Disturbance of the intestinal microbiota in patients with non-alcoholic fatty liver disease who were exposed to the stress factors of the war period
Authors: Fadieienko G. D. , Kushnir I. E. , Chernova V. M. , Solomentseva T. A. , Galchynska V. Y. 
Published: December 2024

Objective — to determine changes in the qualitative and quantitative composition of the intestinal microbiota (IM) at the level of the main phyla in patients with non‑alcoholic fatty liver disease (NAFLD) who were affected by various negative stress factors of the war period.
Materials and methods. The study involved 114 patients with NAFLD with metabolic disorders, including 54 patients in the pre‑war period (comparison group) and 60 patients that were exposed to the stress factors of the war period (main group). Both groups were comparable in terms of gender and age. The content of chronic stress hormones — brain‑derived neurotrophic factor (BDNF), prolactin, dehydroepiandrosterone sulfate (DHEA) was determined by the method of solid‑phase enzyme‑linked immunosorbent assay using appropriate sets of reagents. Determination of the composition of IM at the level of the main phylotypes was carried out by the method of quantitative polymerase chain reaction (PCR) in real time (qRT‑PCR) using universal primers for 16S rRNA gene and taxon‑specific primers produced by “Thermo Fisher Scientific”. Statistical data processing was performed using the statistical program package SPSS 17.0.
Results. In patients of the main group, a significant predominance of Firmicutes (up to 57%) was observed of the microbial spectrum, while the content of Bacteroidetes was only 8%. Actinobacteria accounted for 10%, and other microorganisms accounted for 25%. At the same time, the microbial spectrum of the IM of patients with NAFLD in the pre‑war period had a completely different ratio of phyla, namely, Firmicutes accounted for less than a half (48%), and Bacteroidetes accounted for 23%, which is 3 times more than in the main group. The content of Actinobacteria and other microbial groups was significantly lower than in the main group. These changes affected the magnitude of the Firmicutes/Bacteroidetes ratio. In particular, in patients with NAFLD of the main group, this indicator was almost 4 times higher than that in the comparison group (p <0.05) and equaled 25.9 and 6.43, respectively. When comparing the levels of stress hormones with the main phyla of IM, we revealed a direct correlation between the average degree of prolactin and BDNF concentration with the content of Firmicutes, and an inverse correlation between prolactin and the content of Bacteroidetes. At the same time, we found a weak direct correlation between the level of prolactin and the content of other intestinal bacteria. A weak inverse relationship between BDNF and Bacteroidetes was observed, although the changes were of a trend nature. When assessing the degree of steatosis in patients who were under the stress load of wartime, it was found that the number of patients with steatosis of higher grades slightly increased. However, the data were not reliable and require longer follow‑up.
Conclusions. The existence of a relationship between the level of stress hormones and the main phyla of IM gives reason to assume the effect of chronic stress on the IM and the subsequent progression of NAFLD.