Accordingly, as reviewed elsewhere,[5] expression and function of intestinal TLR/NLR are normally regulated in a manner that prevents activation of these receptors by the microbiota. However, activation of intestinal TLR/NLR may still drive a variety of inflammatory diseases including liver disease. Moreover, as discussed below, the liver also expresses TLR/NLR that are increasingly appreciated to play a direct role in liver disease. As study of the microbiota in liver Selleckchem Nutlin 3 disease is in its infancy, it is useful to first consider lessons from study of how the intestinal microbiota can promote other

diseases. The microbiota has long been considered as a central player in inflammatory bowel disease.[6] Altered gut microbiota is associated with disease in humans and mice, and

gut microbiota is essential for most murine models of colitis. The essential role seems to largely reflect that gut microbial products activating TLR/NLR drive the inflammation that defines disease. But yet, TLR/NLR also play a key role in keeping gut bacteria in check, thus preventing disease. Thus, given that humans would not normally exist in germfree states, the most important lesson from the intestine may be that a properly functioning immune system, which will clearly involve TLR/NLR signaling, can maintain a healthy microbiota such that it does JQ1 not cause a potentially problematic level of activation of TLR/NLR that would result in clinical indicators of inflammation. Importantly, such problematic, i.e., colitis-associated, levels of TLR/NLR activation can result from an inherently colitogenic microbiota, excessive immune activation, or an underlying

immune deficiency that results in a compensatory immune activation that is necessary to clear the bacteria. Intestinal Loperamide microbiota can also promote metabolic disease by three primary mechanisms. First, microbiota can alter the efficiency of energy harvest from ingested food in that microbiotas from obese humans exhibit altered Bacteroidetes/Firmicutes ratios, which promote increased energy harvest and adiposity when transplanted into germfree mice.[7] Another means by which microbial metabolism may negatively influence the host is by generating toxic metabolites from the diet. For example, Wang et al.[8] observed that microbiota converts choline to phosphatidylcholine linked to heart disease. Perhaps an overarching means by which altered host-microbiota interactions promotes metabolic disease is by driving low-grade inflammation, as several mouse strains that fail to maintain healthy populations of gut microbiota develop metabolic syndrome.[9-11] In addition, such metabolic disease may be driven, at least in part, by microbiota-derived TLR/NLR agonists activating proinflammatory signaling in organs that control central metabolism.