Gut Microbiome: A Potential Modifiable Risk Factor in Biliary Atresia

Area of Science:

• Pediatric Gastroenterology
• Microbiology
• Hepatology

Background:

• Biliary atresia (BA) is a common cause of pediatric liver transplantation.
• Kasai portoenterostomy (KPE) restores bile flow in ~60% of infants, but cirrhosis remains common.
• Gut microbiome alterations (dysbiosis) are implicated in various liver diseases.

Purpose of the Study:

• To explore the role of the gut microbiome in biliary atresia (BA).
• To investigate potential microbiome-targeted therapies for BA to reduce liver transplantation (LT) rates.

Main Methods:

• Review of emerging molecular studies on the gut microbiome in BA.
• Analysis of host-microbiome mechanistic pathways, including bacterial translocation and metabolite production.

Main Results:

• Early molecular studies suggest a pathogenic role for Enterobacteriaceae and Streptococcus in BA.
• A potential beneficial role for Bifidobacteria in BA is also indicated.
• Microbiome-based therapies are under development for liver diseases like cirrhosis.

Conclusions:

• The gut microbiome may represent a novel, modifiable risk factor in biliary atresia.
• Targeting the gut microbiome could potentially decrease the need for liver transplantation in children with BA.