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World J Hepatol. Feb 27, 2022; 14(2): 372-385
Published online Feb 27, 2022. doi: 10.4254/wjh.v14.i2.372
Immunomodulation by probiotics and prebiotics in hepatocellular carcinoma
Edda Russo, Camila Fiorindi, Francesco Giudici, Amedeo Amedei
Edda Russo, Francesco Giudici, Amedeo Amedei, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Tuscany, Italy
Camila Fiorindi, Department of Health Professions, Dietary Production Line and Nutrition, University Hospital of Careggi, Florence 50134, Italy
Author contributions: Russo E, Giudici F, Fiorindi C and Amedei A conceptualized the review; Russo E and Fiorindi C wrote the paper, collected the data and prepared the figures; Giudici F and Amedei A corrected the final version; Russo E, Giudici F, Amedei A were responsible for funding acquisition; and all authors critically revised the manuscript.
Supported by a grant from ECCO 2021 to Francesco Giudici.
Conflict-of-interest statement: Authors declare no any conflict of interest.
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: Amedeo Amedei, PhD, Professor, Department of Experimental and Clinical Medicine, University of Florence, Complesso Cubo, Viale Pieraccini 6, Florence 50134, Tuscany, Italy. amedeo.amedei@unifi.it
Received: May 27, 2021
Peer-review started: May 27, 2021
First decision: July 6, 2021
Revised: July 21, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: February 27, 2022
Abstract

Hepatocellular carcinoma (HCC) is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis. Recent attention has been paid to the involvement of the gut-liver axis (GLA) in HCC pathogenesis. This axis results from a bidirectional, anatomical and functional relationship between the gastrointestinal system and the liver. Moreover, the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment, contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns, such as bacterial lipopolysaccharides, DNA, peptidoglycans and flagellin. Indeed, the alteration of gut microflora may disturb the intestinal barrier, bringing several toll-like receptor ligands to the liver thus activating the inflammatory response. This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation, represented by probiotics, and prebiotics, affects HCC through the GLA.

Keywords: Hepatocellular carcinoma, Gut microbiota, Probiotics, Prebiotics, Gut-liver axis, Immunomodulation

Core Tip: In patients with chronic liver disease and cirrhosis, hepatocellular carcinoma (HCC) is the most common primary malignancy. Recent attention has been paid to the involvement of the gut-liver axis (GLA) in HCC pathogenesis. This review explores the potential for new treatment options as a result of novel insights into the processes by which microbiota immunomodulation, represented by probiotics and prebiotics, affects HCC through the GLA.