The gut microbiota has been shown to promote alcohol-induced liver injury in mice. In this report, Bernd Schnabl and co-authors find that the presence of cytolysin-producing Enterococcus faecalis in the gut microbiota correlates with worse prognosis of patients with alcoholic hepatitis. They show that transplantation of cytolysin-positive microbiotas in mice leads to more severe liver disease, and that ethanol increases intestinal permeability, resulting in migration of E. faecalis to the liver where cytolysin exacerbates hepatocyte death and inflammation. The authors also isolate a bacteriophage that specifically targets cytolysin-positive E. faecalis, and show that administration of this bacteriophage attenuates alcohol-induced hepatitis in mice. While these findings are encouraging for the potential of phage therapy to treat this disease, a prospective clinical trial in humans is now needed to confirm whether such a therapeutic approach is safe and effective.
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