Luo M, Xin RJ, Hu FR, Yao L, Hu SJ, Bai FH. Role of gut microbiota in the pathogenesis and therapeutics of minimal hepatic encephalopathy via the gut-liver-brain axis. World J Gastroenterol 2023; 29(1): 144-156 [PMID: 36683714 DOI: 10.3748/wjg.v29.i1.144]
Corresponding Author of This Article
Fei-Hu Bai, MD, Chief Physician, Professor, Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, No. 301 Zhengyuan North Street, Jinfeng District, Yinchuan 750021, Ningxia Hui Autonomous Region, China. baifeihu@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 7, 2023; 29(1): 144-156 Published online Jan 7, 2023. doi: 10.3748/wjg.v29.i1.144
Role of gut microbiota in the pathogenesis and therapeutics of minimal hepatic encephalopathy via the gut-liver-brain axis
Ming Luo, Rui-Juan Xin, Fang-Rui Hu, Li Yao, Sheng-Juan Hu, Fei-Hu Bai
Ming Luo, Rui-Juan Xin, Fang-Rui Hu, Li Yao, Sheng-Juan Hu, Fei-Hu Bai, Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan 750021, Ningxia Hui Autonomous Region, China
Author contributions: Luo M and Xin RJ designed the outline, prepared the tables, and drafted the manuscript; Hu FR and Yao L summarized the data and plotted the figure; Hu SJ and Bai FH revised the manuscript. All authors approved the final version of the manuscript.
Supported byNingxia Natural Science Foundation, No. 2020AAC03329; and the Key Research and Development Projects of Ningxia, No. 2022BEG03128.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei-Hu Bai, MD, Chief Physician, Professor, Department of Gastroenterology, People’s Hospital of Ningxia Hui Autonomous Region, No. 301 Zhengyuan North Street, Jinfeng District, Yinchuan 750021, Ningxia Hui Autonomous Region, China. baifeihu@hotmail.com
Received: September 26, 2022 Peer-review started: September 26, 2022 First decision: November 5, 2022 Revised: November 23, 2022 Accepted: December 13, 2022 Article in press: December 13, 2022 Published online: January 7, 2023
Abstract
Minimal hepatic encephalopathy (MHE) is a frequent neurological and psychiatric complication of liver cirrhosis. The precise pathogenesis of MHE is complicated and has yet to be fully elucidated. Studies in cirrhotic patients and experimental animals with MHE have indicated that gut microbiota dysbiosis induces systemic inflammation, hyperammonemia, and endotoxemia, subsequently leading to neuroinflammation in the brain via the gut-liver-brain axis. Related mechanisms initiated by gut microbiota dysbiosis have significant roles in MHE pathogenesis. The currently available therapeutic strategies for MHE in clinical practice, including lactulose, rifaximin, probiotics, synbiotics, and fecal microbiota transplantation, exert their effects mainly by modulating gut microbiota dysbiosis. Microbiome therapies for MHE have shown promised efficacy and safety; however, several controversies and challenges regarding their clinical use deserve to be intensively discussed. We have summarized the latest research findings concerning the roles of gut microbiota dysbiosis in the pathogenesis of MHE via the gut-liver-brain axis as well as the potential mechanisms by which microbiome therapies regulate gut microbiota dysbiosis in MHE patients.
Core Tip: Minimal hepatic encephalopathy (MHE) is a common neuropsychiatric complication of liver cirrhosis. Gut microbiota dysbiosis has an essential role in the pathogenesis of MHE via the gut-liver-brain axis. Current therapeutic strategies for MHE are based on the modulation of gut microbiota dysbiosis. This review presents the recent evidence on the roles of gut microbiota dysbiosis in the pathogenesis and treatment of MHE via the gut-liver-brain axis.
