Clin Mol Hepatol.
2025 Feb;31(Suppl):S94-S111. 10.3350/cmh.2024.0811.
Microbiome-centered therapies for the management of metabolic dysfunction-associated steatotic liver disease
- Saeed H1
- Díaz LA2,3
- Gil-Gómez A4,5
- Burton J6
- Bajaj JS7
- Romero-Gomez M4,5,8,9
- Arrese M3
- Arab JP3,7
- Khan MQ
10,11
- Affiliations
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- 1Division of Infectious Diseases, Department of Medicine, University of Western Ontario, London, ON, Canada
- 2MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA, USA
- 3Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- 4SeLiver Group, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- 5Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- 6Department of Microbiology & Immunology, Western University, London, ON, Canada
- 7Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- 8Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Seville, Spain
- 9UCM Digestive diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- 10Division of Gastroenterology, Department of Medicine, University of Western Ontario, London, ON, Canada
- 11Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
- KMID: 2565373
- DOI: http://doi.org/10.3350/cmh.2024.0811
Abstract
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is a significant global health issue, affecting over 30% of the population worldwide due to the rising prevalence of metabolic risk factors such as obesity and type 2 diabetes mellitus. This spectrum of liver disease ranges from isolated steatosis to more severe forms such as steatohepatitis, fibrosis, and cirrhosis. Recent studies highlight the role of gut microbiota in MASLD pathogenesis, showing that dysbiosis significantly impacts metabolic health and the progression of liver disease. This review critically evaluates current microbiome-centered therapies in MASLD management, including prebiotics, probiotics, synbiotics, fecal microbiota transplantation, and emerging therapies such as engineered bacteria and bacteriophage therapy. We explore the scientific rationale, clinical evidence, and potential mechanisms by which these interventions influence MASLD. The gut-liver axis is crucial in MASLD, with notable changes in microbiome composition linked to disease progression. For instance, specific microbial profiles and reduced alpha diversity are associated with MASLD severity. Therapeutic strategies targeting the microbiome could modulate disease progression by improving gut permeability, reducing endotoxin-producing bacteria, and altering bile acid metabolism. Although promising, these therapies require further research to fully understand their mechanisms and optimize their efficacy. This review integrates findings from clinical trials and experimental studies, providing a comprehensive overview of microbiome-centered therapies’ potential in managing MASLD. Future research should focus on personalized strategies, utilizing microbiome features, blood metabolites, and customized dietary interventions to enhance the effectiveness of these therapies.
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