Short chain fatty acids exchange: Is the cirrhotic, dysfunctional liver still able to clear them?

  • Johanne G. Bloemen
    Correspondence
    Corresponding author. Tel.: +31 43 3881494; fax: +31 43 3875473.
    Affiliations
    Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands

    Top Institute Food & Nutrition, P.O. Box 557, 6709 PA Wageningen, The Netherlands
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  • Steven W.M. Olde Damink
    Affiliations
    Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands

    Institute of Hepatology, University College London, 69-75 Chenies Mews, London WC1E6HX, United Kingdom
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  • Koen Venema
    Affiliations
    Top Institute Food & Nutrition, P.O. Box 557, 6709 PA Wageningen, The Netherlands

    TNO Quality of Life, Utrechtseweg 48, 3704 HE, Zeist, The Netherlands
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  • Wim A. Buurman
    Affiliations
    Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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  • Rajiv Jalan
    Affiliations
    Institute of Hepatology, University College London, 69-75 Chenies Mews, London WC1E6HX, United Kingdom
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  • Cornelis H.C. Dejong
    Affiliations
    Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Published:October 26, 2009DOI:https://doi.org/10.1016/j.clnu.2009.10.002

      Summary

      Background & aims

      Prebiotics are increasingly used to improve gut integrity. A presumed mechanism of their beneficial action is the synthesis of short chain fatty acids (SCFA: acetate, propionate and butyrate). High systemic concentrations of propionate and butyrate are toxic and can adversely affect the patient. In physiological situations the liver uses propionate and butyrate for energy metabolism. The aim of the present study was to investigate to which extent patients with liver cirrhosis are still able to metabolize portal derived SCFA in the liver.

      Methods

      Twelve patients with liver cirrhosis and an intrahepatic portosystemic shunt (TIPSS) were studied. Blood was sampled from the femoral artery, portal and hepatic vein. Organ plasma flow was measured. Net release or uptake was calculated by multiplying the arteriovenous differences by plasma flow. SCFA plasma concentrations were measured using LC-MS.

      Results

      Arterial concentrations were 124±12, 8±1 and 10±1 μmol/l for acetate, propionate and butyrate, respectively. The gut produced 32.5±13.0, 4.8±1.3 and 6.2±2.1 μmolkgbw−1h−1 of acetate, propionate and butyrate, respectively. Assuming 70% portosystemic shunting, hepatic uptake of propionate and butyrate was 3.1±0.9 and 5.2±1.4 μmolkgbw−1h−1. Hepatic uptake of acetate was non significant (12.1±12.3 μmolkgbw−1min−1). As a consequence of shunting, part of total acetate escaped from the splanchnic bed, which equalled 34.9±14.7 μmolkgbw−1h−1.

      Conclusion

      The liver of patients with stable cirrhosis is able to use butyrate and propionate, most likely preventing increased systemic concentrations. This suggests that prebiotics can be administered safely, but monitoring butyrate levels may be advisable in patients with diminished liver function.

      Keywords

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