Review
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World J Gastroenterol. Nov 28, 2022; 28(44): 6213-6229
Published online Nov 28, 2022. doi: 10.3748/wjg.v28.i44.6213
Role of intestinal flora in primary sclerosing cholangitis and its potential therapeutic value
Zhen-Jiao Li, Hong-Zhong Gou, Yu-Lin Zhang, Xiao-Jing Song, Lei Zhang
Zhen-Jiao Li, Hong-Zhong Gou, Yu-Lin Zhang, Xiao-Jing Song, Lei Zhang, The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
Zhen-Jiao Li, Hong-Zhong Gou, Yu-Lin Zhang, Xiao-Jing Song, Lei Zhang, Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Zhen-Jiao Li, Hong-Zhong Gou, Yu-Lin Zhang, Xiao-Jing Song, Lei Zhang, Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Zhang L conceptualized the framework of the article; Li ZJ wrote the first draft of the article; Gou HZ, Zhang YL and Song XJ made critical revision of the manuscript for important intellectual content; All authors read and approved the final version.
Supported by the National Natural Science Foundation of China, No. 31960236; the Talent Innovation and Entrepreneurship Project of Lanzhou City, No. 2019-RC-34; and the Lanzhou Cheng guan District Science and Technology Planning Project, No. 2020SHFZ0029.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Zhang, Doctor, Professor, The First Clinical Medical College, Lanzhou University, Donggang Road Street, Chengguan District, Lanzhou 730000, Gansu Province, China. 13993181644@139.com
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: October 20, 2022
Revised: October 31, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: November 28, 2022
Abstract

Primary sclerosing cholangitis (PSC) is an autoimmune disease characterized by chronic cholestasis, a persistent inflammation of the bile ducts that leads to sclerotic occlusion and cholestasis. Gut microbes, consisting of microorganisms colonized in the human gut, play an important role in nutrient intake, metabolic homeostasis, immune regulation, and immune regulation; however, their presence might aid PSC development. Studies have found that gut-liver axis interactions also play an important role in the pathogenesis of PSC. Patients with PSC have considerably reduced intestinal flora diversity and increased abundance of potentially pathogenic bacteria. Dysbiosis of the intestinal flora leads to increased intestinal permeability, homing of intestinal lymphocytes, entry of bacteria and their associated metabolites, such as bile acids, into the liver, stimulation of hepatic immune activation, and promotion of PSC. Currently, PSC effective treatment is lacking. However, a number of studies have recently investigated the targeted modulation of gut microbes for the treatment of various liver diseases (alcoholic liver disease, metabolic fatty liver, cirrhosis, and autoimmune liver disease). In addition, antibiotics, fecal microbiota transplantation, and probiotics have been reported as successful PSC therapies as well as for the treatment of gut dysbiosis, suggesting their effectiveness for PSC treatment. Therefore, this review briefly summarizes the role of intestinal flora in PSC with the aim of providing new insights into PSC treatment.

Keywords: Primary sclerosing cholangitis, Intestinal flora, Antibiotics, Fecal microbiota transplantation, Probiotics, Bile acids

Core Tip: Primary sclerosing cholangitis (PSC) is an autoimmune disease that currently lacks treatment. The intestinal flora comprises microorganisms that colonize the human gut and play essential roles in nutrient intake, metabolic homeostasis, immune regulation, and PSC development. Thus, the intestinal flora may be a potential therapeutic target for PSC, and many recent studies have attempted to regulate it. In this review, we have reviewed the role of the intestinal flora in PSC. We believe that our study makes a significant contribution to the literature because our paper demonstrated the great potential of the gut flora as a therapeutic target for PSC treatment.