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Méndez-Sánchez et al. Hepatoma Res 2020;6:5 Hepatoma Research
DOI: 10.20517/2394-5079.2019.29

Review Open Access

The mechanism of dysbiosis in alcoholic liver
disease leading to liver cancer

Nahum Méndez-Sánchez , Alejandro Valencia-Rodríguez , Alfonso Vera-Barajas , Ludovico Abenavoli ,
1,2
3
1
1
Emidio Scarpellini , Guadalupe Ponciano-Rodríguez , David Q.-H. Wang 6
5
4
1 Liver Research Unit, Medica Sur Clinic & Foundation, Mexico City 14050, Mexico.
2 Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico.
3 Department of Health Sciences, University “Magna Graecia” Viale Europa, Catanzaro 88100, Italy.
4 Clinical Nutrition Unit, and Internal Medicine Unit, “Madonna del Soccorso” General Hospital, Via Luciano Manara 7, San Benedetto
del Tronto (AP) 63074, Italy.
5 Public Health Department, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04510, Mexico.
6 Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center,
Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Correspondence to: Prof. Nahum Méndez-Sánchez, FACG, AGAF, Liver Research Unit, Medica Sur Clinic and Foundation, National
Autonomous University of Mexico, Puente de Piedra 150, Col. Toriello Guerra, México City 14050, México.
E-mail: nmendez@medicasur.org.mx; nah@unam.mx

How to cite this article: Méndez-Sánchez N, Valencia-Rodríguez A, Vera-Barajas A, Abenavoli L, Scarpellini E, Ponciano-Rodríguez G,
Wang DQH. The mechanism of dysbiosis in alcoholic liver disease leading to liver cancer. Hepatoma Res 2020;6:5.
http://dx.doi.org/10.20517/2394-5079.2019.29

Received: 11 Nov 2019 First Decision: 6 Jan 2020 Revised: 10 Jan 2020 Accepted: 11 Feb 2020 Published: 20 Feb 2020

Science Editor: Mark Alan Feitelson Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Currently, alcoholic liver disease (ALD) is one of the most prevalent chronic liver diseases worldwide, representing
one of the main etiologies of cirrhosis and hepatocellular carcinoma (HCC). Although we do not know the exact
mechanisms by which only a selected group of patients with ALD progress to the final stage of HCC, the role of the
gut microbiota within the progression to HCC has been intensively studied in recent years. To date, we know that
alcohol-induced gut dysbiosis is an important feature of ALD with important repercussions on the severity of this
disease. In essence, an increased metabolism of ethanol in the gut induced by an excessive alcohol consumption
promotes gut dysfunction and bacterial overgrowth, setting a leaky gut. This causes the translocation of bacteria,
endotoxins, and ethanol metabolites across the enterohepatic circulation reaching the liver, where the recognition
of the pathogen-associated molecular patterns via specific Toll-like receptors of liver cells will induce the
activation of the nuclear factor kappa-B pathway, which releases pro-inflammatory cytokines and chemokines. In
addition, the mitogenic activity of hepatocytes will be promoted and cellular apoptosis will be inhibited, resulting
in the development of HCC. In this context, it is not surprising that microbiota-regulating drugs have proven
effectiveness in prolonging the overall survival of patients with HCC, making attractive the implementation of
these drugs as co-adjuvant for HCC treatment.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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