Microbial Players in Primary Sclerosing Cholangitis: Current Evidence and Concepts

Area of Science:

• Hepatology
• Gastroenterology
• Microbiology

Background:

• Primary sclerosing cholangitis (PSC) is a rare, progressive cholestatic liver disease leading to cirrhosis.
• Liver transplantation remains the only definitive treatment for PSC.
• The etiology of PSC is multifactorial, involving genetic, immune, and environmental factors, with the gut-liver axis increasingly recognized.

Purpose of the Study:

• To review current clinical and mechanistic data on the gut bacterial and fungal microbiome in PSC.
• To elucidate the role of specific microbes and microbial population dynamics in PSC pathogenesis.
• To discuss emerging microbe-altering therapeutic strategies targeting the gut-liver axis and bile acid metabolism.

Main Methods:

• Comprehensive literature review of studies on gut microbiota (bacterial and fungal) in primary sclerosing cholangitis.
• Analysis of clinical and mechanistic data linking microbial dysbiosis to PSC.
• Synthesis of information on therapeutic interventions modulating the gut microbiome and bile acid metabolism.

Main Results:

• The gut-liver axis, particularly the gut microbiome, plays a significant role in PSC pathogenesis.
• The fungal microbiome (mycobiome) in PSC has been understudied but warrants further investigation.
• Specific microbial alterations and population dynamics are associated with PSC progression.

Conclusions:

• Understanding the complex interplay between bacterial and fungal gut microbiota is crucial for PSC research.
• Targeting the gut microbiome and bile acid metabolism offers promising therapeutic avenues for PSC.
• Further research into the mycobiome's role in PSC is essential for developing effective treatments.