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

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2010-06, Vol.29 (3), p.365-369
• Main Authors: Bloemen, Johanne G, Olde Damink, Steven W.M, Venema, Koen, Buurman, Wim A, Jalan, Rajiv, Dejong, Cornelis H.C
• Format: Article
• Language: English
• Subjects: Acetate; Acetic Acid - blood; Acetic Acid - chemistry; Acetic Acid - metabolism; Adult; Aged; Biological and medical sciences; Body Mass Index; Butyrate; Butyric Acid - blood; Butyric Acid - chemistry; Butyric Acid - metabolism; Cirrhosis; Fatty Acids, Volatile - blood; Fatty Acids, Volatile - chemistry; Fatty Acids, Volatile - metabolism; Feeding. Feeding behavior; Female; Femoral Artery; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Tract - blood supply; Gastrointestinal Tract - metabolism; Hepatic Veins; Humans; Interorgan metabolism; Liver - blood supply; Liver - metabolism; Liver Cirrhosis - blood; Liver Cirrhosis - metabolism; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Portal Vein; Portasystemic Shunt, Transjugular Intrahepatic; Portography; Prebiotics - toxicity; Propionate; Propionates - blood; Propionates - chemistry; Propionates - metabolism; SCFA; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0261-5614; 1532-1983
• DOI: 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 μmol kg bw−1 h−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 μmol kg bw−1 h−1 . Hepatic uptake of acetate was non significant (12.1 ± 12.3 μmol kg bw−1 min−1 ). As a consequence of shunting, part of total acetate escaped from the splanchnic bed, which equalled 34.9 ± 14.7 μmol kg bw−1 h−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.