Leopoldo R Arosemena
University of Miami - LMM School of Medicine, USA
Title: Medical Director of the Broward General Medical Center Liver transplant
Biography
Biography: Leopoldo R Arosemena
Abstract
It has been proposed that alterations in the highly complex gut microbiome leads to intestinal barrier damage and the release of pro-inflammatory endotoxins to the portal circulation, which trigger variable injuries in the liver and subsequently in the rest of the body. In return, the liver influences intestinal function by producing bile (including bile acids), which are then modified by intestinal bacteria (gut-liver axis). We are improving our understanding of those interactions at the molecular level, but we are still far from mastering this knowledge. Multiple studies show that beneficial bacteria (probiotics) introduced in an abnormal environment (dysbiosis) can induce improvements in different clinical outcomes. Many hepatopathies have been associated with a decrease in the diversity of species living in the intestine and predominance of species considered pro-inflammatory. Research groups around the world are closer to elucidate which combination of microorganisms can be used to affect positively certain diseases in individuals. A review of the pathophysiology of diseases like alcoholic liver disease, NASH, viral hepatitis, inflammatory hepatopathies, hepatocellular carcinoma, hepatic fibrogenesis indicate a close relationship among dietary factors, microbiome and genetic predisposition. Modification of the intestinal milieu by antibiotics, probiotics, prebiotics (probiotic food), symbiotics (prebiotics and probiotics) and surgical procedures, can lead to regression of multiple manifestations of chronic liver and systemic inflammation. When we consider the heterogeneity of the studies and individual variations on gut microbiome, it is remarkable how fast we have developed the technology to obtain more consistent results in research and clinical practice. Different species of Lactobacillus, Bifidobacterium and Saccharomyces independently or in combinations have the most published data indicating decrease on multiple inflammatory markers. Most of the data available is done in pre-clinical settings, but human studies are confirming many of those concepts, including data on safety and effectiveness.