ENDOTOXINEMIA IN PATIENTS WITH OBESITY AND NON-ALCOHOLIC FATTY LIVER DISEASE
Authors: Fadieienko Galyna , Gridnyev Oleksiy , Kushnir Inna 
Published: October 2021

Objective — to study the features of endotoxinemia and its relationship with changes in the intestinal microbial spectrum in obese patients with non-alcoholic fatty liver disease (NAFLD). Materials and methods. 84 patients with obesity and NAFLD were examined. The control group consisted of 20 apparently healthy individuals. The concentration of endotoxin (ET) in the blood serum was determined using the LAL Chromogenic Endpoint Assay kit manufactured by Hycult Biotech (Netherlands), relative quantitative composition of the microbiota at the level of basic phylotypes — by real-time polymerase chain reaction (CFX96Touch (Bio-Rad, USA)) using universal primers for the 16SpPHK gene and taxon-specific primers), quantitative composition of microbiota — using test of the «Colonoflor-16» system (Alfalab, RF) by real-time polymerase chain reaction.Results. Among patients with comorbidity of obesity and NAFLD, there were 40.48 % of males and 59.52 % of females, whose mean age was 53.72 ± 4.61 years. The ET level in the examined patients with comorbidity of obesity and NAFLC was significantly (p < 0.001) higher (1.01 ET/ml) than in the control group (0.60 ET/ml), was significantly (p < 0,05) is higher in women than in men (1.06 and 0.92 UE/ml, respectively) and increased with increasing age of patients (r = 0.30, p < 0.05). The ET level correlated with the relative content of Firmicutes (r = 0.39, p < 0.05) and their ratio in Bacteroidetes (r = 0.29, p < 0.05) and the level of Bifidobacterium spp. (r = 0 .37, p < 0 .05) a nd h ad a n i nverse r elationship w ith t he r elative c ontent o f B acteroidetes ( r = – 0.42, p < 0.01), including Bacteroides fragilis group (r = – 0.43, p < 0.01), Escherichia coli (r = – 0.41, p < 0.01) and total bacterial mass (r = – 0.39, p < 0.05). In the intestinal microbiota of the examined patients, a decrease in the representatives of the Lactobacillus spp. and Bifidobacterium spp. in 84.5 % and 30.9 % of patients, respectively, as well as Bacteroides thetaiotaomicron (88.0 %), Akkermansia muciniphila (79.8 %) and Faecalibacteriumprausnitzii (33.3 %). Whereas the number of gram-negative bacteria increased primarily due to Enterobacter spp, Citrobacter spp (45.2 %), Escherichia coli (19 %), Bacteroides fragilis group (29.8 %). It should be noted that the decrease in the level of A. muciniphila was often accompanied by an increase in the content of enterobacteria, while the excess content of B. fragilis group was accompanied by an increase above the upper limit of E. coli and the presence of anaerobic imbalance in the microbiota. In turn, increasing the number of Enterobacter spp. / Citrobacter spp. It was often accompanied by an increase in the content of E. coli and representatives of the B. fragilis group, against the background of a reduced number of A. muciniphila. Conclusions. The above indicates the presence of metabolic endotoxinemia in patients with comorbidity of obesity and NAFLD against the background of a decrease in the number of gram-positive anaerobic Lactobacillus spp. i Bifidobacterium spp. and bacteria involved in providing the intestinal barrier function (Bacteroides Thetaiotaomicron, Akkermansia muciniphila, Faecalibacterium prausnitzii), which creates conditions for an increased amount of ET into the blood and is especially important against the background of an increase in the content of gram-negative bacteria (representatives of gammaproteobacteria and bacteria of the Bacteroides fragilis), which are the source of ET.