Evidence map›Paper›PMID 41507585›Full record

Observational studyNature microbiology2026

Gut microbial ethanol metabolism contributes to auto-brewery syndrome in an observational cohort.

Cynthia L Hsu, Shikha Shukla, Linton Freund, Annie C Chou, Yongqiang Yang, Ryan Bruellman, Fernanda Raya Tonetti, Noemí Cabré, Susan Mayo, Hyun Gyu Lim and 11 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Nature microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Cynthia L HsuDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Shikha ShuklaDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Linton FreundDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Annie C ChouDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Yongqiang YangDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Ryan BruellmanDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Fernanda Raya TonettiDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Noemí CabréDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Susan MayoDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Hyun Gyu LimDepartment of Bioengineering, University of California San Diego, La Jolla, CA, USA.ORCID http://orcid.org/0000-0002-0469-2388
Valeria MagallanInfectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
Barbara J CordellAuto-Brewery Syndrome Information and Research, Inc., Carthage, TX, USA.ORCID http://orcid.org/0000-0002-3698-9872
Sonja LangDepartment of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany.
Münevver DemirDepartment of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Peter StärkelDepartment of Hepatology and Gastroenterology, St Luc University Hospital, Catholic University of Louvain, Brussels, Belgium.
Cristina LlorenteDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.ORCID http://orcid.org/0000-0001-8135-9186
Bernhard O PalssonDepartment of Bioengineering, University of California San Diego, La Jolla, CA, USA.ORCID http://orcid.org/0000-0003-2357-6785
Chitra MandyamDepartment of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
Brigid S BolandDepartment of Medicine, University of California San Diego, La Jolla, CA, USA.
Elizabeth Hohmann *Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA. ehohmann@mgh.harvard.edu.ORCID http://orcid.org/0009-0002-4886-3131
Bernd Schnabl *Department of Medicine, University of California San Diego, La Jolla, CA, USA. beschnabl@health.ucsd.edu.ORCID http://orcid.org/0000-0002-6281-825X

Funding

San Diego Digestive Diseases Research CenterP30DK120515 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Bernd G. Schnabl · 2019 to 2026
$10.8M
Medial Prefrontal Cortical Gliogenesis and Alcohol DependenceR01AA020098 · NIAAA · VETERANS MEDICAL RESEARCH FDN/SAN DIEGO · PI Chitra D Mandyam · 2012 to 2026
$4.9M
Microbiome and Intestinal Innate Immune Response in Alcoholic Liver DiseaseR37AA020703 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Bernd G. Schnabl · 2021 to 2026
$2.5M
Role of gut microbial ethanol production in alcohol use disorder and alcohol-associated liver diseaseR00AA031328 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Cynthia Li-Shin Hsu · 2025 to 2026
$497k
The role of intestinal gp130 in alcohol-associated liver diseaseR21AA030654 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI LLORENTE IZQUIERDO, ANA CRISTINA · 2023 to 2023
$415k
Role of gut microbial ethanol production in alcohol use disorder and alcohol-associated liver diseaseK99AA031328 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI HSU, CYNTHIA LI-SHIN · 2023 to 2024
$351k
American Association for the Study of Liver Diseases (AASLD) CTORA23-208366Biomedical Laboratory Research and Development, VA Office of Research and Development (VA Biomedical Laboratory Research and Development) BX004594BLRD VA I01 BX004594NIAAA NIH HHS K99 AA031328NIAAA NIH HHS R00 AA031328NIAAA NIH HHS R01 AA020098NIAAA NIH HHS R21 AA030654NIAAA NIH HHS R37 AA020703NIDDK NIH HHS P30 DK120515U.S. Department of Energy (DOE) DE-AC02-05CH11231U.S. Department of Health & Human Services | National Institutes of Health (NIH) R01 AA029106, R21 AA030654, P30 AR073761
6 · The paper itself

Abstract

Auto-brewery syndrome (ABS) is a rarely diagnosed disorder of alcohol intoxication due to gut microbial ethanol production. Despite case reports and a small cohort study, the microbiological profiles of patients remain poorly understood. Here we conducted an observational study of 22 patients with ABS and 21 unaffected household partners. Faecal samples from individuals with ABS during a flare produced more ethanol in vitro, which could be reduced by antibiotic treatment. Gut microbiome analysis using metagenomics revealed an enrichment of Proteobacteria, including Escherichia coli and Klebsiella pneumoniae. Genes in metabolic pathways associated with ethanol production were enriched, including the mixed-acid fermentation pathway, heterolactic fermentation pathway and ethanolamine utilization pathway. Faecal metabolomics revealed increased acetate levels associated with ABS, which correlated with blood alcohol concentrations. Finally, one patient was treated with faecal microbiota transplantation, with positive correlations between gut microbiota composition and function, and symptoms. These findings can inform future clinical interventions for ABS.

Indexed as

EthanolGastrointestinal MicrobiomeAdultCohort StudiesEscherichia coliFecal Microbiota TransplantationFecesFemaleFermentationHumansMaleMetabolic Networks and PathwaysMetabolomicsMetagenomicsMiddle AgedEthanol

Identifiers

PMID41507585
PMCPMC13244660

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.