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Li T, Chiang JYL. Bile acid-based therapies for non-alcoholic steatohepatitis and alcoholic liver disease. Hepatobiliary Surg Nutr. 2020;9(2):152-169doi: 10.21037/hbsn.2019.09.03.
Li, T., & Chiang, J. Y. L. (2020). Bile acid-based therapies for non-alcoholic steatohepatitis and alcoholic liver disease. Hepatobiliary surgery and nutrition, 9(2), 152-169. https://doi.org/10.21037/hbsn.2019.09.03
Li, Tiangang, and Chiang, John Y L. "Bile acid-based therapies for non-alcoholic steatohepatitis and alcoholic liver disease." Hepatobiliary surgery and nutrition vol. 9,2 (2020): 152-169. doi: https://doi.org/10.21037/hbsn.2019.09.03
Li T, Chiang JYL. Bile acid-based therapies for non-alcoholic steatohepatitis and alcoholic liver disease. Hepatobiliary Surg Nutr. 2020 Apr;9(2):152-169. doi: 10.21037/hbsn.2019.09.03. PMID: 32355674; PMCID: PMC7188552.
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Hepatobiliary Surg Nutr. 2020 Apr;9(2):152-169. doi: 10.21037/hbsn.2019.09.03.

Bile acid-based therapies for non-alcoholic steatohepatitis and alcoholic liver disease.

Hepatobiliary surgery and nutrition

Tiangang Li, John Y L Chiang

Affiliations

  1. Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City, KS, USA.
  2. Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA.

PMID: 32355674 PMCID: PMC7188552 DOI: 10.21037/hbsn.2019.09.03

Abstract

Bile acids are synthesized from cholesterol only in hepatocytes. Bile acids circulating in the enterohepatic system act as physiological detergent molecules to help solubilize biliary cholesterol and emulsify dietary lipids and fat-soluble vitamins in small intestine. Bile acids are signaling molecules that activate nuclear receptor farnesoid X receptor (FXR) and cell surface G protein-coupled receptor TGR5. FXR critically regulates bile acid homeostasis by mediating bile acid feedback inhibition of hepatic bile acid synthesis. In addition, bile acid-activated cellular signaling pathways regulate metabolic homeostasis, immunity, and cell proliferation in various metabolically active organs. In the small and large intestine, gut bacterial enzymes modify primary bile acids to generate secondary bile acids to help shape the bile acid pool composition and subsequent biological effects. In turn, bile acids exhibit anti-microbial properties and modulate gut microbiota to influence host metabolism and immunity. Currently, bile acid-based therapies including systemic and intestine-restricted FXR agonists, TGR5 agonists, fibroblast growth factor 19 analogue, intestine FXR antagonists, and intestine apical sodium-bile acid transporter (ASBT) inhibitors have been developed as promising treatments for non-alcoholic steatohepatitis (NASH). These pharmacological agents improved metabolic and inflammatory disorders via distinct mechanisms of action that are subjects of extensive research interest. More recently, human and experimental alcoholic liver disease (ALD) has been associated with disrupted bile acid homeostasis. In additional, new findings showed that targeting bile acid metabolism and signaling may be promising therapeutic approaches for treating ALD.

2020 Hepatobiliary Surgery and Nutrition. All rights reserved.

Keywords: Bile acid; alcoholic liver disease (ALD); farnesoid X receptor (FXR); microbiota; non-alcoholic steatohepatitis (NASH)

Conflict of interest statement

Conflicts of Interest: The series “Gut Microbiome and Liver Disease” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to dec

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