Gut microbiota and systemic sclerosis: Mechanistic insights and microbial therapies

Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive fibrosis in the skin and multiple organs. The cause and mechanism of SSc remain largely elusive, and there are limited therapeutic options available that effectively alter the progression of fibrosis associated with the disease. Emerging evidence indicates that the gut microbiota and its metabolites play a crucial regulatory role in maintaining immune homeostasis and modulating fibrotic responses in SSc. In this review, we provide a comprehensive summary of clinical evidence regarding gut microbiota dysbiosis in SSc, examines the potential mechanisms of gut microbiota involvement in SSc pathogenesis, and discusses recent advancements in diagnostic and therapeutic approaches based on gut microbiota for SSc. Finally, we emphasize the current limitations as well as future research directions. We aim to comprehensively present the current status of research on the relationship between gut microbiota and SSc, thereby offering valuable insights for further exploration of the pathogenesis of the disease and the development of personalized therapeutic strategies based on the gut microbiota and its metabolites.