Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Gut Microbes. 2023 Jan-Dec;15(1):2208501. doi: 10.1080/19490976.2023.2208501.
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease with ursodeoxycholic acid (UDCA) as first-line treatment. Poor response to UDCA is associated with a higher risk of progressing to cirrhosis, but the underlying mechanisms are unclear. UDCA modulates the composition of primary and bacterial-derived bile acids (BAs). We characterized the phenotypic response to UDCA based on BA and bacterial profiles of PBC patients treated with UDCA. Patients from the UK-PBC cohort ( = 419) treated with UDCA for a minimum of 12-months were assessed using the Barcelona dynamic response criteria. BAs from serum, urine, and feces were analyzed using Ultra-High-Performance Liquid Chromatography-Mass Spectrometry and fecal bacterial composition measured using 16S rRNA gene sequencing. We identified 191 non-responders, 212 responders, and a subgroup of responders with persistently elevated liver biomarkers ( = 16). Responders had higher fecal secondary and tertiary BAs than non-responders and lower urinary bile acid abundances, with the exception of 12-dehydrocholic acid, which was higher in responders. The sub-group of responders with poor liver function showed lower alpha-diversity evenness, lower abundance of fecal secondary and tertiary BAs than the other groups and lower levels of phyla with BA-deconjugation capacity (/, , ) compared to responders. UDCA dynamic response was associated with an increased capacity to generate oxo-/epimerized secondary BAs. 12-dehydrocholic acid is a potential biomarker of treatment response. Lower alpha-diversity and lower abundance of bacteria with BA deconjugation capacity might be associated with an incomplete response to treatment in some patients.
原发性胆汁性胆管炎 (PBC) 是一种慢性胆汁淤积性肝病,熊去氧胆酸 (UDCA) 是其一线治疗药物。UDCA 治疗应答不佳与发展为肝硬化的风险增加相关,但潜在机制尚不清楚。UDCA 可调节初级胆汁酸和细菌衍生胆汁酸 (BAs) 的组成。我们根据 PBC 患者接受 UDCA 治疗后的 BA 和细菌谱特征,对 UDCA 的表型应答进行了特征描述。使用巴塞罗那动态应答标准,评估了来自英国 PBC 队列的至少接受 12 个月 UDCA 治疗的 419 例患者。使用超高效液相色谱-质谱法分析血清、尿液和粪便中的 BAs,并使用 16S rRNA 基因测序测量粪便细菌组成。我们确定了 191 名无应答者、212 名应答者和一组持续存在肝生物标志物升高的应答者( = 16)。与无应答者相比,应答者的粪便次级和三级 BAs 更高,而尿液胆汁酸丰度更低,但 12-去氧胆酸除外,该物质在应答者中更高。肝功能较差的应答者亚组的 alpha 多样性均匀度较低,粪便次级和三级 BAs 的丰度也低于其他组,并且具有 BA 去结合能力的菌门(/,,)的水平也低于应答者。UDCA 动态应答与生成氧代/表异构化次级 BAs 的能力增加相关。12-去氧胆酸可能是治疗应答的潜在生物标志物。alpha 多样性较低和具有 BA 去结合能力的细菌丰度较低,可能与某些患者对治疗的不完全应答有关。
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