Research progress on the role of bile acid metabolism in intestinal epithelial cell injury in necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency frequently occurring in premature infants. Its etiology is not yet fully elucidated, which makes clinical diagnosis and treatment challenging. In recent years, the core role of bile acid metabolism dysregulation and the signaling pathways involved in the pathogenesis of NEC have become increasingly prominent. This review focuses on the core characteristics of abnormal bile acid composition and enterohepatic circulation imbalance in children with NEC, analyzing the bidirectional regulatory relationship between bile acids and intestinal microbiota. It also emphasizes the mechanism by which excessive activation of Farnesoid X receptor drives the occurrence and development of NEC by damaging the intestinal epithelial barrier, inducing ferroptosis in intestinal epithelial cells, and exacerbating intestinal immune inflammation. Intestinal epithelial cells are recognized as the central integrators and primary targets of bile acid dysregulation and intestinal microbiota dysbiosis in NEC pathogenesis. This review systematically summarizes relevant research progress and explores the potential value and clinical translational prospects of novel prevention and treatment strategies targeting bile acid metabolism and signaling pathways, providing theoretical support for optimizing NEC diagnosis and treatment, and improving the prognosis of premature infants.