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  • Treatment with probiotics can also be used to alter the

    2022-08-04

    Treatment with probiotics can also be used to alter the microbiota profile of CF patients. One study reports that administration of the probiotic Lactobacillus Reuteri improved digestive health and inflammation [112]. The fecal microbial profile changed, showing a decrease in Proteobacteria and an increase of the Firmicutes phylum. As numerous species of the Firmicutes phylum are involved in BA biotransformation, one could speculate that this change affects BA homeostasis. Treatment with another probiotic, Lactobacillus GG, decreased fecal calprotectin, a marker for intestinal inflammation, and changed microbial composition partially towards that of healthy controls [113,114]. However, in a large trial in CF children, one year of treatment with Lactobacillus GG versus placebo did not affect hospitalization, pulmonary outcomes or BMI [115]. Nevertheless, as probiotic use does seem to improve the GI phenotype of CF, it will be interesting to evaluate its effects on BA homeostasis and metabolic function. Another GI feature of CF patients is a delayed intestinal transit time, possibly leading to constipation or in severe cases Lithium Citrate receptor distal intestinal obstruction syndrome (DIOS) [[116], [117], [118]]. Interestingly, Bijvelds et al. showed that active BA Lithium Citrate receptor in the ileum triggered CFTR activation and subsequent local salt and water excretion [31]. It is therefore tempting to speculate that the absence of this postprandial ileal water release contributes to specific distal localization of obstruction occurring in CF patients. The inability to sufficiently hydrate intestinal content and mucus likely explains the fact that BA malabsorption does not lead to diarrhea in CF. As CF patients often suffer from constipation, laxatives are commonly prescribed. Laxative treatment shortens intestinal transit time and is able to alter microbiota and BA homeostasis. In rats, the commonly used laxative polyethylene glycol (PEG) decreased BA dehydroxylation, increasing the amount of primary BAs in the BA pool [119]. Whole body Cftr knockout mice display a severe intestinal phenotype and need to be kept either on a liquid diet or a solid diet in combination with laxative. A study by De Lisle et al. compared the effects of either a solid diet with PEG or a liquid diet with or without n-acetylcysteine (NAC), a mucolytic agent, on various aspects of the intestinal phenotype [120]. Laxative treatment had pronounced effects on the intestine and improved markers of intestinal inflammation and reduced bacterial overgrowth. In CF patients, laxative treatment was also found to be associated with a decrease in occurrence of SIBO [121]. Considering these beneficial effects of laxative treatment on the CF intestine, it is tempting to speculate that laxative treatment could decrease fecal BA excretion.
    Summary
    Introduction The prevalence of NAFLD is rapidly increasing worldwide and it is now the most common liver disorder in the Western world [1]. Obesity, type 2 diabetes (T2D), hyperlipidemia, and hypertension are highly prevalent in individuals with NAFLD and, therefore, NAFLD risk factors are almost identical to the constituents of the metabolic syndrome 2, 3. NAFLD is a complex spectrum of liver diseases ranging from benign, usually asymptomatic, steatosis to the more aggressive necroinflammatory form, nonalcoholic steatohepatitis (NASH). NASH is characterized by varying degrees of steatosis, cytoskeletal damage (hepatocellular ballooning), and lobular inflammation with or without fibrosis [4]. Although not all patients with NAFLD develop liver-related complications, patients with NASH are at increased risk of developing hepatic fibrosis, which can progress to cirrhosis, hepatocellular carcinoma (HCC), and end-stage liver disease 5, 6. As a consequence, NASH is currently the second indication for orthotopic liver transplantation, and it is projected that NASH will become the leading indication for liver transplantation within developing countries by 2020 [7]. To date, no evidence-based drug therapy has been approved for NASH management and, because therapeutic advances have been slow, NASH is classified as a medical condition with high unmet therapeutic need.