Year 2025 / Volume 117 / Number 9
Original
Xyloglucan protects the intestinal barrier and reduces bacterial translocation in experimental cirrhosis — A promising non-antibiotic strategy

490-496

DOI: 10.17235/reed.2025.11236/2025

Ignacio Iborra, Ramón Bartolí, Alba Ardèvol, Maria Torner, María Bermúdez-Ramos, Ana Bargalló, Helena Masnou, Rosa M. Morillas,

Abstract
Background: cirrhosis alters the intestinal barrier, increasing permeability and promoting bacterial translocation (BT). Norfloxacin (NF) is currently the only effective strategy to reduce BT, but the rise of multidrug-resistant bacteria highlights the need for new approaches. Aims: to evaluate the effect of xyloglucan, alone or with norfloxacin, on the intestinal barrier in cirrhotic rats with ascites. Methods: decompensated cirrhosis with ascites was induced in 32 rats using CCl4. Subsequently, xyloglucan (XG), NF, XG + NF (XG+NF), or water (control) were administered for one week. Parameters measured included BT incidence, endotoxemia, interferon gamma (IFN-), interleukin-23 (IL-23), plasmalemma vesicle-associated protein 1 (PV1)/CD34 ratio, occludin and liver histology. Results: BT incidence was lower in all treatment groups (XG, NF, XG+NF) compared to controls, and significantly lower in NF and XG+NF. Endotoxemia was reduced significantly in all treatment groups compared to controls, with values significantly correlating with BT incidence, occludin expression, IFN- levels, IL-23 levels, and PV1/CD34 ratio. There were no differences in IL-23 levels, but all treatment groups exhibited a decrease in IFN-, which was significant in the NF and XG+NF groups. All treatment groups showed significant increases in occludin levels and decreases in PV1/CD34 ratio compared to controls. All groups showed similar histological signs of cirrhosis. Conclusions: xyloglucan reduces intestinal mucosal inflammation, improves mucosal integrity and vascular permeability, and reduces endotoxemia and BT incidence. Xyloglucan alone showed similar results to NF. However, combining xyloglucan with NF does not provide additional benefits. These findings support evaluating xyloglucan as a new therapeutic strategy to prevent infections in cirrhosis.
Lay Summary
Cirrhosis is a chronic liver disease that can weaken the intestinal barrier, allowing bacteria from the gut to enter the bloodstream, a process known as bacterial translocation. This contributes to severe infections and worsens the condition of people living with cirrhosis. Currently, the antibiotic norfloxacin, is one of the few treatments available to prevent this process. However, the increasing problem of antibiotic resistance makes it important to explore alternative, non-antibiotic strategies. In this study, the effects of xyloglucan were tested, a plant-based compound known for forming a protective film over the intestinal lining. The experiment was conducted in rats with advanced cirrhosis. The animals were treated with xyloglucan alone, norfloxacin alone, both combined, or no treatment. The results showed that xyloglucan helped strengthen the gut barrier, reduced signs of inflammation, and lowered the amount of bacteria entering the bloodstream. These effects were similar to those achieved with norfloxacin. Unfortunately, combining both treatments did not lead to greater benefits than using either treatment alone. These findings suggest that xyloglucan could be a promising new tool to prevent infections in cirrhosis, offering a potential alternative or complement to antibiotics, especially in a context where antibiotic resistance is becoming an urgent concern.
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References
1. Borzio M, Salerno F, Piantoni L, et al. Bacterial infection in patients with advanced cirrhosis: a multicentre prospective study. Ddoi: 10.1016/s1590-8658(01)80134-1
2. Arvaniti V, D’Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis. Gastroenterology 2010;139(4):1246–56, 1256.e1-5.
3. Muñoz L, Borrero M, Úbeda M, et al. Intestinal Immune Dysregulation Driven by Dysbiosis Promotes Barrier Disruption and Bacterial Translocation in Rats With Cirrhosis. Hepatology 2019;70(3):925–38.
4. Van der Merwe S, Chokshi S, Bernsmeier C, Albillos A. The multifactorial mechanisms of bacterial infection in decompensated cirrhosis. J Hepatol 2021;75:S82–100.
5. Chang C-S, Chen G-H, Lien H-C, Yeh H-Z. Small intestine dysmotility and bacterial overgrowth in cirrhotic patients with spontaneous bacterial peritonitis. Hepatology 1998;28(5):1187–90.
6. Bauer TM, Schwacha H, Steinbruckner B, et al. Small intestinal bacterial overgrowth in human cirrhosis is associated with systemic endotoxemia. Am J Gastroenterol 2002;97(9):2364–70.
7. Lang S, Schnabl B. Microbiota and Fatty Liver Disease—the Known, the Unknown, and the Future. Cell Host Microbe 2020;28(2):233–44.
8. Al-Sadi R, Ye D, Dokladny K, Ma TY. Mechanism of IL-1beta-induced increase in intestinal epithelial tight junction permeability. J Immunol 2008;180(8):5653–61.
9. Chiang H-Y, Lu H-H, Sudhakar JN, et al. IL-22 initiates an IL-18-dependent epithelial response circuit to enforce intestinal host defence. Nat Commun 2022;13(1):874.
10. Shue EH, Carson-Walter EB, Liu Y, et al. Plasmalemmal Vesicle Associated Protein-1 (PV-1) is a marker of blood-brain barrier disruption in rodent models. BMC Neurosci 2008;9(1):29.
11. Luissint A-C, Parkos CA, Nusrat A. Inflammation and the Intestinal Barrier: Leukocyte–Epithelial Cell Interactions, Cell Junction Remodeling, and Mucosal Repair. Gastroenterology 2016;151(4):616–32.
12. Angeli P, Bernardi M, Villanueva C, et al. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018;69(2):406–60.
13. Mücke MM, Mücke VT, Graf C, et al. Efficacy of Norfloxacin Prophylaxis to Prevent Spontaneous Bacterial Peritonitis: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2020;11(8):e00223.
14. Fernández J, Acevedo J, Castro M, et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: A prospective study. Hepatology 2012;55(5):1551–61.
15. De Mattos AA, Costabeber AM, Lionҫo LC, Tovo CV. Multi-resistant bacteria in spontaneous bacterial peritonitis: A new step in management? World J Gastroenterol. 2014;20(39):14079–86.
16. De Servi B, Ranzini F, Piqué N. Effect of Utipro® (containing gelatinxyloglucan) against Escherichia coli invasion of intestinal epithelial cells: Results of an in vitro study. Future Microbiol 2016;11(5):651–8.
17. Piqué N, Gómez-Guillén M del C, Montero MP. Xyloglucan, a plant polymer with barrier protective properties over the mucous membranes: An overview. Int J Mol Sci. 2018;19(3).
18. Gnessi L, Bacarea V, Marusteri M, Piqué N. Xyloglucan for the treatment of acute diarrhea: Results of a randomized, controlled, open-label, parallel group, multicentre, national clinical trial. BMC Gastroenterol 2015;15(1).
19. Pleșea Condratovici C, Bacarea V, Piqué N. Xyloglucan for the Treatment of Acute Gastroenteritis in Children: Results of a Randomized, Controlled, Clinical Trial. Gastroenterol Res Pract 2016;2016:1–7.
20. Alexea O, Bacarea V, Piqué N. The combination of oligo- and polysaccharides and reticulated protein for the control of symptoms in patients with irritable bowel syndrome: Results of a randomised, placebo-controlled, double-blind, parallel group, multicentre clinical trial. United European Gastroenterol J 2016;4(3):455–65.
21. Trifan A, Burta O, Tiuca N, Petrisor DC, Lenghel A, Santos J. Efficacy and safety of Gelsectan for diarrhoea‐predominant irritable bowel syndrome: A randomised, crossover clinical trial. United European Gastroenterol J 2019;7(8):1093–101.
22. Esposito E, Campolo M, Casili G, et al. Efficacy of Xyloglucan against <b><i>Escherichia coli</i></b> Extraintestinal Urinary Tract Infection: An in vivo Study. Microb Physiol 2020;30(1–6):50–60.
23. Kostev K, Cai T. Cystitis and Utipro® Plus: Real-World Evidence. Healthcare 2023;11(18):2564.
24. Runyon BA, Sugano S, Kanel G, Mellencamp MA. A rodent model of cirrhosis, ascites, and bacterial peritonitis. Gastroenterology 1991;100(2):489–93.
25. Das PK, Chopra P, Nayak NC. Hepatocellular tolerance to carbon tetrachloride induced injury in the rat: A study of its nature and possible mode of evolution. Exp Mol Pathol 1974;21(2):218–36.
26. Batts KP, Ludwig J. An Update on Terminology and Reporting. Am J Surg Pathol 1995;19(12):1409–17.
27. Kuckartz U, Rädiker S, Ebert T, Schehl J. Statistik: Eine verständliche Einführung. Springer; 2013. p. 213.
28. D’Amico G, Morabito A, D’Amico M, et al. Clinical states of cirrhosis and competing risks. J Hepatol. 2018;68(3):563–76.
29. Piano S, Bunchorntavakul C, Marciano S, Rajender Reddy K. Infections in cirrhosis. Lancet Gastroenterol Hepatol 2024;
30. Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology 2004;39(3):841–56.
31. Rimola A, García-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. J Hepatol 2000;32(1):142–53.
32. Vega-Magaña N, Delgado-Rizo V, García-Benavides L, et al. Bacterial Translocation Is Linked to Increased Intestinal IFN-γ, IL-4, IL-17, and mucin-2 in Cholestatic Rats. Ann Hepatol 2018;17(2):318–29.
33. Yang X, Liao L, Liang Z, Yu S, Guo Z. Correlation Analysis of IL-17, IL-21, IL-23 with Non-Alcoholic Liver Fibrosis and Cirrhosis. J Inflamm Res 2024;Volume 17:2327–35.
34. Riva A, Gray EH, Azarian S, et al. Faecal cytokine profiling as a marker of intestinal inflammation in acutely decompensated cirrhosis. JHEP Reports 2020;2(6):100151.
35. Gómez-Hurtado I, Moratalla A, Moya-Pérez Á, et al. Role of interleukin 10 in norfloxacin prevention of luminal free endotoxin translocation in mice with cirrhosis. J Hepatol 2014;61(4):799–808.
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Iborra I, Bartolí R, Ardèvol A, Torner M, Bermúdez-Ramos M, Bargalló A, et all. Xyloglucan protects the intestinal barrier and reduces bacterial translocation in experimental cirrhosis — A promising non-antibiotic strategy. 11236/2025


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Publication history

Received: 24/03/2025

Accepted: 22/04/2025

Online First: 12/05/2025

Published: 15/09/2025

Article Online First time: 49 days

Article editing time: 175 days


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