The gut microbiome and nonalcoholic fatty liver disease: prospects for drug therapy

Nonalcoholic fatty liver disease (NAFLD) is most commonly a component of the metabolic syndrome with a global prevalence of 25% and the number of patients continues to increase. According to current projections, in the near future, NAFLD will become the most common indication for liver transplantation. The search for new risk factors for the development and progression of this disease is actively underway. The article considers the role of intestinal microbiota in proinflammatory processes, bile acid metabolism and liver lipogenesis. Attention is paid to the qualitative composition of the microbiome depending on the stage of NAFLD. Conclusions are made about heterogeneity of the research results in case of NAFLD and relatively stable microbiota in liver cirrhosis. Faecalibacterium prausnitzii and its role in the progression of NAFLD are considered separately. Probable reasons for the disagreement of the results of the studies are presented. In the part devoted to the treatment of NAFLD, the focus is on the ways of correction of intestinal dysbiosis, the influence of various microbiological preparations on lipogenesis and the process of inflammation in the liver. The optimal composition of probiotic preparations is discussed in detail. Their combination with prebiotics and isolated administration of inulin, fructooligosaccharide. Conclusions are drawn that in the future the assessment of intestinal microbiome will help to improve therapeutic approaches in the treatment of NAFLD patients.