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of endotoxin-producing bacteria and intestinal permeability, with the final translocation of bacteria and
bacteria metabolites to the liver, inducing liver injury and carcinogenesis via the recognition of TLR-4 and
the activation of NF-κβ pathway. Microbiota-regulating drugs have proven an important efficacy in the
survival of patients with cirrhosis and HCC. However, alcohol abstinence will always be the best option for
these patients; thus, emphasis should be placed on dissemination programs that teach the population about
the important complications derived from alcohol consumption.

DECLARATIONS
Authors’ contributions
Study concept and design: Méndez-Sánchez N
Literature research: Valencia-Rodríguez A, Vera-Barajas A, Abenavoli L, Scarpellini E, Ponciano-Rodríguez G
Drafting of the manuscript: Méndez-Sánchez N, Valencia-Rodríguez A, Vera-Barajas A, Abenavoli L,
Scarpellini E, Ponciano-Rodríguez G
Critical revision of the manuscript for important intellectual content: Méndez-Sánchez N, Wang DQH

Availability of data and materials
Not applicable.

Financial support and sponsorship
This work was supported partially by Medica Sur Clinic & Foundation. This work was supported in part by
a research grant R01 DK114516 (to DQ-HW) from the National Institutes of Health (US Public Health Service).

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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