Gut microbial profiling as a therapeutic and diagnostic target for managing primary biliary cholangitis.

ABSTRACT

Introduction: Microbial antigens present in the intestine has been suggested as possible triggers of primary biliary cholangitis (PBC) and it has been demonstrated that the gut microbiome is modified in PBC patients. On this basis, the modulation of the gut microbiome has been proposed as a pharmacological target for PBC management. To provide a state-of-the-art analysis of the preclinical and clinical evidence on this topic, a systematic review of literature in PubMed, Scopus, and Science Direct was conducted (inclusive dates: 2000–2020).

Area covered: In particular, several strategies for microbiome modulation have been investigated in both experimental and clinical studies, i.e. dietary interventions, and the administration of probiotics and prebiotics and drugs. Moreover, clinical evidence point to two drugs approved for PBC, i.e. ursodeoxycholic and obeticholic acids, as gut flora modulators. Accordingly, fecal microbiota transplantation is also under evaluation for PBC treatment. On the other hand, typical alterations of the microbiome have been observed in PBC patients, although their diagnostic impact remains to be better evaluated.

Expert opinion: The addition of gut microbiome manipulation to standard pharmacological treatments is one important challenge for PBC therapy in the near future. Further studies are needed to ascertain whether microbiome profiling could be considered a diagnostic strategy in PBC.

KEYWORDS:

• PBC
• microbiota
• microbiome
• microbial profiling
• metagenomics
• metabolomic
• bile acids
• UDCA
• obeticholic acid

Article highlights

• There is an important link between the microbiome, immune system, and bile acids, which can be exploited for the management of autoimmune cholestatic diseases.

• The microbiome can be targeted to treat PBC either by dietary or pharmacological interventions or both.

• Typical microbiome profiles have been identified in PBC patients and should be evaluated as diagnostic markers.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.