IINTESTINAL MICROBIOME AND BILE ACIDS METABOLISM IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS USING MARE’S MILK
Introduction. Primary biliary cholangitis (PBC), formerly known as primary biliary cirrhosis - is an uncommon disease that affects mainly women and characterized by cholestasis, the presence of serum antimitochondrial antibodies (AMA) chronic course with often progresses to the end-stage of liver disease (cirrhosis). The review presents the latest data on the etiopathogenesis of autoimmune liver diseases, including the relationship between the metabolism of bile acids and intestinal microbiome in PBC. Briefly covers the therapeutic approaches for modeling intestinal microbiome
Objectives. To present a review of current data on the pathogenesis of autoimmune liver diseases, the interaction of bile acid metabolism and intestinal microbiome in PBC, as well as therapeutic approaches for correcting intestinal microbiota, including diet changes and using mare's milk.
Search strategy: Search and analysis of scientific publications across the databases and web-resources PubMed, CochraneLibrary, Medline, Embase, ResearchGate were performed. The depth of the search was 20 years, within 2000 - 2018, including the latest publications as of 2019. The review included randomized and cohort studies reportsand systematic reviews. Given the fact that PBС is a rare disease, and there are very few studies on mare's milk (2 publications, 2 ongoing studies), the number of publications on the searched topic is limited. The references in all identified articles were also searched.Excluded: case report format articles, summaries of reports, private messages and newspaper publications. A total of 71 publications were analyzed, of which 41 are included in this review.There were excluded: case-report articles, summaries of reports, personal messages and newspaper publications. A total of 109 publications were analyzed, of which 41 were included in this review.
Results. Bile acids are important signaling molecules involved in the regulation of lipid metabolism in the liver, glucose and maintenance of metabolic and energy homeostasis. The results of multiple trials indicated interactions between the bile and the intestinal microbiota and PBC. There is evidence that the microbiome may play a role in the pathogenesis of PBC. In the absence of bile acids, the bile acid 7α-dehydroxylating bacterial population collapses.
Conclusion. Modulation of the microbiome by pre-/pro-and synbiotics can deliver significant positive hepatic effects without much concern of major side-effects. In light of the search for safe, effective and convenient methods of treatment, adding mare's milk to the treatment of PBC is the dietary approach with high potential for affecting the chain in the pathogenesis of PBC through modeling the composition of the intestinal microbiome. In the presence of the treatment complexity the clinical medicine obtains a remedy in the form of a natural product - mare's milk, the preventive, dietary, and therapeutic effects of which are known for long.
Maya S. Zhumabayeva1, https://orcid.org/0000-0002-2632-6717
Gulmira S. Dossatayeva1, https://orcid.org/0000-0003-4226-3741
Galiya M. Shaimardanova1, https://orcid.org/0000-0002-1414-8618
Larissa V. Kozina1, https://orcid.org/0000-0002-0581-6231
Viktor A. Tkachev2, https://orcid.org/0000-0003-4455-3427
1 JSC "National Scientific Medical Center", Nur-Sultan, Republic of Kazakhstan;
2 NJSC"Medical University of Astana", Department of Propaedeutics of Internal Diseases,
Nur-Sultan, Republic of Kazakhstan.
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