Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease globally, but it is largely under-diagnosed, even among persons with an advanced stage of the condition. Liver cirrhosis in patients with NAFLD is an important predictor of survival, but healthcare providers find it challenging to identify individuals who have liver cirrhosis before it’s advanced.
Screening for liver cirrhosis is difficult and invasive, so researchers are working on developing a simpler, stool-based test. In a study through the NAFLD Research Center and Center for Microbiome Innovation, researchers were able to identify unique patterns of bacterial species in the stool of patients with NAFLD-cirrhosis.
What Did The Study Find?
“If we are better able to diagnose NAFLD-related cirrhosis, we will be better at enrolling the right types of patients in clinical trials, and ultimately will be better equipped to prevent and treat it,” said senior author Rohit Loomba, MD, director of the NAFLD Research Center and a faculty member in the Center for Microbiome Innovation, in a statement.
“This latest advance toward a noninvasive stool test for NAFLD-cirrhosis may also help pave the way for other microbiome-based diagnostics and therapeutics, and better enable us to provide personalized, or precision, medicine for a number of conditions,” said Dr. Loomba.
Loomba and colleagues note that over the last decade, the “gut-liver axis” has emerged as a pivotal component of NAFLD and could be a potential source for developing noninvasive biomarkers that can detect liver disease. But data thus far are limited regarding the diagnostic accuracy of a stool, microbiome-derived signature for identifying NAFLD-cirrhosis, particularly among individuals at high risk of the disease.
How Do The Findings Impact Patients And Providers?
The researchers previously found that the first-degree relatives of patients with NAFLD-cirrhosis have a high risk of advanced-fibrosis, but the factors associated with progression towards NAFLD-cirrhosis among families are unclear. In a prior proof-of-concept study, their research also showed a gut microbiome pattern that differentiated mild/moderate NAFLD from advanced disease in patients with biopsy-proven NAFLD. In this latest study, they looked at whether or not a similar stool-based “read-out” of the microbiome in a person with NAFLD could might provide insight into cirrhosis status.
Microbiome compositions obtained from 203 individuals were studied, including 98 participants encompassing the entire spectrum of NAFLD and 105 of their first-degree relatives, including twins. Individuals who shared housing tended to also have similar microbiome profiles, which further validated previous studies. Individuals with extreme forms of NAFLD also appeared to have less diverse and stable gut microbiomes. Thus, there were strong familial correlations of gut-microbiome profiles which were driven by shared housing.
Loomba and his team also identified 27 bacterial features in the gut microbiome that could detect NAFLC-cirrhosis with 92 percent. The test was also able to detect previously undiagnosed NAFLD-cirrhosis in first-degree relatives with 87 percent accuracy, which was confirmed by magnetic resonance imaging (MRI).
“These results confirm a strong impact of the environment in the familial similarity of the gut-microbiome,” they write, and “provides evidence for a fecal-microbiome-derived signature to detect NAFLD-cirrhosis.”
Last updated on 10/1/19.