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The gut–liver axis and gut microbiota in health and liver disease

Nature Reviews Microbiology volume 21, pages 719–733 (2023)Cite this article

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Abstract

The trillions of microorganisms in the human intestine are important regulators of health, and disruptions in the gut microbial communities can cause disease. The gut, liver and immune system have a symbiotic relationship with these microorganisms. Environmental factors, such as high-fat diets and alcohol consumption, can disrupt and alter microbial communities. This dysbiosis can lead to dysfunction of the intestinal barrier, translocation of microbial components to the liver and development or progression of liver disease. Changes in metabolites produced by gut microorganisms can also contribute to liver disease. In this Review, we discuss the importance of the gut microbiota in maintenance of health and the alterations in microbial mediators that contribute to liver disease. We present strategies for modulation of the intestinal microbiota and/or their metabolites as potential treatments for liver disease.

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Fig. 1: The gut–liver axis.
Fig. 2: Barrier systems against translocation of microorganisms.
Fig. 3: Gut microbiomes differ with aetiology of liver disease.
Fig. 4: Targeted approaches for treatment of liver disease.

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Acknowledgements

C.L.H. is supported by a Pilot and Feasibility Award from the Southern California Research Center for ALPD and Cirrhosis P50 AA011999 and by T32 DK007202. The Review article was supported by services provided by National Institutes of Health (NIH) centre P30 DK120515.

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  1. Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Cynthia L. Hsu & Bernd Schnabl

  2. Department of Medicine, VA San Diego Healthcare System, San Diego, CA, USA

    Bernd Schnabl

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The authors contributed equally to all aspects of the article.

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Correspondence to Bernd Schnabl.

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Competing interests

B.S. has consulted for Ambys Medicines, Ferring Research Institute, Gelesis, HOST Therabiomics, Intercept Pharmaceuticals, Mabwell Therapeutics, Patara Pharmaceuticals and Takeda, and is founder of Nterica Bio. UC San Diego has filed several patents with B.S. as inventor, and UC San Diego has received research support from Axial Biotherapeutics, BiomX, CymaBay Therapeutics, NGM Biopharmaceuticals, Prodigy Biotech and Synlogic Operating Company. C.L.H. declares no competing interests.

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Hsu, C.L., Schnabl, B. The gut–liver axis and gut microbiota in health and liver disease. Nat Rev Microbiol 21, 719–733 (2023). https://doi.org/10.1038/s41579-023-00904-3

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