Targeting the gut-liver axis in liver disease Reiner Wiest, Agustin Albillos, Michael Trauner, Jasmohan S. Bajaj, Rajiv Jalan  Journal of Hepatology  Volume 67, Issue 5, Pages 1084-1103 (November 2017) DOI: 10.1016/j.jhep.2017.05.007 Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Fig. 1 Pathophysiology of Gut-liver-axis. The microbiome sets the stage for the gut-liver-axis, representing an excessive source of bacterial products and metabolites in terms of both quantity and diversity. In conditions of increased intestinal permeability, the epithelial barrier is crossed more than in healthy conditions by bacterial products (lipopolysaccharides, peptidoglycans, bacterial DNA, flagellin etc.), which stimulate the gut-associated lymphatic tissue to release pro-inflammatory cytokines (TNF, IL1, IL6 etc.), chemokines, as well as eicosanoids, leading to portal-venous P/MAMP- and cytokinemia. Moreover, bacterial metabolites (trimethylamine, ethanol and other volatile organoids, fatty acids, acetaldehyde etc.) increasingly permeate the epithelial barrier. Anything crossing the epithelial barrier faces the gut-vascular barrier, which determines the likely rate and size of molecules entering the portal-venous circulation. The intrahepatic effects of this portal-venous inflow of stimulants, as well as platelets on kupffer cells and hepatic stellate cells, drives inflammation, fibrogenesis and carcinogenesis. Journal of Hepatology 2017 67, 1084-1103DOI: (10.1016/j.jhep.2017.05.007) Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Fig. 2 Bile acid (BA) enterohepatic circulation, signalling and related drugs. BAs secreted from hepatocytes (e.g. primary BA such as cholic acid [CA]) are undergoing enterohepatic circulation. They are absorbed in the terminal ileum by apical sodium-dependent bile acid transporter (ASBT), leading to fibroblast growth factor (FGF)19-synthesis via farnesoid-X-receptor (FXR)-stimulation. FGF19 on hepatocytes leads to feedback inhibition of de novo synthesis of primary BA, via inhibition of the rate limiting enzyme Cyp7A1. The microbiota modulates the BA pool luminally by generating secondary BAs such as deoxycholic acid (DCA), which in the colon passively cross the epithelial barrier. Journal of Hepatology 2017 67, 1084-1103DOI: (10.1016/j.jhep.2017.05.007) Copyright © 2017 European Association for the Study of the Liver Terms and Conditions

Fig. 3 Physical appearance of Yaq-001 and binding capacity. Journal of Hepatology 2017 67, 1084-1103DOI: (10.1016/j.jhep.2017.05.007) Copyright © 2017 European Association for the Study of the Liver Terms and Conditions