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Semin Liver Dis
DOI: 10.1055/a-2601-9480
Review Article

Intestinal Microbes, Metabolites, and Hormones in Alcohol-Associated Liver Disease

Ruimeng Wang
1   Second Clinical Medical College, Anhui Medical University, Hefei, China
2   Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
,
Fang Ma
3   Center for Scientific Research of Anhui Medical University, Anhui Medical University, Hefei, China
,
Dou Yin
2   Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
,
Hua Wang
4   Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
5   Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education, Anhui Medical University, Hefei, China
,
Xiaohui Wei
2   Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
› Author Affiliations
Funding This work was supported by the National Natural Science Foundation of China (82003811), the Natural Science Foundation of the Anhui Higher Education Institutions(2023AH050554), and funds from Anhui Medical University (2019xkj002 and XJ201917).
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Abstract

Alcohol-associated liver disease (ALD)—encompassing conditions including steatosis, fibrosis, cirrhosis, and hepatocellular carcinoma—refers to hepatic damage arising from excessive or hazardous alcohol consumption, and is now recognized as a significant global health burden. Although the mechanisms underlying ALD remain incompletely understood, several pathways have been substantiated over the last five decades, notably the involvement of intestinal microorganisms and the involvement of the gut–liver axis in alcohol metabolism and ALD pathogenesis. Ethanol intake disrupts the intestinal microbial balance and compromises the gut barrier, resulting in increased permeability to microbial products. The subsequent translocation of microbial metabolites and other antigenic substances to the liver activates hepatic immune responses, thereby contributing to liver injury. In addition, gastrointestinal hormones are also implicated in ALD progression through various mechanisms. Although no therapies for ALD have been approved by the Food and Drug Administration, various therapeutic strategies targeting the intestinal microbiota and gut barrier have been identified. In conclusion, this review discusses the role of the gut–liver axis in alcohol metabolism and ALD pathogenesis and explores the emerging therapeutic strategies.

Keywords

alcohol-associated liver disease - bacterial products - gastrointestinal hormones - microbial therapy

Authors' Contributions

R.W. wrote the original draft and prepared pictures. X.W. and H.W. presented the idea and designed the whole outline of this review and revised the final manuscript. F.M. contributed to table preparation. F.M. and D.Y. participated in manuscript editing and data curation. All authors approved the final manuscript.




Publication History

Accepted Manuscript online:
07 May 2025

Article published online:
21 May 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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