Cholestasis: exploring the triangular relationship of gut microbiota-bile acid-cholestasis and the potential probiotic strategies

ABSTRACT

Cholestasis is a condition characterized by the abnormal production or excretion of bile, and it can be induced by a variety of causes, the factors of which are extremely complex. Although great progress has been made in understanding cholestasis pathogenesis, the specific mechanisms remain unclear. Therefore, it is important to understand and distinguish cholestasis from different etiologies, which will also provide indispensable theoretical support for the development of corresponding therapeutic drugs. At present, the treatment of cholestasis mainly involves several bile acids (BAs) and their derivatives, most of which are in the clinical stage of development. Multiple lines of evidence indicate that ecological disorders of the gut microbiota are strongly related to the occurrence of cholestasis, in which BAs also play a pivotal role. Recent studies indicate that probiotics seem to have certain effects on cholestasis, but further confirmation from clinical trials is required. This paper reviews the etiology of and therapeutic strategies for cholestasis; summarizes the similarities and differences in inducement, symptoms, and mechanisms of related diseases; and provides information about the latest pharmacological therapies currently available and those under research for cholestasis. We also reviewed the highly intertwined relationship between gut microbiota-BA-cholestasis, revealing the potential role and possible mechanism of probiotics in the treatment of cholestasis.

KEYWORDS:

• Cholestasis
• enterohepatic circulation
• bile acids
• gut microbiota
• probiotic

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

There are no research data in this paper.

Additional information

Funding

This work was supported by the Natural Science Foundation of Jiangsu Province [BE2021623]; Natural Science Foundation of Jiangsu Province [BK20220155]; the Key Scientific and Technological Research Projects in the Key Areas of the Xinjiang Production and Construction Corps [2018AB010]; National Natural Science Foundation of China Key Program [31820103010]; National Natural Science Foundation of China Key Program [32001665]; National Natural Science Foundation of China Key Program [U1903205].