TY - JOUR T1 - GI highlights from the literature JF - Gut JO - Gut SP - 194 LP - 195 DO - 10.1136/gutjnl-2017-315602 VL - 67 IS - 1 AU - Mairi H McLean Y1 - 2018/01/01 UR - http://gut.bmj.com/content/67/1/194.abstract N2 - The therapeutic effect of metformin on type 2 diabetes depends on microbiota modulationWu H, Esteve E, Tremaroli V, et al. Metformin alters the gut microbiome of individuals with treatment-naive type 2 diabetes, contributing to the therapeutic effects of the drug. Nat Med 2017;23:850–58.Metformin is widely used as a first-line medication for type 2 diabetes (T2D). Recent mouse models have shown that metformin increases the abundance of Akkermansia muciniphila (a strict anaerobe that exerts beneficial effects on glucose homeostasis), suggesting that its therapeutic effect may rely in the modulation of gut microbiota. In this double-blind randomised trial, patients with newly diagnosed T2D who were naive to treatment received either metformin (n=22) or placebo (n=18) for 4 months. In the metformin group, several alterations of microbiota were identified after the treatment including an increase of Escherichia and a decrease of Intestinibacter at the genus level. There was also an increase in A. muciniphila abundance and in the number of positive connections among microbes. Metformin directly promoted the growth of A. muciniphila in pure cultures. These findings were confirmed in a subgroup of patients in the placebo group who subsequently received metformin 6 months after the start of the study. Moreover, high-fat-diet-fed germ-free mice were transplanted with faecal samples from patients in the metformin group before and after metformin treatment, and only those who received faeces collected after 4 months of treatment experienced improvement of glucose tolerance. Finally, in two models of gut simulators, metformin was shown to influence, both in A. muciniphila and in Bilophila wadsworthia, the expression of several genes especially those encoding for metalloproteins or metal transporters. These results support the concept that some of the antidiabetic effects of metformin may depend on the modulation of the host microbiota.Fructose consumption and progressive NAFLDSoftic S, Gupta MK, Wang GX, et al. Divergent effects of glucose and fructose on hepatic lipogenesis and insulin … ER -