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World J Hepatol. Apr 27, 2023; 15(4): 525-537
Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.525
Therapeutic possibilities of gut microbiota modulation in acute decompensation of liver cirrhosis
Dmitry Victorovich Garbuzenko
Dmitry Victorovich Garbuzenko, Department of Faculty Surgery, South Ural State Medical University, Chelyabinsk 454080, Russia
Author contributions: Garbuzenko DV contributed to the conception, design, acquisition, analysis, and interpretation of data, wrote the manuscript, and approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Dmitry Victorovich Garbuzenko, MD, PhD, DSc (Med), Professor, Department of Faculty Surgery, South Ural State Medical University, 64 Vorovskogo Str., Chelyabinsk 454080, Russia. garb@inbox.ru
Received: December 17, 2022
Peer-review started: December 17, 2022
First decision: January 22, 2023
Revised: February 1, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: April 27, 2023
Abstract

The formation of liver cirrhosis (LC) is an unfavorable event in the natural history of chronic liver diseases and with the development of portal hypertension and/or impaired liver function can cause a fatal outcome. Decompensation of LC is considered the most important stratification variable for the risk of death. It is currently postulated that decompensation of LC occurs through an acute (including acute-on-chronic liver failure) and non-acute pathway. Acute decompensation of LC is accompanied by the development of life-threatening complications, characterized by an unfavorable prognosis and high mortality. Progress in understanding the underlying molecular mechanisms has led to the search for new interventions, drugs, and biological substances that can affect key links in the pathogenesis of acute decompensation in LC, for example the impaired gut-liver axis and associated systemic inflammation. Given that particular alterations in the composition and function of gut microbiota play a crucial role here, the study of the therapeutic possibilities of its modulation has emerged as one of the top concerns in modern hepatology. This review summarized the investigations that describe the theoretical foundations and therapeutic potential of gut microbiota modulation in acute decompensation of LC. Despite the encouraging preliminary data, the majority of the suggested strategies have only been tested in animal models or in preliminary clinical trials; additional multicenter randomized controlled trials must demonstrate their efficacy in larger patient populations.

Keywords: Liver cirrhosis, Acute decompensation, Pathogenesis, Therapy, Gut microbiota, Modulation

Core Tip: Given that particular alterations in the composition and function of gut microbiota play a crucial role in the pathogenesis of acute decompensation in liver cirrhosis (LC), this review summarized the investigations that describe the theoretical foundations and therapeutic potential of gut microbiota modulation in acute decompensation of LC. Despite the encouraging preliminary data, the majority of the suggested strategies have only been tested in animal models or in preliminary clinical trials. Additional multicenter randomized controlled trials must demonstrate their efficacy in larger patient populations.