Linkage of Gut Microbiome with Cognition in Hepatic Encephalopathy

Div. of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth Univ. and McGuire VA Medical Ctr., 1201, Broad Rock Blvd., Richmond, VA 23249, USA.
AJP Gastrointestinal and Liver Physiology (Impact Factor: 3.8). 09/2011; 302(1):G168-75. DOI: 10.1152/ajpgi.00190.2011
Source: PubMed


Hepatic encephalopathy (HE) has been related to gut bacteria and inflammation in the setting of intestinal barrier dysfunction. We aimed to link the gut microbiome with cognition and inflammation in HE using a systems biology approach. Multitag pyrosequencing (MTPS) was performed on stool of cirrhotics and age-matched controls. Cirrhotics with/without HE underwent cognitive testing, inflammatory cytokines, and endotoxin analysis. Patients with HE were compared with those without HE using a correlation-network analysis. A select group of patients with HE (n = 7) on lactulose underwent stool MTPS before and after lactulose withdrawal over 14 days. Twenty-five patients [17 HE (all on lactulose, 6 also on rifaximin) and 8 without HE, age 56 ± 6 yr, model for end-stage liver disease score 16 ± 6] and ten controls were included. Fecal microbiota in cirrhotics were significantly different (higher Enterobacteriaceae, Alcaligeneceae, and Fusobacteriaceae and lower Ruminococcaceae and Lachnospiraceae) compared with controls. We found altered flora (higher Veillonellaceae), poor cognition, endotoxemia, and inflammation (IL-6, TNF-α, IL-2, and IL-13) in HE compared with cirrhotics without HE. In the cirrhosis group, Alcaligeneceae and Porphyromonadaceae were positively correlated with cognitive impairment. Fusobacteriaceae, Veillonellaceae, and Enterobacteriaceae were positively and Ruminococcaceae negatively related to inflammation. Network-analysis comparison showed robust correlations (all P < 1E-5) only in the HE group between the microbiome, cognition, and IL-23, IL-2, and IL-13. Lactulose withdrawal did not change the microbiome significantly beyond Fecalibacterium reduction. We concluded that cirrhosis, especially when complicated with HE, is associated with significant alterations in the stool microbiome compared with healthy individuals. Specific bacterial families (Alcaligeneceae, Porphyromonadaceae, Enterobacteriaceae) are strongly associated with cognition and inflammation in HE.

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    • "Here we show that VSL#3 attenuates the age-related decrease in LTP. The mechanisms involved in regulation of LTP by VSL#3 are likely to be many; the most parsimonious explanation is that the anti-inflammatory effects of the treatment observed in the gut [61], [62] extend to the brain [63]–[64]. In this context, we provide evidence that VSL#3 modulates hippocampal expression of two markers of microglial activation (and therefore inflammation), CD68 and CD11b, confirming the previously-described inverse correlation between LTP and inflammatory changes. "
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    ABSTRACT: The intestinal microbiota is increasingly recognized as a complex signaling network that impacts on many systems beyond the enteric system modulating, among others, cognitive functions including learning, memory and decision-making processes. This has led to the concept of a microbiota-driven gut-brain axis, reflecting a bidirectional interaction between the central nervous system and the intestine. A deficit in synaptic plasticity is one of the many changes that occurs with age. Specifically, the archetypal model of plasticity, long-term potentiation (LTP), is reduced in hippocampus of middle-aged and aged rats. Because the intestinal microbiota might change with age, we have investigated whether the age-related deficit in LTP might be attenuated by changing the composition of intestinal microbiota with VSL#3, a probiotic mixture comprising 8 Gram-positive bacterial strains. Here, we report that treatment of aged rats with VSL#3 induced a robust change in the composition of intestinal microbiota with an increase in the abundance of Actinobacteria and Bacterioidetes, which was reduced in control-treated aged rats. VSL#3 administration modulated the expression of a large group of genes in brain tissue as assessed by whole gene expression, with evidence of a change in genes that impact on inflammatory and neuronal plasticity processes. The age-related deficit in LTP was attenuated in VSL#3-treated aged rats and this was accompanied by a modest decrease in markers of microglial activation and an increase in expression of BDNF and synapsin. The data support the notion that intestinal microbiota can be manipulated to positively impact on neuronal function.
    PLoS ONE 09/2014; 9(9):e106503. DOI:10.1371/journal.pone.0106503 · 3.23 Impact Factor
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    • "Veillonella spp have also been over-represented in patients with irritable bowel syndrome, most often those with a mixed or constipation-predominant clinical picture [30]. The presence of Veillonellaceae may be a marker for the presence of HE and MHE in the stool and colonic mucosa of cirrhotic patients [11], [29]. Since the major fermentative substrate for Veillonella is lactic acid, it often has a symbiotic relationship with taxa such as Streptococcaceae whose end-product of metabolism is lactate. "
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    ABSTRACT: Hepatic encephalopathy (HE) represents a dysfunctional gut-liver-brain axis in cirrhosis which can negatively impact outcomes. This altered gut-brain relationship has been treated using gut-selective antibiotics such as rifaximin, that improve cognitive function in HE, especially its subclinical form, minimal HE (MHE). However, the precise mechanism of the action of rifaximin in MHE is unclear. We hypothesized that modulation of gut microbiota and their end-products by rifaximin would affect the gut-brain axis and improve cognitive performance in cirrhosis. Aim To perform a systems biology analysis of the microbiome, metabolome and cognitive change after rifaximin in MHE. Twenty cirrhotics with MHE underwent cognitive testing, endotoxin analysis, urine/serum metabolomics (GC and LC-MS) and fecal microbiome assessment (multi-tagged pyrosequencing) at baseline and 8 weeks post-rifaximin 550 mg BID. Changes in cognition, endotoxin, serum/urine metabolites (and microbiome were analyzed using recommended systems biology techniques. Specifically, correlation networks between microbiota and metabolome were analyzed before and after rifaximin. There was a significant improvement in cognition(six of seven tests improved,p<0.01) and endotoxemia (0.55 to 0.48 Eu/ml, p = 0.02) after rifaximin. There was a significant increase in serum saturated (myristic, caprylic, palmitic, palmitoleic, oleic and eicosanoic) and unsaturated (linoleic, linolenic, gamma-linolenic and arachnidonic) fatty acids post-rifaximin. No significant microbial change apart from a modest decrease in Veillonellaceae and increase in Eubacteriaceae was observed. Rifaximin resulted in a significant reduction in network connectivity and clustering on the correlation networks. The networks centered on Enterobacteriaceae, Porphyromonadaceae and Bacteroidaceae indicated a shift from pathogenic to beneficial metabolite linkages and better cognition while those centered on autochthonous taxa remained similar. Rifaximin is associated with improved cognitive function and endotoxemia in MHE, which is accompanied by alteration of gut bacterial linkages with metabolites without significant change in microbial abundance. NCT01069133.
    PLoS ONE 04/2013; 8(4):e60042. DOI:10.1371/journal.pone.0060042 · 3.23 Impact Factor
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    • "Investigations of the human microbiome and the development of next-generation sequencing technologies have yielded new opportunities for scientists to study the composition and function of the human microbiome and its association with neurological disorders. Hepatic encephalopathy, a condition commonly found in cirrhotic patients with liver failure and characterized by alterations in cognitive functions, was associated with changes in the gut microbiota and inflammation in the presence of intestinal barrier dysfunction [Bajaj et al. 2011]. Recent scientific studies shed light upon the intricate relationships between the intestinal microbiota and the gut–brain axis. "
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