Characterization of fecal microbial communities in patients with liver cirrhosis

Abstract

Liver cirrhosis is the pathologic end stage of chronic liver disease. Increasing evidence suggests that gut flora is implicated in the pathogenesis of liver cirrhosis complications. The aim of this study was to characterize the fecal microbial communities in patients with liver cirrhosis in comparison with healthy individuals. We recruited 36 patients with liver cirrhosis and 24 healthy controls. The fecal microbial community was analyzed by way of 454 pyrosequencing of the 16S ribosomal RNA V3 region followed by real-time quantitative polymerase chain reaction. Community-wide changes of fecal microbiota in liver cirrhosis were observed compared with healthy controls. The proportion of phylum Bacteroidetes was significantly reduced (P 5 0.008), whereas Proteobacteria and Fusobacteria were highly enriched in the cirrhosis group (P 5 0.001 and 0.002, respectively). Enterobacteriaceae (P 5 0.001), Veillonellaceae (P 5 0.046), and Streptococcaceae (P 5 0.001) were prevalent in patients with cirrhosis at the family level. A positive correlation was observed between Child-Turcotte-Pugh (CTP) score and Streptococcaceae (R 5 0.386, P 5 0.02). Lachnospiraceae decreased significantly in patients with cirrhosis (P 5 0.004) and correlated negatively with CTP score (R 5 20.49, P 5 0.002). Using partial least square discriminate analysis, we identified 149 operational taxonomic units (OTUs) as key phylotypes that responded to cirrhosis, most of which were Lachnospiraceae (65 OTUs), Streptococcaceae (23 OTUs), and Veillonellaceae (21 OTUs). Conclusion: Fecal microbial communities are distinct in patients with cirrhosis compared with healthy individuals. The prevalence of potentially pathogenic bacteria, such as Enterobacteriaceae and Streptococcaceae, with the reduction of beneficial populations such as Lachnospiraceae in patients with cirrhosis may affect prognosis. (HEPATOLOGY 2011;54:562-572)

Probiotics and Liver Disease

“…Cirrhosis patients have colonic microbiota that are different from that of healthy control subjects. 10,11 Increases in Enterobacteriaceae and Enterococcus with a reduction in Bifidobacterium species were noted in one report. Whether these changes are a cause or a consequence of cirrhosis is not clear.…”

“…10 An earlier report had indicated a reduced proportion of bacteroidetes and an increase in proteobacteria and fusobacteria. 11 In fact, a positive correlation was observed between Child-Turcotte-Pugh score and streptococcaceae. 11 Another report contradicted these findings vis-à-vis the diversity in intestinal microbiota amongst subjects with hepatitis B virus-related cirrhosis, subjects with chronic hepatitis B, and controls.…”

Hepatobiliary Quiz (Answers)—14 (2015)

“…There is a reduction in Veillonellaceae (gram negative cocci) and an increase in Eubacteriaceae (gram positive cocci). 40,41 Rifaximin is effective and well tolerated, with minimal systemic absorption. A meta-analysis comparing rifaximin with lactulose found that patients taking rifaximin fared better than those on lactulose.…”

Management of Covert Hepatic Encephalopathy

“…Veillonellaceae are gram negative cocci that are more abundant in the stool of patients with cirrhosis compared to healthy individuals. 16 The initial studies for rifaximin demonstrated its efficacy in the management of OHE. Compared to lactulose, rifaximin is more effective in the treatment of OHE.…”

“…The gut microbiota plays an integral role in the production of ammonia and other toxins resulting in oxidative stress/inflammation. [16][17][18][19] It would only seem natural that treatment modalities in CHE would focus on the modulation of the gut flora. Therapeutic strategies for CHE must be extrapolated from MHE trials as CHE is a relatively recent term and no studies on therapy are available at this time.…”