Sarcopenia in cirrhosis: Prospects for therapy targeted to gut microbiota

被引:13
作者
Maslennikov, Roman [1 ,2 ,5 ]
Alieva, Aliya [1 ]
Poluektova, Elena [1 ,2 ]
Zharikov, Yury [3 ]
Suslov, Andrey [3 ]
Letyagina, Yana [3 ]
Vasileva, Ekaterina [1 ]
Levshina, Anna [1 ,4 ]
Kozlov, Evgenii [4 ]
Ivashkin, Vladimir [1 ,2 ]
机构
[1] Sechenov Univ, Dept Internal Med Gastroenterol & Hepatol, Moscow 119435, Russia
[2] Sci Community Human Microbiome Res, Moscow 119435, Russia
[3] Sechenov Univ, Dept Human Anat & Histol, Moscow 119435, Russia
[4] Sechenov Univ, Dept Clin Immunol & Allergy, Lab Immunopathol, Moscow 119991, Russia
[5] Sechenov Univ, Dept Internal Med Gastroenterol & Hepatol, Pogodinskaya Str 1,Bld 1, Moscow 119435, Russia
关键词
Cirrhosis; Muscle; Fragility; Liver; Microbiota; Microbiome; INTESTINAL BACTERIAL OVERGROWTH; MINIMAL HEPATIC-ENCEPHALOPATHY; RANDOMIZED CONTROLLED-TRIAL; MUSCLE PROTEIN-SYNTHESIS; TERM RIFAXIMIN THERAPY; SKELETAL-MUSCLE; LIVER-CIRRHOSIS; CLINICAL EFFECTIVENESS; HEPATORENAL-SYNDROME; AMMONIA METABOLISM;
D O I
10.3748/wjg.v29.i27.4236
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Decreased muscle mass and function, also known as sarcopenia, is common in patients with cirrhosis and is associated with a poor prognosis. Although the pathogenesis of this disorder has not been fully elucidated, a disordered gut-muscle axis probably plays an important role. Decreased barrier function of the gut and liver, gut dysbiosis, and small intestinal bacterial overgrowth (SIBO) can lead to increased blood levels of ammonia, lipopolysaccharides, pro-inflammatory mediators, and myostatin. These factors have complex negative effects on muscle mass and function. Drug interventions that target the gut microbiota (long-term use of rifaximin, lactulose, lactitol, or probiotics) positively affect most links of the compromised gut-muscle axis in patients with cirrhosis by decreasing the levels of hyperammonemia, bacterial translocation, and systemic inflammation and correcting gut dysbiosis and SIBO. However, although these drugs are promising, they have not yet been investigated in randomized controlled trials specifically for the treatment and prevention of sarcopenia in patients with cirrhosis. No data exist on the effects of fecal transplantation on most links of gut-muscle axis in cirrhosis; however, the results of animal experimental studies are promising.
引用
收藏
页码:4236 / 4251
页数:16
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