SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Philippe SOGNI
Coup de coeur :
 
 
Hepatology
  2015/10  
 
  2015 Oct;62(4):1260-71  
  doi: 10.1002/hep.27819  
 
  Salivary microbiota reflects changes in gut microbiota in cirrhosis with hepatic encephalopathy  
 
  Bajaj JS, Betrapally NS, Hylemon PB, Heuman DM, Daita K, White MB, Unser A, Thacker LR, Sanyal AJ, Kang DJ, Sikaroodi M, Gillevet PM  
  http://onlinelibrary.wiley.com/doi/10.1002/hep.27819/abstract  
 
 

Altered gut microbiome is associated with systemic inflammation and cirrhosis decompensation. However, the correlation of the oral microbiome with inflammation in cirrhosis is unclear. Our aim was to evaluate the oral microbiome in cirrhosis and compare with stool microbiome. Outpatients with cirrhosis (with/without hepatic encephalopathy [HE]) and controls underwent stool/saliva microbiome analysis (for composition and function) and also systemic inflammatory evaluation. Ninety-day liver-related hospitalizations were recorded. Salivary inflammation was studied using T helper 1 cytokines/secretory immunoglobulin A (IgA), histatins and lysozyme in a subsequent group. A total of 102 patients with cirrhosis (43 previous HE) and 32 age-matched controls were included. On principal component analysis (PCA), stool and saliva microbiome clustered far apart, showing differences between sites as a whole. In salivary microbiome, with previous HE, relative abundance of autochthonous families decreased whereas potentially pathogenic ones (Enterobacteriaceae, Enterococcaceae) increased in saliva. Endotoxin-related predicted functions were significantly higher in cirrhotic saliva. In stool microbiome, relative autochthonous taxa abundance reduced in previous HE, along with increased Enterobacteriaceae and Enterococcaceae. Cirrhotic stool microbiota demonstrated a significantly higher correlation with systemic inflammation, compared to saliva microbiota, on correlation networks. Thirty-eight patients were hospitalized within 90 days. Their salivary dysbiosis was significantly worse and predicted this outcome independent of cirrhosis severity. Salivary inflammation was studied in an additional 86 age-matched subjects (43 controls/43 patients with cirrhosis); significantly higher interleukin (IL)−6/IL-1β, secretory IgA, and lower lysozyme, and histatins 1 and 5 were found in patients with cirrhosis, compared to controls.

Conclusions
Dysbiosis, represented by reduction in autochthonous bacteria, is present in both saliva and stool in patients with cirrhosis, compared to controls. Patients with cirrhosis have impaired salivary defenses and worse inflammation. Salivary dysbiosis was greater in patients with cirrhosis who developed 90-day hospitalizations. These findings could represent a global mucosal-immune interface change in cirrhosis.

 
Question posée
 
La dysbiose (altération du microbiote) est-elle associée à la cirrhose et à la gravité de celle-ci ?
 
Question posée
 
Oui à première vue.
 
Commentaires

Un point intéressant est que cette étude prend en compte aussi bien la dysbiose par prélèvement de selles que de salive ! Elle compare des patients cirrhotiques et non-cirrhotiques en montrant que la dysbiose est plus marquée chez les patients cirrhotiques que non cirrhotiques et surtout chez les patients cirrhotiques hospitalisés pendant plus de 90 jours. Ce dernier point apparaît difficile à interpréter étant donné la prescription fréquente d’antibiothérapie chez ces patients. Cette dysbiose est associée à une activation des cytokines proinflammatoires. Mais qui de la poule ou de l’œuf… Le point important sera de voir si en modifiant le microbiote on peut améliorer le pronostic et notamment le risque de sepsis chez les patients cirrhotiques.

 
www.snfge.org