In 22 patients with auto-brewery syndrome, we found enrichment of gut bacterial genes in metabolic pathways associated with ethanol production. Treatment with faecal microbiota transplantation in one patient led to improvement in symptoms that correlated with changes in gut microbiota composition and improved metabolic function.
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References
Dinis-Oliveira, R. J. The auto-brewery syndrome: a perfect metabolic "storm" with clinical and forensic implications. J. Clin. Med. 10, 4637 (2021). A review article summarizing existing clinical diagnosis and management of ABS.
Bayoumy, A. B. et al. Gut fermentation syndrome: a systematic review of case reports. United European Gastroenterol. J. 9, 332–342 (2021). A systemic review of 17 case reports of ABS and culprit microbes.
Xue, G. et al. Three Klebsiella species as potential pathobionts generating endogenous ethanol in a clinical cohort of patients with auto-brewery syndrome: a case control study. eBioMedicine 91, 104560 (2023). This study identifies high-ethanol-producing Klebsiella species in patients with ABS.
Yuan, J. et al. Fatty liver disease caused by high-alcohol-producing Klebsiella pneumoniae. Cell Metab. 30, 675–688.e7 (2019). This study shows that alcohol-producing Klebsiella pneumoniae strains are common in individuals with non-alcoholic fatty liver disease and can elicit steatotic liver disease in mice.
Meijnikman, A. S., Nieuwdorp, M. & Schnabl, B. Endogenous ethanol production in health and disease. Nat. Rev. Gastroenterol. Hepatol. 21, 556–571 (2024). A review article that describes the pathophysiology and disease implications of excessive microbial ethanol production.
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This is a summary of: Hsu, C. L. et al. Gut microbial ethanol metabolism contributes to auto-brewery syndrome in an observational cohort. Nat. Microbiol. https://doi.org/10.1038/s41564-025-02225-y (2026).
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Microbial ethanol production in patients with auto-brewery syndrome. Nat Microbiol 11, 348–349 (2026). https://doi.org/10.1038/s41564-025-02250-x
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DOI: https://doi.org/10.1038/s41564-025-02250-x
