A new research review published in Gut Pathogens explores an emerging approach to treating primary biliary cholangitis (PBC) by targeting the gut microbiome.
Globally, incidence of PBC is on the rise. While ursodeoxycholic acid (UDCA) remains the standard treatment, about 40% of patients do not respond well to it. Researchers are working to develop second-line treatments, including therapies that focus on the gut–liver connection.
While the cause of PBC is unknown, studies have found that people with the chronic liver disease often have an imbalance in their gut microbiota, which is made up of bacteria, fungi, viruses and other pathogens. This imbalanced state is known as dysbiosis and may lead to inflammation and immune dysfunction through what’s called the “gut-liver axis.” Issues such as a “leaky gut,” disrupted bile acid metabolism and an overactive immune response can all contribute to dysbiosis.
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The study authors describe several strategies now being explored to restore a healthier gut microbiome. These include changes in diet, the use of probiotics to boost beneficial bacteria and fecal microbiota transplantation (FMT), which involves transferring stool from a healthy donor to a patient’s intestines. Animal studies have shown that these approaches may improve liver tests, reduce inflammation and protect bile ducts from damage.
However, research in this area is still at an early stage. Factors such as differences in gut bacteria between individuals, disease severity and safety concerns make it difficult to predict who will benefit most from these therapies. While FMT has been tested in other liver and intestinal diseases, no published clinical trials have yet evaluated it specifically for PBC, though some are in progress.
“Gut microbiota-targeted therapy for PBC is still exploratory, with key limitations including individual differences. Variations in disease stage, underlying chronic conditions, and intestinal microecology among patients affect host-microbiota interactions,” noted the study’s authors.
The study authors call for further large-scale, long-term studies to validate efficacy of gut microbiota-targeted therapy, optimize patient-specific approaches and ensure safe implementation.
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