Gut Microecosystem and Metabolic Dysfunction-Associated Steatotic Liver Disease: Exploring the Crosstalk and Advancing Therapeutic Strategies

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a global health concern. In recent years, the gut microbiota, often referred to as the body's "second genome," has been recognized as playing a crucial role in the pathogenesis of MASLD. PubMed was searched for articles published in the last decade using keywords like "MASLD," "NAFLD," "gut microbiota," "FXR," and "Trace elements." The progress of the latest NAFLD clinical trial was also reviewed from the Chinese Clinical Trial Registry, organized by clinical phase. In the development of MASLD, the gut microbiota not only participates in regulating host gene expression but also exerts a core influence on immune function and affects the liver's reparative capabilities. Furthermore, the metabolic products of the gut microbiota are involved in the occurrence and development of liver diseases through the gut-liver axis. A diet high in fat can trigger metabolic inflammation, changes in gut microbiota, and abnormalities in metabolic products, all of which may initiate inflammatory responses. The emerging strategies for treating MASLD are surprising. Clinical trial information for chemical drugs was obtained from the Chinese platform for registration and disclosure of drug clinical trials, and it was found that in the current drug development, some drugs have advanced to Phase III clinical trials. The diversity of gut bacteria among individuals and the impact of microbial composition beyond bacteria should not be overlooked. Whether drug therapy combined with dietary patterns is more effective than monotherapy remains to be seen.