Usefulness of postbiotics for the management of MAFLD. Mechanisms of action and therapeutic perspectives

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver condition worldwide, being the leading cause of chronic liver disease. This liver condition encompasses a wide spectrum of liver alterations, from the relatively benign and reversible steatosis to more harmful stages including cirrhosis and hepatocellular carcinoma. Often, MAFLD is associated to obesity, and gut microbiota alterations (commonly referred to as dysbiosis) stand out as etiological factor. Since no specific pharmacological treatment has been developed so far for the management of MAFLD, scientific community is constantly looking for new therapeutic tools. In this regard, the usage of probiotics has gained momentum since tackling MAFLD associated gut microbiota dysbiosis may help managing this liver condition. However, the administration of viable bacteria to vulnerable subjects may pose certain risks. In this context, scientific community has focused on postbiotics, which consist of non-viable microbial cells (usually obtained through heat-inactivation of probiotic bacteria) and crude cell extracts. Interestingly, the available literature indicates that bacterial viability is not essential to obtain beneficial health effects since specific bacterial components have been identified as drivers of such effects. Regarding the usefulness of postbiotics for MAFLD management, the available literature indicates that postbiotic administration is an effective approach reducing liver lipid content when administered alongside the stressor causing this liver condition. These effects are mainly driven by the upregulation of hepatic lipid oxidation as well as the downregulation of de novo lipogenesis and triglyceride assembly. Noteworthily, these beneficial effects have been observed in a wide variety of bacterial strains and in different experimental conditions (different dose and duration). Nonetheless, the majority of studies analysed the preventive effects of this approach (administration alongside steatotic diets) and thus further studies are needed to confirm its therapeutic effect (administration once the stressor causing MAFLD is not present). As for clinical studies, no data have been published yet mainly because the majority of studies are ongoing clinical trials. Altogether, the available scientific evidence indicates that postbiotic administration seems to be effective for the management of MAFLD.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver condition worldwide, being the leading cause of chronic liver disease. This liver condition encompasses a wide spectrum of liver alterations, from the relatively benign and reversible steatosis to more harmful stages including cirrhosis and hepatocellular carcinoma. Often, MAFLD is associated to obesity, and gut microbiota alterations (commonly referred to as dysbiosis) stand out as etiological factor. Since no specific pharmacological treatment has been developed so far for the management of MAFLD, scientific community is constantly looking for new therapeutic tools. In this regard, the usage of probiotics has gained momentum since tackling MAFLD associated gut microbiota dysbiosis may help managing this liver condition. However, the administration of viable bacteria to vulnerable subjects may pose certain risks. In this context, scientific community has focused on postbiotics, which consist of non-viable microbial cells (usually obtained through heat-inactivation of probiotic bacteria) and crude cell extracts. Interestingly, the available literature indicates that bacterial viability is not essential to obtain beneficial health effects since specific bacterial components have been identified as drivers of such effects. Regarding the usefulness of postbiotics for MAFLD management, the available literature indicates that postbiotic administration is an effective approach reducing liver lipid content when administered alongside the stressor causing this liver condition. These effects are mainly driven by the upregulation of hepatic lipid oxidation as well as the downregulation of de novo lipogenesis and triglyceride assembly. Noteworthily, these beneficial effects have been observed in a wide variety of bacterial strains and in different experimental conditions (different dose and duration). Nonetheless, the majority of studies analysed the preventive effects of this approach (administration alongside steatotic diets) and thus further studies are needed to confirm its therapeutic effect (administration once the stressor causing MAFLD is not present). As for clinical studies, no data have been published yet mainly because the majority of studies are ongoing clinical trials. Altogether, the available scientific evidence indicates that postbiotic administration seems to be effective for the management of MAFLD.