFLD, as its actual incidence seems to be higher than previously described. Moreover, the authors demonstrated that in subjects with NAFLD and advanced fibrosis, there was an augmented systemic immune response to . Amphotericin B, which has been widely regarded as an antifungal with a good safety profile, low rate of resistance and high efficacy, has already been shown to prevent liver injury and steatosis in mice. Similarly in this study when germ-free mice colonized with feces from patients with NASH were fed with a Western diet, treatment with amphotericin B protected against steatohepatitis and liver fibrosis. In conclusion, this study has provided novel insights into the fecal mycobiome composition in advanced NAFLD especially in the non obese population while suggesting a role for antifungal therapy in the management of NAFLD.
从脂肪肝到肝硬化的整个非酒精性脂肪性肝病（NAFLD）谱，一直被认为是特定代谢途径和介质、肠道屏障功能改变及炎症反应的结果。以往研究将肠道微生物群与NAFLD发病机制联系起来，主要聚焦于细菌。在Demir等人最近的一项研究中，研究人员对NAFLD患者和对照组的粪便真菌群进行了特征分析。NAFLD严重程度与特定的粪便真菌群特征相关，尤其是在非肥胖患者中，这突出了NAFLD非肥胖表型此前未被描述的方面。最近，人们对非肥胖NAFLD的病理生理学和进展越来越感兴趣，因为其实际发病率似乎高于此前报道。此外，作者证明，在患有NAFLD和晚期纤维化的受试者中，对两性霉素B的全身免疫反应增强。两性霉素B已被广泛认为是一种安全性良好、耐药率低且疗效高的抗真菌药物，已被证明可预防小鼠肝损伤和脂肪变性。同样，在本研究中，当用来自NASH患者粪便定殖的无菌小鼠喂食西式饮食时，两性霉素B治疗可预防脂肪性肝炎和肝纤维化。总之，本研究为晚期NAFLD尤其是非肥胖人群的粪便真菌群组成提供了新的见解，同时提示抗真菌治疗在NAFLD管理中的作用。
