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The Dual Roles of Gut Microbiota in Biliary Atresia: Mechanisms, Biomarker Potential, and Therapeutic Implications

Jianing Yan1, Li Jiang1, Yating Li1

  • 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China.

Microorganisms
|May 27, 2026
PubMed

Insights

Biliary atresia (BA) involves gut microbiome changes impacting liver health. While some microbes worsen BA, others may protect the liver, but more research is needed for clinical use.

Area of Science:

  • Gastroenterology and Hepatology
  • Microbiology
  • Immunology

Background:

  • Biliary atresia (BA) is a severe infant liver disease leading to failure without early intervention.
  • The standard Kasai hepatoportoenterostomy (KPE) surgery has limitations, with many patients experiencing complications.
  • The gut-liver axis and gut microbiota are increasingly recognized as key players in BA's progression.

Purpose of the Study:

  • To review the dual role of gut microbiota in biliary atresia (BA).
  • To summarize microbiome signatures before and after Kasai hepatoportoenterostomy (KPE).
  • To critically evaluate microbiota-based biomarkers and interventions for BA.

Main Methods:

  • Literature review of studies on gut microbiota in biliary atresia.
  • Analysis of evidence regarding the gut-liver axis in BA pathogenesis.
  • Evaluation of current and potential microbiota-based therapies.

Main Results:

  • Gut dysbiosis in BA can impair the intestinal barrier, increase MAMPs translocation, and promote liver injury.
  • Beneficial gut microbes and metabolites may protect the liver by maintaining barrier function and immune homeostasis.
  • Specific microbiome signatures exist in BA, varying before and after KPE.

Conclusions:

  • Gut microbiota significantly influences biliary atresia progression and outcomes.
  • Microbiota-based biomarkers and interventions show promise but require further validation.
  • Standardized prospective studies are essential before clinical implementation.

Keywords:
biliary atresiabiomarkersdysbiosisgastrointestinal microbiomegut–liver axistherapeutics

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