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Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that causes cognitive and motor impairment in patients with liver disease. Recent evidence indicates that the gut microbiota plays a key role in the pathogenesis of HE, suggesting that interventions based on the gut microbiome may have preventive and/or therapeutic benefits. Indeed, strategies targeting the gut microbiota, such as lactulose and rifaximin, probiotics, prebiotics, postbiotics and fecal microbiota transplantation, have shown some success in treating HE by increasing the abundance of potentially beneficial taxa and/or decreasing the abundance of potentially harmful taxa. However, challenges remain in the effective application of microbiome-targeted therapies in the context of HE. These include understanding the precise gut microbiota changes that causally relate to HE, determining the specific microbial species or consortia involved in HE risk and prognosis, assessing the factors involved in the resilience of the HE gut microbiome in some individuals, and evaluating the clinical outcomes of microbiota modifications in the context of the disease. Accordingly, further research is needed to gain greater insight into the complex interplay between the gut microbiome and HE, including identifying the factors that negatively influence the gut-liver-brain axis leading to HE in liver cirrhosis and exploring their relationship with the gut microbiome. Furthermore, studies that integrate multi-omics analysis of microbiota-gut-brain axis parameters are necessary to develop precision models based on specific individual features, such as microbiome profiling before intervention. These models could aid in classifying patients with HE based on their predicted clinical response to specific microbiome-targeted interventions with potential therapeutic effects for HE. In this chapter, we provide details of the most commonly used available techniques, methods, and recommendations for achieving tailored microbiome-based strategies that could aid in the prevention or treatment of HE.

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Gut Microbiota-Based Strategies for Targeting Hepatic Encephalopathy

  • 实验方案

  • 发表日期：

    2025年

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  • Marina Romaní-Pérez,
  • María del Carmen Cenit,
  • Ana Agustí

摘要

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that causes cognitive and motor impairment in patients with liver disease. Recent evidence indicates that the gut microbiota plays a key role in the pathogenesis of HE, suggesting that interventions based on the gut microbiome may have preventive and/or therapeutic benefits. Indeed, strategies targeting the gut microbiota, such as lactulose and rifaximin, probiotics, prebiotics, postbiotics and fecal microbiota transplantation, have shown some success in treating HE by increasing the abundance of potentially beneficial taxa and/or decreasing the abundance of potentially harmful taxa. However, challenges remain in the effective application of microbiome-targeted therapies in the context of HE. These include understanding the precise gut microbiota changes that causally relate to HE, determining the specific microbial species or consortia involved in HE risk and prognosis, assessing the factors involved in the resilience of the HE gut microbiome in some individuals, and evaluating the clinical outcomes of microbiota modifications in the context of the disease. Accordingly, further research is needed to gain greater insight into the complex interplay between the gut microbiome and HE, including identifying the factors that negatively influence the gut-liver-brain axis leading to HE in liver cirrhosis and exploring their relationship with the gut microbiome. Furthermore, studies that integrate multi-omics analysis of microbiota-gut-brain axis parameters are necessary to develop precision models based on specific individual features, such as microbiome profiling before intervention. These models could aid in classifying patients with HE based on their predicted clinical response to specific microbiome-targeted interventions with potential therapeutic effects for HE. In this chapter, we provide details of the most commonly used available techniques, methods, and recommendations for achieving tailored microbiome-based strategies that could aid in the prevention or treatment of HE.