Pomegranate Dietary Supplements in AUD and ALD

A large body of anecdotal evidence suggests beneficial effects for many botanical dietary supplements (BDS) on human health. The U.S. alone spent \~$7.5 billion on BDS in 2016, suggesting significant interest in the consumption of such products. Since ancient times, pomegranate has been known as a 'healing food', with numerous health benefits, including prevention of health risk factors for high blood pressure, arthritis, high cholesterol, oxidative stress, and hyperglycemia (1-4). Despite reported benefits from consumption of pomegranate dietary supplements (PDS), the overall outcomes of clinical trials were not uniform, and the results were inconclusive (5-7). However, gut microbial metabolites derived from polyphenolics of pomegranate have been shown to promote many beneficial activities, including anti-oxidative and anti-inflammatory activities (8- 12). Thus, the inter-individual variation in human gut microbiota compositions and their metabolic capacities may hamper the predicted PDS-mediated benefits. We postulate that harboring the specific gut microbiota responsible for metabolizing PDS into beneficial metabolites is critical to manifesting the complete benefits of PDS consumption. Recently, we reported one such microbial metabolite, 'urolithin A' (UroA), derived from ellagic acid-rich diets (e.g., pomegranate), significantly enhanced gut barrier function in addition to blocking unwarranted inflammation in colitis models (13) and protected from alcoholic liver disease (ALD) in mouse models (unpublished data). UroA is produced only in 40-50% of humans, who harbor the appropriate microbiota capable of converting consumed ellagic acid-rich diets (such as pomegranates, berries, and walnuts). UroA levels varied significantly among populations, to micromolar levels in some individuals. The direct correlations between UroA levels and human health/disease conditions are not yet available.

This project aims to determine an individual's ability to generate active gut microbial metabolites called urolithins upon consumption of pomegranate dietary supplements. We, and others, reported that urolithins are the major active metabolites that are responsible for the beneficial activities that are rendered from eating pomegranates, berries, or walnuts. However, the production of urolithins from the parent compound ellagic acid (EA) is dependent upon the presence of certain bacteria in the human gut. In this trial, we propose to investigate variations in gut microbiota and their capacity to metabolize pomegranate dietary supplements (PDS) into active urolithins. We will measure the levels of urolithins in blood as well as inflammatory cytokines in plasma samples upon consumption of PDS.

• Pomegranate Dietary Ssupplement (Dietary supplement), also known as Nutricost Pomegranate Extract: Nutricost Pomegranate Extract 15,000mg Equivalent from 1,000mg of 15:1 Extract Per Servings, 120 Capsules for 40 Servings Per Bottle - Vegan, GMO Free and Gluten Free;

Primary outcomes

• To characterize the metabolite and cytokine profiles to inform future trials designed for enhancing cut barrier function [2036 yr.]: To evaluate the impact of pomegranate dietary supplements (PDS) on gut microbiome composition and epithelial barrier function in healthy, alcohol use disorder (AUD), early-stage ALD (eALD), and alcohol-associated liver cirrhosis (AC) subjects by characterizing the metabolite and cytokine profiles to inform future trials designed for enhancing cut barrier function in alcohol-associated liver disease (ALD).
• If inter-individual variation in gut microbiome is responsible for the production of beneficial metabolites [2036 yr.]: To determine if inter-individual variation in gut microbiome is responsible for the production of beneficial metabolites in healthy, AUD, eALD, and AC patients by correlating urolithin levels to inflammatory mediators in both healthy and diseased conditions.
• To determine if more correlative studies between produced metabolites, inflammatory mediators, and disease conditions could provide informed decisions during disease progression. [2036 yr.]: Develop identifiers for the pathology and treatment development of the study cohorts.
• To evaluate the omics of the subject and the microbiomes in their saliva, urine, and stool. [2036 yr.]: To evaluate the omics of the subject and the microbiomes in their saliva, urine, and stool. This will help determine what response changes are genetic changes (both bacterial and human) in saliva; and omics, and genetic changes in stool and urine (both human and bacterial) could illustrate their role in profiling these potential modifiable risk factors for AUD/ALD. The data could be correlated with the blood sample-derived cytokine, gut dysfunction, and candidate biomarkers of liver (K18s) and AUD severity (neurotransmitters, such as dopamine, GABA, serotonin, etc.)

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Healthy Group:

Inclusion: Healthy individuals, Exclusion: AUD, ALD, AC, and inflammatory conditions,

Alcohol Use Disorder Group:

Inclusion: AUD diagnosis Exclusion: alcohol-associated systemic conditions

Alcohol-associated liver disease Group:

Inclusion: early-stage ALD comorbid with AUD Exclusion: Only AUD or AUD with AC

Alcohol-associated cirrhosis Inclusion: AC with AUD Exclusion: AUD, and early stage ALD, as well as determined by the study cohort criteria

• Ghosh S, Singh R, Vanwinkle ZM, McClain CJ, Vatsalya V, Haribabu B, Vemula PK, Jala VR. Urolithin A regulates gut: liver axis to ameliorate alcohol-associated liver disease. Front Pharmacol. 2026 Jan 19;16:1706111. doi: 10.3389/fphar.2025.1706111. eCollection 2025. PMID 41635923

• Craig J McClain, MD, Study chair, University of Louisville
• Vatsalya Vatsalya, MD, Study director, University of Louisville
• Venkatakrishna R Jala, PhD, Principal investigator, University of Louisville

NIH grants: P50AA024337