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However, the underlying mechanisms of steatosis progression in CD are not clear. Among the most effective CD treatments are agents that inhibit Tumor\u2010Necrosis\u2010Factor (TNF) activity, yet it is unclear why anti\u2010TNF\u03b1 agents would affect steatosis in CD. Recent studies suggest that microbiome can affect both, CD and steatosis pathogenesis. Therefore, we here analysed a potential relationship between anti\u2010TNF treatment and hepatic steatosis in CD, focusing on the gut\u2010liver axis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross\u2010sectional study evaluated patients with established CD, with and without anti\u2010TNF\u03b1 treatment, analysing serum markers of liver injury, measurement of transient elastography, controlled attenuation parameter (CAP) and MRI for fat detection. Changes in lipid and metabolic profiles were assessed by serum and stool lipidomics and metabolimics. Additionally, we analysed gut microbiota composition and mediators of bile acid (BA) signalling via stool and serum analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients on anti\u2010TNF\u03b1 treatment had less hepatic steatosis as assessed by CAP and MRI. Serum FGF19 levels were significantly higher in patients on anti\u2010TNF\u03b1 therapy and associate with reduced steatosis and increased bowel motility. Neutral lipids including triglycerides were reduced in the serum of patients on anti\u2010TNF treatment. Bacteria involved in BA metabolism and FGF19 regulation, including <jats:italic>Firmicutes<\/jats:italic>, showed group\u2010specific alterations with low levels in patients without anti\u2010TNF\u03b1 treatment. Low abundance of <jats:italic>Firmicutes<\/jats:italic> was associated with higher triglyceride levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Anti\u2010TNF\u03b1 treatment is associated with reduced steatosis, lower triglyceride levels, alterations in FXR\u2010signalling (eg FGF19) and microbiota composition in CD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15003","type":"journal-article","created":{"date-parts":[[2021,7,5]],"date-time":"2021-07-05T07:31:24Z","timestamp":1625470284000},"page":"2646-2658","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Anti\u2010TNF\u03b1 treatment in Crohn\u2019s disease: Impact on hepatic steatosis, gut\u2010derived hormones and metabolic status"],"prefix":"10.1111","volume":"41","author":[{"given":"Paul","family":"Manka","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University Hospital Knappschaftskrankenhaus Ruhr\u2010University Bochum Bochum Germany"},{"name":"Department of Gastroenterology and Hepatology University Hospital Essen Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1349-8309","authenticated-orcid":false,"given":"Svenja","family":"Sydor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University Hospital Knappschaftskrankenhaus Ruhr\u2010University Bochum Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishikant","family":"Wase","sequence":"additional","affiliation":[{"name":"Biomolecular Analysis Facility University of Virginia School of Medicine Charlottesville VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Best","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University Hospital Knappschaftskrankenhaus Ruhr\u2010University Bochum Bochum 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and Infectious Diseases Otto\u2010von\u2010Guericke\u2010University Hospital Magdeburg Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Coombes","sequence":"additional","affiliation":[{"name":"Inflammation Biology School of Immunology and Microbial Sciences Faculty of Life Sciences and Medicine King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco\u2010Javier","family":"Cubero","sequence":"additional","affiliation":[{"name":"Department of Immunology, Ophthalmology and ORL Complutense University School of Medicine Madrid Spain"},{"name":"12 de Octubre Health Research Institute (imas 12) Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisan","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital Essen Essen 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