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Abstract Details
Microbiome Therapeutics for Hepatic Encephalopathy
J Hepatol. 2021 Aug 25;S0168-8278(21)01998-X. doi: 10.1016/j.jhep.2021.08.004.Online ahead of print.
Patricia Bloom1, Elliot B Tapper2, Vincent B Young3, Anna S Lok2
Author information
1Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan. Electronic address: ppbloom@med.umich.edu.
2Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan.
3Department of Internal Medicine, Division of Infectious Disease, University of Michigan; Department of Microbiology and Immunology, University of Michigan.
Abstract
Hepatic encephalopathy (HE) is a complication of cirrhosis characterized by neuropsychiatric and motor dysfunction. Microbiota-host interactions have an important role in HE pathogenesis. Therapies targeting microbial community composition and function have been explored for the treatment of HE. Prebiotics, probiotics and fecal microbiota transplant (FMT) have aimed to increase the abundance of potentially beneficial taxa, while antibiotics have aimed to decrease the abundance of potentially harmful taxa. Other microbiome therapeutics, including postbiotics and absorbents, have been used to target microbial products. Microbiome-targeted therapies for HE have had some success, notably lactulose and rifaximin, with early promise for probiotics and FMT. Microbiome therapeutics face several challenges in HE, including the resilience of the microbiome to sustainable change and unpredictable clinical outcomes from microbiota alterations. Future work in this space should focus on rigorous trial design, microbiome therapy selection, and a personalized approach to HE.