The gut-liver axis and metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, affecting billions of people. Research over the last two decades has increasingly shown that a dysregulated gut-liver axis contributes to development and progression of the disease. The liver and intestine communicate via the biliary system, the portal vein and mediators in the bloodstream, the so-called gut-liver axis. Intestinal microbes are also involved in maintaining homeostasis in the liver. Dysbiosis, which describes changes in the diversity and physiological composition of the gut microbiome can also serve as a basis for pathogens and molecules that drive the development or progression of MASLD. Among others, this is mediated through a disruption of the intestinal barrier and through unfavorable effects on the metabolism, such as altered bile acid metabolism or altered production of short-chain fatty acids. This review discusses how the gut microbiota and its products contribute to the pathogenesis of MASLD and how targeted microbiome-directed interventions can be used as potential therapeutic approaches.