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Gillard J, Leclercq IA. Biological tuners to reshape the bile acid pool for therapeutic purposes in non-alcoholic fatty liver disease. Clin Sci (Lond) 2023; 137:65-85. [PMID: 36601783 PMCID: PMC9816373 DOI: 10.1042/cs20220697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
Bile acids synthesized within the hepatocytes are transformed by gut microorganisms and reabsorbed into the portal circulation. During their enterohepatic cycling, bile acids act as signaling molecules by interacting with receptors to regulate pathways involved in many physiological processes. The bile acid pool, composed of a variety of bile acid species, has been shown to be altered in diseases, hence contributing to disease pathogenesis. Thus, understanding the changes in bile acid pool size and composition in pathological processes will help to elaborate effective pharmacological treatments. Five crucial steps along the enterohepatic cycle shape the bile acid pool size and composition, offering five possible targets for therapeutic intervention. In this review, we provide an insight on the strategies to modulate the bile acid pool, and then we discuss the potential benefits in non-alcoholic fatty liver disease.
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Affiliation(s)
- Justine Gillard
- Laboratory of Hepato‐Gastroenterology, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Isabelle A. Leclercq
- Laboratory of Hepato‐Gastroenterology, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
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Koelfat KV, Visschers RG, Hodin CM, de Waart DR, van Gemert WG, Cleutjens JP, Gijbels MJ, Shiri-Sverdlov R, Mookerjee RP, Lenaerts K, Schaap FG, Steven W.M. OD. FXR agonism protects against liver injury in a rat model of intestinal failure-associated liver disease. J Clin Transl Res 2017; 3:318-327. [PMID: 30895273 PMCID: PMC6426251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intestinal failure-associated liver disease (IFALD) is a clinical challenge. The pathophysiol-ogy is multifactorial and remains poorly understood. Disturbed recirculation of bile salts, e.g. due to loss of bile via an enterocutaneous fistula, is considered a major contributing factor. We hypothesize that impaired signaling via the bile salt receptor FXR underlies the development of IFALD. The aim of this study was to investigate whether activation of FXR improves liver homeostasis during chronic loss of bile in rats. METHODS To study consequences of chronic loss of bile, rats underwent external biliary drainage (EBD) or sham surgery for seven days, and the prophylactic potential of the FXR agonist INT-747 was assessed. RESULTS EBD for 7 days resulted in liver test abnormalities and histological liver damage. Expression of the intestinal FXR target gene Fgf15 was undetectable after EBD, and this was accompanied by an anticipated increase in hepatic Cyp7a1 expression, indicating increased bile salt synthesis. Treatment with INT-747 improved serum biochemistry, reduced loss of bile fluid in drained rats and prevented development of drainage-associated histological liver injury. CONCLUSIONS EBD results in extensive hepatobiliary injury and cholestasis. These data suggest that FXR activation might be a novel therapy in preventing liver dysfunction in patients with intestinal failure. RELEVANCE FOR PATIENTS This study demonstrates that chronic loss of bile causes liver injury in rats. Abro-gated recycling of bile salts impairing of enterohepatic bile salt/FXR signaling underlies these pathological changes, as administration of FXR agonist INT747 prevents biliary drainage-induced liver damage. Phar-macological activation of FXR might be a therapeutic strategy to treat disorders accompanied by a per-turbed enterohepatic circulation such as intestinal failure-associated liver disease.
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Affiliation(s)
- Kiran V.K. Koelfat
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Ruben G.J. Visschers
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Caroline M.J.M. Hodin
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - D. Rudi de Waart
- 2 Tytgat Institute for Liver and Intestinal Research, Academic
Medical Center, Amsterdam, the Netherlands
| | - Wim G. van Gemert
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Jack P.M. Cleutjens
- 3 Department of Pathology, Maastricht University Medical Center,
Maastricht, the Netherlands
| | - Marion J. Gijbels
- 3 Department of Pathology, Maastricht University Medical Center,
Maastricht, the Netherlands,4 Department of Medical Biochemistry, Academic Medical Center,
Amsterdam, the Netherlands
| | - Ronit Shiri-Sverdlov
- 5 Department of Molecular Genetics, Maastricht University,
Maastricht, the Netherlands
| | - Rajeshwar P. Mookerjee
- 6 Institute for Liver and Digestive Health, University College
London, London, United Kingdom
| | - Kaatje Lenaerts
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands
| | - Frank G. Schaap
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands,7 Department of Visceral- and Transplantation Surgery, RWTH
Aachen University, Germany
| | - Olde Damink Steven W.M.
- 1 Department of Surgery, Maastricht University Medical Center,
Maastricht University, NUTRIM School of Nutrition and Translational Research in
Me-tabolism, Maastricht, the Netherlands,7 Department of Visceral- and Transplantation Surgery, RWTH
Aachen University, Germany
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