# Pathogenesis and intervention strategies for metabolic dysfunction–associated fatty liver disease from the perspective of the gut–microbiota–liver axis

**Authors:** Jiabao Liao, Ze Zhou, You Lv, Yiting Zhang, Siyi Liu, Haixia Tang, Fei Qv, Si Wang, Lianhao Yang, Yanming Lu, Zhixia Yang, Xuehua Xie, Mengqiu Shao

PMC · DOI: 10.3389/fimmu.2026.1667180 · Frontiers in Immunology · 2026-02-04

## TL;DR

This review explores how gut and liver communication, mediated by gut microbes, contributes to fatty liver disease and suggests new treatment strategies.

## Contribution

The paper reviews the gut-liver axis's role in MAFLD and proposes novel therapeutic strategies targeting gut microbiota.

## Key findings

- The gut microbiota mediates communication between the gut and liver, influencing MAFLD pathogenesis.
- Changes in gut microbiota and its metabolites during MAFLD affect liver health through the gut-liver axis.
- Probiotic intervention and phage therapy are potential strategies for treating MAFLD by targeting gut microecology.

## Abstract

Trillions of microorganisms in the human gut are important regulators of health, and the gut and liver have a symbiotic relationship with them. The study found that there is bidirectional communication of substances and signals between the gut and liver, and the gut microbiota is an important medium for mediating bidirectional communication in the gut-liver axis. During metabolic dysfunction-associated fatty liver disease (MAFLD) development, the gut microbiota and its metabolites change to different degrees and affect MAFLD pathogenesis through the gut-liver axis. However, the bidirectional communication mechanism between the gut and liver in MAFLD remains unexplored, and further investigation in this domain is warranted. In this review, we summarize the role of the gut-liver axis in the pathogenesis of MAFLD and explore potential therapeutic strategies targeting intestinal microecology (such as probiotic intervention and phage therapy) to provide a theoretical basis for the precise prevention and treatment of MAFLD.

## Full-text entities

- **Genes:** Tjp1 (tight junction protein 1) [NCBI Gene 21872] {aka ZO1}, IRS1 (insulin receptor substrate 1) [NCBI Gene 3667] {aka HIRS-1}, HCAR2 (hydroxycarboxylic acid receptor 2) [NCBI Gene 338442] {aka GPR109A, HCA2, HM74a, HM74b, NIACR1, PUMAG}, SLC10A2 (solute carrier family 10 member 2) [NCBI Gene 6555] {aka ASBT, IBAT, ISBT, NTCP2, PBAM, PBAM1}, Aox1 (aldehyde oxidase 1) [NCBI Gene 11761] {aka Ao, Aox-1, Aox-2, Aox2, Moro, Ro}, TICAM1 (TIR domain containing adaptor molecule 1) [NCBI Gene 148022] {aka IIAE6, MyD88-3, PRVTIRB, TICAM-1, TRIF}, IL18 (interleukin 18) [NCBI Gene 3606] {aka IGIF, IL-18, IL-1g, IL1F4}, MAP1LC3A (microtubule associated protein 1 light chain 3 alpha) [NCBI Gene 84557] {aka ATG8E, LC3, LC3A, MAP1ALC3, MAP1BLC3}, GSDMD (gasdermin D) [NCBI Gene 79792] {aka DF5L, DFNA5L, FKSG10, GSDMDC1}, XPNPEP2 (X-prolyl aminopeptidase 2) [NCBI Gene 7512] {aka AEACEI, APP2}, ABCB11 (ATP binding cassette subfamily B member 11) [NCBI Gene 8647] {aka ABC16, BRIC2, BSEP, PFIC-2, PFIC2, PGY4}, ADIPOQ (adiponectin, C1Q and collagen domain containing) [NCBI Gene 9370] {aka ACDC, ACRP30, ADIPQTL1, ADPN, APM-1, APM1}, CUTC (cutC copper transporter) [NCBI Gene 51076] {aka CGI-32}, CLDN5 (claudin 5) [NCBI Gene 7122] {aka AWAL, BEC1, CPETRL1, TMDVCF, TMVCF}, SIRT1 (sirtuin 1) [NCBI Gene 23411] {aka SIR2, SIR2L1, SIR2alpha}, LBP (lipopolysaccharide binding protein) [NCBI Gene 3929] {aka BPIFD2}, HP (haptoglobin) [NCBI Gene 3240] {aka HP2ALPHA2, HPA1S}, PTPRVP (protein tyrosine phosphatase receptor type V, pseudogene) [NCBI Gene 148713] {aka ESP, OST-PTP, PTPRV}, ARG1 (arginase 1) [NCBI Gene 383], SREBF1 (sterol regulatory element binding transcription factor 1) [NCBI Gene 6720] {aka HMD, IFAP2, SREBP1, bHLHd1}, EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) [NCBI Gene 2146] {aka ENX-1, ENX1, EZH2b, KMT6, KMT6A, WVS}, FOXP3 (forkhead box P3) [NCBI Gene 50943] {aka AIID, DIETER, IPEX, JM2, PIDX, XPID}, IL12B (interleukin 12B) [NCBI Gene 3593] {aka CLMF, CLMF2, IL-12B, IMD28, IMD29, NKSF}, NFKB1 (nuclear factor kappa B subunit 1) [NCBI Gene 4790] {aka CVID12, EBP-1, KBF1, NF-kB, NF-kB1, NF-kappa-B1}, GPT (glutamic--pyruvic transaminase) [NCBI Gene 2875] {aka AAT1, ALT, ALT1, GPT1, SGPT}, INSR (insulin receptor) [NCBI Gene 3643] {aka CD220, HHF5}, NR0B2 (nuclear receptor subfamily 0 group B member 2) [NCBI Gene 8431] {aka SHP, SHP1}, MYLK (myosin light chain kinase) [NCBI Gene 4638] {aka AAT7, KRP, MLCK, MLCK1, MLCK108, MLCK210}, TLR9 (toll like receptor 9) [NCBI Gene 54106] {aka CD289}, INS (insulin) [NCBI Gene 3630] {aka IDDM, IDDM1, IDDM2, ILPR, IRDN, MODY10}, CHUK (component of inhibitor of nuclear factor kappa B kinase complex) [NCBI Gene 1147] {aka BPS2, IKBKA, IKK-1, IKK-alpha, IKK1, IKKA}, MIR1225 (microRNA 1225) [NCBI Gene 100188847] {aka MIRN1225}, GLP1R (glucagon like peptide 1 receptor) [NCBI Gene 2740] {aka GLP-1, GLP-1-R, GLP-1R}, CLDN3 (claudin 3) [NCBI Gene 1365] {aka C7orf1, CPE-R2, CPETR2, HRVP1, RVP1}, CLOCK (clock circadian regulator) [NCBI Gene 9575] {aka KAT13D, bHLHe8}, GCG (glucagon) [NCBI Gene 2641] {aka GLP-1, GLP1, GLP2, GRPP}, IL1B (interleukin 1 beta) [NCBI Gene 3553] {aka IL-1, IL1-BETA, IL1F2, IL1beta}, PEMT (phosphatidylethanolamine N-methyltransferase) [NCBI Gene 10400] {aka PEAMT, PEMPT, PEMT2, PLMT}, FASLG (Fas ligand) [NCBI Gene 356] {aka ALPS1B, APT1LG1, APTL, CD178, CD95-L, CD95L}, CPT1A (carnitine palmitoyltransferase 1A) [NCBI Gene 1374] {aka CPT I, CPT1, CPT1-L, CPTI-L, L-CPT1}, TLR4 (toll like receptor 4) [NCBI Gene 7099] {aka ARMD10, CD284, TLR-4, TOLL}, AKT1 (AKT serine/threonine kinase 1) [NCBI Gene 207] {aka AKT, PKB, PKB-ALPHA, PRKBA, RAC, RAC-ALPHA}, IL22 (interleukin 22) [NCBI Gene 50616] {aka IL-21, IL-22, IL-D110, IL-TIF, ILTIF, TIFIL-23}, ADH1A (alcohol dehydrogenase 1A (class I), alpha polypeptide) [NCBI Gene 124] {aka ADH1}, JUN (Jun proto-oncogene, AP-1 transcription factor subunit) [NCBI Gene 3725] {aka AP-1, AP1, c-Jun, cJUN, p39}, RETN (resistin) [NCBI Gene 56729] {aka ADSF, FIZZ3, RENT, RETN1, RSTN, XCP1}, NR1I2 (nuclear receptor subfamily 1 group I member 2) [NCBI Gene 8856] {aka BXR, ONR1, PAR, PAR1, PAR2, PARq}, CYP7B1 (cytochrome P450 family 7 subfamily B member 1) [NCBI Gene 9420] {aka CBAS3, CP7B, SPG5A}, STAT3 (signal transducer and activator of transcription 3) [NCBI Gene 6774] {aka ADMIO, ADMIO1, APRF, HIES}, TLR2 (toll like receptor 2) [NCBI Gene 7097] {aka CD282, TIL4}, MUC2 (mucin 2, oligomeric mucus/gel-forming) [NCBI Gene 4583] {aka MLP, MUC-2, SMUC}, SLC5A8 (solute carrier family 5 member 8) [NCBI Gene 160728] {aka AIT, SMCT, SMCT1}, PNPLA3 (patatin like domain 3, 1-acylglycerol-3-phosphate O-acyltransferase) [NCBI Gene 80339] {aka ADPN, C22orf20, iPLA(2)epsilon}, AGRP (agouti related neuropeptide) [NCBI Gene 181] {aka AGRT, ART, ASIP2}, CYP7A1 (cytochrome P450 family 7 subfamily A member 1) [NCBI Gene 1581] {aka CP7A, CYP7, CYPVII}, AKR1A1 (aldo-keto reductase family 1 member A1) [NCBI Gene 10327] {aka ALDR1, ALR, ARM, DD3, HEL-S-6}, OCLN (occludin) [NCBI Gene 100506658] {aka BLCPMG, PPP1R115, PTORCH1}, Pparg (peroxisome proliferator activated receptor gamma) [NCBI Gene 19016] {aka Nr1c3, PPAR-gamma, PPAR-gamma2, PPARgamma, PPARgamma2}, IL10 (interleukin 10) [NCBI Gene 3586] {aka CSIF, GVHDS, IL-10, IL10A, TGIF}, TNF (tumor necrosis factor) [NCBI Gene 7124] {aka DIF, IMD127, TNF-alpha, TNFA, TNFSF2, TNLG1F}
- **Diseases:** Metabolic (MESH:D008659), MCD (MESH:D002796), microbiota disorder (MESH:D009358), hepatocyte damage (MESH:D020263), obese (MESH:D009765), weight gain (MESH:D015430), very low-density lipoprotein (VLDL) secretion disorders (MESH:D001851), MAFLD (MESH:D005234), diarrhea (MESH:D003967), cancers (MESH:D009369), Dysbiosis (MESH:D064806), acute pancreatitis (MESH:D010195), liver fibrosis (MESH:D008103), gut barrier dysfunction (MESH:C536830), hepatic metabolic (MESH:D024821), cirrhosis (MESH:D005355), hepatic inflammatory (MESH:D007249), fatty degeneration (MESH:D008067), liver disease (MESH:D008107), disease (MESH:D004194), injury (MESH:D014947), intestinal diseases (MESH:D007410), hepatic lipid (MESH:D011017), inflammatory storm (MESH:C566109), impaired glucose tolerance (MESH:D018149), hepatocellular (MESH:D006528), immune dysregulation (OMIM:614878), abdominal distension (MESH:D000007), ALD (MESH:D008108), hepatic fat accumulation (MESH:D005218), T2DM (MESH:D003924), cytokines (MESH:D000080424), Gut-liver axis disorders (MESH:D017093), hepatocellular injury (MESH:D056486), immune (MESH:D007154), cholestasis (MESH:D002779), cardiovascular diseases (MESH:D002318), Insulin resistance (MESH:D007333), TMAO (MESH:C536108), acute liver injury (MESH:D017114), toxicity (MESH:D064420), end-stage liver disease (MESH:D058625), Endotoxemia (MESH:D019446), gut microbiota disorder (MESH:C536735), lipid metabolism disorders (MESH:D052439)
- **Chemicals:** inulin (MESH:D007444), acetic acid (MESH:D019342), glycolipid (MESH:D006017), TMA (MESH:C023336), OCA (MESH:C034482), blood glucose (MESH:D001786), glycine (MESH:D005998), cholesterol (MESH:D002784), Ethanol (MESH:D000431), NAM (MESH:D009536), luminal (MESH:D010634), Metformin (MESH:D008687), malonyl-CoA (MESH:D008316), glycogen (MESH:D006003), acetyl coenzyme A (MESH:D000105), vancomycin (MESH:D014640), Choline (MESH:D002794), pentose phosphate (MESH:D010428), cholic acid (MESH:D019826), lipoteichoic acid (MESH:C009900), fructooligosaccharide (MESH:C116580), carbon tetrachloride (MESH:D002251), TG (MESH:D014280), deoxycholic acid (MESH:D003840), Glycerophosphocholine (MESH:D005997), succinate (MESH:D019802), methionine (MESH:D008715), fat (MESH:D005223), oxygen (MESH:D010100), AMPs (MESH:D000089882), TMAO (MESH:C005855), acetaldehyde (MESH:D000079), Tryptophan (MESH:D014364), NAD + (MESH:D009243), acetate (MESH:D000085), ROS (MESH:D017382), CA (MESH:D002118), SCFA (MESH:D005232), glucose (MESH:D005947), Butyric acid (MESH:D020148), UDCA (MESH:D014580), taurine (MESH:D013654), ODN (MESH:D009838), obeticholic acid (MESH:C464660), purine (MESH:C030985), TAK-242 (MESH:C507035), lipid (MESH:D008055), LPS (MESH:D008070), Triclosan (MESH:D014260), Dexamethasone (MESH:D003907), Butyrate (MESH:D002087), fatty acid (MESH:D005227), Nicotine (MESH:D009538), PC (MESH:D010713), lithocholic acid (MESH:D008095), propionate (MESH:D011422), CDCA (MESH:D002635), BA (MESH:D001647), BB536 (-), hydroxyproline (MESH:D006909)
- **Species:** Agathobacter rectalis (species) [taxon 39491], Bacteroides thetaiotaomicron (species) [taxon 818], Prevotella bivia (species) [taxon 28125], Lactobacillus acidophilus (species) [taxon 1579], Nicotiana tabacum (American tobacco, species) [taxon 4097], Veillonella (genus) [taxon 29465], Enterococcus faecalis (species) [taxon 1351], Pseudomonadota (proteobacteria, phylum) [taxon 1224], Mus musculus (house mouse, species) [taxon 10090], Klebsiella pneumoniae (species) [taxon 573], Bifidobacterium longum (species) [taxon 216816], Salmonella (genus) [taxon 590], Escherichia coli (E. coli, species) [taxon 562], Enterococcus faecium (species) [taxon 1352], Bacillota (clostridial firmicutes, phylum) [taxon 1239], Enterobacteriaceae (enterobacteria, family) [taxon 543], Propionibacterium (genus) [taxon 1743], Escherichia coli Nissle 1917 (strain) [taxon 316435], Bacteria Latreille et al. 1825 (Bacteria stick insect, genus) [taxon 629395], Rattus norvegicus (brown rat, species) [taxon 10116], Homo sapiens (human, species) [taxon 9606], Faecalibacterium prausnitzii (species) [taxon 853], Clostridioides difficile (species) [taxon 1496], Ruminococcus sp. (species) [taxon 41978], Streptococcus (genus) [taxon 1301], Akkermansia muciniphila (species) [taxon 239935], Erysipelothrix (genus) [taxon 1647]
- **Mutations:** rs738409, rs58542926

## Full text

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## Figures

6 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12913104/full.md

## References

269 references — full list in the complete paper: https://tomesphere.com/paper/PMC12913104/full.md

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Source: https://tomesphere.com/paper/PMC12913104