Systematic review: microbial manipulation as therapy for primary sclerosing cholangitis

Area of Science:

• Gastroenterology and Hepatology
• Microbiome Research
• Drug Discovery

Background:

• Primary sclerosing cholangitis (PSC) is a progressive, incurable liver disease.
• A potential link exists between PSC and gut microbial dysbiosis.
• Current therapies for PSC are limited, highlighting the need for novel treatment strategies.

Purpose of the Study:

• To review medical therapies targeting the gut-liver axis in PSC.
• To evaluate interventions that modulate the gastrointestinal microbiome for PSC treatment.

Main Methods:

• A comprehensive scoping review of PubMed and Cochrane Library databases was performed.
• Studies investigating interventions for manipulating the gastrointestinal microbiome in PSC were included.

Main Results:

• Various therapies, including antibiotics (vancomycin, metronidazole, rifaximin, minocycline, azithromycin), aim to alter the gut microbiome in PSC.
• Vancomycin showed alkaline phosphatase improvement in two RCTs but lacked disease progression data.
• Fecal microbiota transplantation and dietary therapy may enhance microbial diversity but require more robust efficacy data due to small patient numbers.

Conclusions:

• The gut-liver axis presents a promising therapeutic target for PSC.
• No current microbiome-targeted therapies have proven to improve transplant-free survival in PSC.
• Well-designed clinical trials with long-term follow-up are essential for evaluating microbiome-targeted therapies in PSC.