New Engl Jl Medicine Aug 30 2018 C Schramm Bile Acids, the Microbiome, Immunity, and Liver Tumors

HCC ( Hepatocellular Carcinoma) is the #2 cause of tumor death in the world. It is growing rapidly due to fatty liver (NAFLD OR NASH)(Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steato Hepatitis). The liver is also commonplace to get metastases. C Schramm and others have demonstrated a mouse model of decreasing all liver tumors using an antibiotic. The antibiotic decreases gram-positive bacteria, specifically clostridia. These, in turn, decrease the conversion of primary bile acids to secondary bile acids. This causes an increase of immune marker CLXCL16, which in turn causes an increase in liver Killer T cells. These liver Killer T cells keep the tumor cells at bay.