Microbiome Targeted Therapies for Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is a rare, progressive cholestatic liver disease of the intrahepatic and extrahepatic bile ducts with poor prognosis. The only life-extending treatment for PSC is liver transplantation, with up to 25% of post-transplant patients developing recurrent disease, highlighting an extrahepatic influence on disease. The gut-liver axis has been widely studied in the development and pathogenesis of PSC, with preclinical and clinical work demonstrating that targeting gut microbiota and its metabolites can elicit therapeutic effects against PSC. This review describes various microbiome-based therapeutics and their effectiveness in treating PSC, including antibiotics, probiotics, fecal microbiota transplantation, and bacteriophages. In conclusion, the use of microbiota-derived metabolites as potential therapeutics is also addressed.