New insights into gut-liver axis in advanced liver diseases: A promising therapeutic target

The gut-liver axis constitutes a bidirectional communication network that integrates the microbial microenvironment, metabolism, and immune signals between the gut and the liver. Currently, there is compelling evidence indicating that the overall dysfunction of the gut-liver axis is a pivotal driver in the pathogenesis of advanced liver diseases. This review focuses on the latest research progress regarding various components of the intestinal barrier and how these components contribute to the onset and progression of cirrhosis and its complications. Chronic exposure to multifactorial stressors can result in irreversible damage to intestinal physical barriers, microbial dysbiosis, and immune dysregulation. These cumulative perturbations within the gut-liver axis promote pathogenic microbial translocation, initiate systemic inflammatory responses, and expedite disease progression. A more in-depth understanding of the gut-liver crosstalk mechanism is anticipated to offer novel therapeutic strategies for restoring microbiota-targeted intestinal homeostasis, which may lead to functional recompensation in decompensated cirrhosis.