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Title: Alterations in Gut Microbiome in Cirrhosis as Assessed by Quantitative Metagenomics: Relationship With Acute-on-Chronic Liver Failure and Prognosis
Author: Solé Padullés, Cristina
Guilly, Susie
Da Silva, Kevin
Llopis, Marta
Le-Chatelier, Emmanuelle
Huelin, Patricia
Carol, Marta
Moreira, Rebeca
Fabrellas i Padrès, Núria
de la Prada, Gloria
Napoleone, Laura
Graupera, Isabel
Pose, Elisa
Juanola, Adrià
Borruel, Natalia
Berland, Magali
Toapanta, David
Casellas, Francesc
Guarner, Francisco
Doré, Jöel
Solà, Elsa
Ehrlich, Stanislav Dusko
Ginès i Gibert, Pere
Keywords: Cirrosi hepàtica
Insuficiència hepàtica
Microbiota intestinal
Hepatic cirrhosis
Liver failure
Gastrointestinal microbiome
Issue Date: 14-Sep-2020
Publisher: Elsevier
Abstract: Background and Aims: Cirrhosis is associated with changes in gut microbiome composition. Although acute-on-chronic liver failure (ACLF) is the most severe clinical stage of cirrhosis, there is lack of information about gut microbiome alterations in ACLF using quantitative metagenomics. We investigated the gut microbiome in patients with cirrhosis encompassing the whole spectrum of disease (compensated, acutely decompensated without ACLF, and ACLF). A group of healthy subjects was used as control subjects. Methods: Stool samples were collected prospectively in 182 patients with cirrhosis. DNA library construction and sequencing were performed using the Ion Proton Sequencer (ThermoFisher Scientific, Waltham, MA). Microbial genes were grouped into clusters, denoted as metagenomic species. Results: Cirrhosis was associated with a remarkable reduction in gene and metagenomic species richness compared with healthy subjects. This loss of richness correlated with disease stages and was particularly marked in patients with ACLF and persisted after adjustment for antibiotic therapy. ACLF was associated with a significant increase of Enterococcus and Peptostreptococcus sp and a reduction of some autochthonous bacteria. Gut microbiome alterations correlated with model for end-stage liver disease and Child-Pugh scores and organ failure and was associated with some complications, particularly hepatic encephalopathy and infections. Interestingly, gut microbiome predicted 3-month survival with good stable predictors. Functional analysis showed that patients with cirrhosis had enriched pathways related to ethanol production, γ-aminobutyric acid metabolism, and endotoxin biosynthesis, among others. Conclusions: Cirrhosis is characterized by marked alterations in gut microbiome that parallel disease stages with maximal changes in ACLF. Altered gut microbiome was associated with complications of cirrhosis and survival. Gut microbiome may contribute to disease progression and poor prognosis. These results should be confirmed in future studies.
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It is part of: Gastroenterology, 2020, vol. 160, num. 1, p. 206-218
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ISSN: 0016-5085
Appears in Collections:Articles publicats en revistes (Infermeria de Salut Pública, Salut mental i Maternoinfantil)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Medicina)

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