The role of gut microbiota in hepatitis B disease progression and treatment

Abstract

Current therapeutic interventions can only suppress hepatitis B virus (HBV) replication or reduce complications without a cure. Therefore, further development of new treatment methods is critical for the global eradication of HBV. Accumulating evidence suggests that the liver and gut share an interconnected relationship referred to as the 'Gut-Liver Axis', where exchanges happen bi-directionally. The gut itself is the host to a unique microbiota profile which has metabolic, immunological, neurological and nutritional functions. Gut microbiota is not only constantly intersecting with the liver but also associated with hepatic injury when dysbiosis occurs. In recent years, there has been increased interest in gut microbiota and its implications on liver disease treatment. Progress has been made in understanding the complex relationship between chronic hepatitis B (CHB) and gut microbiota. New investigative techniques such as colony-free sequencing enabled new perspectives into this field.Mouse models and human studies revealed that HBV infection is associated with significant alteration of gut microbiota, which differ depending on the stage of CHB disease progression. Different mechanisms of the hepatic injury from gut microbiota dysbiosis have also been proposed based on findings of increased intestinal permeability to toxins, disruption of normal bacterial metabolism, and colonization of the gut by oral microbiota. New treatment methods targeting gut microbiota in CHB, such as probiotics and faecal microbiota transplant, have also gained promising results in recent years. The current review recapitulated the most recent investigations into the relationship between gut microbiota and CHB to provide research directions towards the new therapeutic target of CHB.

A Meta-Analysis of How Nonalcoholic Fatty Liver Disease Affect Antiviral Treatment of Patients with e Antigen-Positive Chronic Hepatitis B

“…The results of this study showed that the patients' AST, TG, TC, and ALT improved more significantly when they were treated with hepatoprotective therapy and the observation group was treated with antiviral therapy alone. Although the basic hepatoprotective therapy could improve liver function, fibrosis level, and ballooning changes to some extent, the effect was more significant with the addition of the antiviral method, and the patients were able to achieve 89% and 100% of the liver function level and HBV DNA conversion rate after the treatment [ 19 ].…”

A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis

“…The ammonia concentration was 96 (87.25-117.75), whereas the level declined to 74 (70-82) at week 20 post-FMT in the case series by Mehta et al [ 25 ]. From the same study, a statistically significant reduction in liver parameters such as the Child-Turcotte-Pugh score (from 9.5 [9-10.75] to 8 [ 7 - 8 ]) and MELD score (from 18 [16.25-19] to 15 [ 14 - 16 ]) was also observed [ 25 ]. Therefore, the evidence suggests that FMT may be beneficial in hindering the progression of chronic liver disease.…”

“…On the other hand, it is hypothesized that factors often seen in chronic liver diseases (CLD), such as portal hypertension and immunological dysfunction, can disrupt the microbiome and lead to complications, such as translocation of bacteria and bacteria-derived byproducts, which can further worsen the liver injury, fibrosis, and systemic inflammation [ 2 , 3 ]. On a molecular level, sinusoidal cells in fibrotic livers produce less nitric oxide, a vasoactive agent, than in non-fibrotic livers [ 7 , 8 ]. Consequently, it can precipitate higher portal pressure that can lead to worsening of portal hypertension and subsequently to further complications, such as variceal bleeding.…”

Review: Microbial Therapeutics for Liver Disease

“…Researchers discovered that Neisseriaceae positively correlated with serum levels of hepatitis B viral DNA, and the oral microbiota dysbiosis during hepatitis B infection was associated with a yellow coating of the tongue, indicating a decrease in Bacteroidetes but an increase in Proteobacteria. 16…”