Efficacy of rifaximin on circulating endotoxins and cytokines in patients with nonalcoholic fatty liver disease. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Gangarapu, Venkatanarayana; Ince, Ali Tüzün; Baysal, Birol; Kayar, Yusuf; Kiliç, Ulkan; Gök, Özlem; Uysal, Ömer; Şenturk, Hakan
• Is Part Of: European journal of gastroenterology & hepatology. Volume 27:Issue 7(2015:Jul.)
• Publication Date: 2015-07
• Subjects: endotoxins -- gut microbiota -- lipopolysaccharides -- nonalcoholic fatty liver disease -- rifaximin; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000348
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objective: Recent studies have suggested that endotoxin-induced cytokines play an important role in nonalcoholic fatty liver disease (NAFLD). Rifaximin is a nonabsorbable antibiotic that might act on Gram-negative bacteria, thereby inhibiting endotoxin proinflammatory cytokine production in patients with NAFLD. Our aim was to investigate the efficacy of rifaximin on NAFLD. Methods: Forty-two patients with biopsy-proven NAFLD [15 steatosis, 27 nonalcoholic steatohepatitis (NASH)] were included in this prospective, open-label, observational cohort study. BMI and serum aspartate aminotransferase, alanine aminotransferase (ALT), gamma glutamyl transferase, lipid profile, ferritin, C-reactive protein, glucose, insulin, homeostatic model assessment as well as endotoxin, serum Toll-like receptor 4 (TlR4), interleukin-1α (IL-1α), IL-6, IL-10, IL-12, and tumor necrosis factor-α (TNF-α) levels were measured before and after a 28-day administration of rifaximin (1200 mg/daily). Results were analyzed using nonparametric Wilcoxon signed-rank tests. Results: A mild reduction in the mean BMI (32.3±6.9 vs. 31.9±6.8, P =0.02) and a significant reduction in the endotoxin (0.9±0.34 vs. 0.8±0.13, P =0.03) and IL-10 (4.08±0.9 vs. 3.73±0.7, P =0.006) levels in the NASH group were noted. A significant reduction was observed in serum aspartate aminotransferase (50.4±39 vs. 33±14, P =0.01), ALT (72±48 vs. 45.2±26.3, P =0.0001), gamma glutamyl transferase (52±33 vs. 41.2±21.1, P =0.02), LDL (137±34 vs. 127±27.5, P =0.03), and ferritin (142±214 vs. 89.3±123, P =0.0001) in the NASH group, but only in ALT (50.4±26 vs. 35.5±23.25, P =0.01), and ferritin (73.6±83 vs. 55±76, P =0.004) levels decreased significantly in the steatosis group. Treatment with rifaximin did not exert a significant effect on serum levels of TLR-4, IL-1, IL-6, IL-12, or TNF-α in either group. Conclusion: In NAFLD and especially in NASH, short-term administration of rifaximin appears to be safe and effective.