Intestinal microbiota in the treatment of metabolically associated fatty liver disease

Table 1 Mean abundance of gut microbiome taxa in patients with or without metabolically associated steatohepatitis

Bacteria	No MASH (n = 22)	MASH (n = 35)
Bifidobacterium	0.9	1.6
Bacteroides	38.3	56.9
Parabacteroides	2.0	1.2
Prevotella	21.7	5.5
Blautia	1.6	1.9
Ruminococcus	0.8	1.4
Megasphaera	1.5	1.5
Sutterella	1.3	0.9

Genera with > 1% occurrence in the whole population are presented. MASH: Metabolically associated steatohepatitis.

Table 2 Clinical trials using antibiotics, probiotics, prebiotics, and synbiotics in metabolically associated fatty liver disease/metabolically associated steatohepatitis

Ref.	Clinical Trials ID	Intervention	Agent	Intervention dose	Target population	Results
Abdel-Razik et al[49], 2018	NCT02884037	Antibiotics	Rifaximin	Rifaximin: 1100 mg/d for 6 mo	MASH, n = 50	Improved insulin resistance, cytokines, and MAFLD-liver fat score
Gangarapu et al[101], 2015	NCT02009592	Antibiotics	Rifaximin	Rifaximin: 1320 mg/d, for 4 wk	MAFLD, n = 42	Reduction in serum AST, ALT, and endotoxin
-	NCT01355575	Antibiotic	Rifaximin	Rifaximin: 800 mg/d for 6 wk	MASH, n = 15	-
-	NCT02510599	Antibiotic	Solithromycin	Solithromycin: 200 mg/d for 1 wk, followed by 200 mg TIW for 12 wk	MASH, n = 10	-
Vajroet al[58], 2011	NCT01650025	Probiotic	VSL#3	VSL#3: 2 sachets/d for 4 mo	Obese children with MAFLD, n = 48	Reduce fatty liver, BMI, GLP-1
-	NCT03511365	Probiotic	VSL#3	VSL#3: 2 times/d for 8 wk	MAFLD, n = 20	-
Tenorio-Jiménez et al[102], 2018	NCT02972567	Probiotic	Lactobacillus strain	Lactobacillus spp: 9 log10 cfu/capsule: 1 capsule/d for 12 wk	Obese subjects with insulin resistance, n = 60	-
Bomhof et al[103], 2019	NCT03184376	Prebiotic	Oligofructose	PrebioticPrebiotic oligofructose: 8 g/d for 12 wk followed by 16 g/d for 24 wk.	MASH, n = 14	Reduced histologically-confirmed steatosis
Mofidiet al[104], 2017	NCT02530138	Synbiotic	Fructo-oligosaccharide + 7 strains of bacteria	Symbiotic: 2 symbiotics capsules/d for 28 wk	MASH, n = 42	Reduction in serum cytokines, hepatic steatosis, and fibrosis
Wong et al[105], 2013	NCT00870012	Synbiotic	Lepicol probiotic and prebiotic formula	Lepicol probiotic and prebiotic formula + simple lifestyle advice	MAFLD, n = 20	Reduction in liver fat and AST level

MAFLD: Metabolically associated fatty liver disease; MASH: Metabolically associated steatohepatitis; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; BMI: Body mass index; GLP-1: Glucagon-like peptide-1.

Table 3 Clinical trials using farnesoid X receptor agonists and fecal microbiota transplantation in metabolically associated fatty liver disease/metabolically associated steatohepatitis

Ref.	Clinical Trials ID	Intervention	Agent	Intervention dose	Target population	Results
Craven et al[106], 2020	NCT00501592	FXR agonists	Obeticholic acid	INT-747: 25 mg/d for 1 mo; 50 mg/d for 1 mo	MAFLD, n = 64	Reduction in body weight, hepatic inflammation andfibrosis, improved insulin sensitivity
Neuschwander-Tetri et al[107], 2015	NCT01265498	FXR agonists	Obeticholic acid	Obeticholic acid: 25 mg/d for 72 wk	MASH, n = 283	Reduction in ALT, AST, and γ- Glutamyl transpeptidase, improved histological features of MASH
Bailey et al[108], 2014	NCT02496390	FMT	-	Fecal Microbial Transplantation: approx 100 mL previously frozen fecal sample obtained from a lean donor prior to colonic preparation	MAFLD, n = 21	-

MAFLD: Metabolically associated fatty liver disease; MASH: Metabolically associated steatohepatitis; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; FXR: Farnesoid X receptor; FMT: Fecal microbiota transplantation.