Current progress on the microbial therapies for acute liver failure

Abstract

Acute liver failure (ALF), associated with a clinical fatality rate exceeding 80%, is characterized by severe liver damage resulting from various factors in the absence of pre-existing liver disease. The role of microbiota in the progression of diverse liver diseases, including ALF, has been increasingly recognized, with the interactions between the microbiota and the host significantly influencing both disease onset and progression. Despite growing interest in the microbiological aspects of ALF, comprehensive reviews remain limited. This review critically examines the mechanisms and efficacy of microbiota-based treatments for ALF, focusing on their role in prevention, treatment, and prognosis over the past decade.

Keywords: acute liver failure; acute liver injury; fecal microbiota transplantation; gut-liver-axis; microbiota; probiotics; type A hepatic encephalopathy.

Figure 1

Hepatoprotective mechanisms of microbiota in acute liver illness. ① Microorganisms play a role in regulating liver function and contributing to the immune response in the liver by repairing the intestinal barrier and producing bioactive metabolites. ② Microorganisms cause the death of liver cells through a process mediated by TLR. ③ Microorganisms regulate the metabolism of tryptophan, which helps to adjust the damage to liver cells. ④ Enhancement of the bacterial community in the intestines. ⑤ Microorganisms release beneficial molecules, metabolize toxins, and reduce the inflammatory response and oxidative stress—created with BioRender.com.