2026-07-08 | The bile acid-gut microbiota-vitamin D axis: new insights into biliary atresia.
Biliary atresia (BA) is a progressive fibroinflammatory disease affecting both intrahepatic and extrahepatic bile ducts. It leads to cholestasis, hepatic fibrosis, and eventually biliary cirrhosis. Although BA is the most common cause of neonatal cholestasis, its exact pathogenesis remains incompletely understood. Emerging evidence suggests that disturbances in bile acid metabolism, gut microbiota dysbiosis, and vitamin D deficiency may play critical roles in the initiation and progression of BA. This review systematically summarizes the dynamic evolution characteristics of bile acid profiles, gut microbiota composition, and vitamin D levels in children with BA across different disease stages. It further explores the potential positive feedback loop effects of the bile acid-gut microbiota-vitamin D axis in the pathogenesis and progression of the disease. Additionally, this review discusses potential diagnostic value and therapeutic strategies based on this axis. Interventions targeting bile acid metabolism, modulating the gut microbiota, and supplementing vitamin D have shown promise in altering the disease course. Despite these advances, further research is needed to elucidate the precise molecular mechanisms underlying this axis in BA. Such knowledge will pave the way for more effective preventive and therapeutic strategies for this complex disease.
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2026-07-06 | Mesenchymal stem cells in intrahepatic and extrahepatic biliary diseases: mechanisms and therapeutic applications.
Mesenchymal stem cells (MSCs) have emerged as promising therapeutic candidates for a wide range of intrahepatic and extrahepatic biliary diseases. However, their clinical application remains limited by an incomplete understanding of underlying mechanisms and heterogeneous therapeutic outcomes. This review provides a comprehensive overview of recent advances in MSC-based therapies for biliary system diseases, including primary biliary cholangitis, intrahepatic biliary fibrosis and cirrhosis, biliary atresia, primary sclerosing cholangitis, and cholangiocarcinoma. We summarize both preclinical and clinical evidence and focus on key therapeutic mechanisms, including immunomodulation, antifibrotic activity, regulation of bile acid metabolism, and protection of biliary epithelial cells.
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2026-06-18 | Antibiotic Prophylaxis Optimization Using Fecal Surveillance Culture in Operated Biliary Atresia Patients: A Retrospective Study on Cholangitis Prevention.
Antibiotics are central to preventing and treating cholangitis following Kasai portoenterostomy (KPE).There is an increasing evidence of resistance to commonly used antibiotics. Study explores an inexpensive and noninvasive method of monitoring and adapting antibiotic therapy post KPE using fecal surveillance cultures (FSCs).Primary aim was to assess load of antibiotic resistance among organisms isolated on FSC and the effect of choosing antibiotic based on this resistance pattern. One secondary aim was to assess the relationship between steroid initiation following KPE and cholangitis. It is a retrospective, observational study including 55 post-KPE patients. FSC were used to guide antibiotic prophylaxis and to tailor treatment during cholangitis episodes in select patients unresponsive to standard therapy. Post-KPE FSC was performed in 45.45% (25/55) patients, isolating Escherichia coli and Klebsiella pneumoniae, with notable resistance to cephalosporins, fluoroquinolones, and carbapenems; tigecycline showed the least resistance. During cholangitis episodes, FSC was done in 65.52% (19/29) cases, isolating E. coli, K. pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. Cephalosporin and fluoroquinolone resistance was highest followed by carbapenem and aminoglycoside with lowest being tigecycline resistance. Resistance was significantly higher in Klebsiella compared to E. coli (P < 0.05). Steroid initiation was significantly earlier in patients who developed cholangitis (15.27 ± 7.69 days post-KPE) compared to those who did not (21.47 ± 9.43 days; P = 0.019). Antibiotic prophylaxis post-KPE should be guided as per the FSC-sensitivity pattern as the rates of resistance to commonly used antibiotics is high. Caution is needed in initiating steroids very early after surgery.
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