Oleh Admin Kalbe Medical pada March 14, 2018 07:31

Kaitan antara Kanker Hati dan Probiotik

Berbagai studi dalam beberapa tahun terakhir telah menunjukkan kontribusi mikrobiota pada kesehatan, terutama pada saluran pencernaan; baik secara langsung seperti pada IBD maupun tidak langsung. Bagaimana organ hati bisa berhubungan dengan mikrobiota, merupakan hal yang pertama kali terlintas. Hal pertama yang perlu diketahui organ hati dan pencernaan berhubungan melalui vena porta (secara anatomi). Hati tidak hanya menerima darah yang penuh nutrisi dari pencernaan, namun juga menjadi target pertama dari mikrobiota usus.

Dari hubungan tersebut, pada beberapa studi juga menemukan bahwa perubahan mikrobiota usus pada penyakit hati kronik berkontribusi pada peradangan kronik dan progresivitas dari penyakit hati; hal ini dapat sedikit banyak berpengaruh pada peningkatan risiko dari perkembangan karsinoma hepatoseluler (HCC/hepatocellular carcinoma) sebagai derajat akhir dari proses penyakit ini.

Bicara mikrobiota tentu akan bicara pertahanan usus, salah satunya adalah asam empedu. Asam empedu menunjukkan faktor lain pada sistem kompleks ini, dengan meregulasi fungsi pertahanan epitelial dan proliferasi dari sel epitelial usus melalui jalur X-activated receptor (FXR)-dependent dan epidermal growth factor receptor (EFGR)-dependent; serta mengontrol pertumbuhan dan perlekatan dari bakteri usus. Asam empedu juga menyediakan jalur penting antara hati, mikrobiota, dan usus. Setelah disintesis di hati, asam empedu mengalami metabolisme oleh bakteri dan dikenali oleh sel epitelial usus melalui ekspresi FXR yang juga berhubungan langsung dengan hati melalui jalur FGF19.

HCC biasanya merupakan hasil dari suatu proses penyakit hati yang kronik dan hampir tidak pernah muncul secara spontan. Selain itu, 80-90% dari kasus HCC muncul pada kondisi hati yang mengalami sirosis atau fibrosis lanjutan. Kontribusi bakteri terhadap HCC merupakan suatu perjalanan panjang. Mekanisme yang saat ini diketahui adalah akibat berubahnya permeabilitas usus dan berubahnya komposisi dari bakteri usus. Salah satu contohnya adalah mikrobiom usus pada pasien dengan penyakit hati lanjut dan sirosis hati menunjukkan cirri khas di mana bakteri patogen lebih banyak dibandingkan dengan bakteri komensal.

Saat ini belum ada pillihan terapeutik untuk pencegahan HCC selain dengan memberikan terapi pada penyakit penyebab/ penyakit pendahulunya. Dengan melihat hubungan ini, maka ¬gut-liver-microbiota axis dapat menjadi target menjanjikan untuk pendekatan preventif. Selain dapat mencegah risiko terjadinya HCC dengan menargetkan ¬gut-liver-microbiota axis juga dapat menurunkan risiko terjadinya fibrosisi hati dan hipertensi portal seperti yang pernah dilakukan studinya pada tikus.

Kesimpulannya, probiotik tampaknya semakin menjanjikan pada kasus HCC. Namun, perlu dilakukan penelitian selanjutnya untuk menentukan strain yang cocok untuk penyakit hati. (OEP)

Image : Ilustrasi
Referensi:
1.Yu LX, Schwabe RF. The gut microbiome and liver cancer: Mechanisms and clinical translation. Nature Reviews: Gastroenterology & Hepatology 2017. doi: 10.1038/nrgastro.2017.72.
2.Tabibian JH. Absence of the intestinal microbiota exacerbates hepatobiliary disease in amurine model of primary sclerosing cholangitis. Hepatology. 2016;63:185-96.

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