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Review
. 2025 Jun;54(2):453-467.
doi: 10.1016/j.gtc.2024.12.001. Epub 2025 Jan 18.

Role of Intestinal Microbiome in Potentiating Inflammation and Predicting Outcomes in Alcohol-Associated Cirrhosis

Sidsel Støy  1 , Bernd Schnabl  2
Affiliations
Review

Role of Intestinal Microbiome in Potentiating Inflammation and Predicting Outcomes in Alcohol-Associated Cirrhosis

Sidsel Støy et al. Gastroenterol Clin North Am. 2025 Jun.

Abstract

In patients with alcohol-associated cirrhosis, the intestinal microbiome composition is disturbed with a loss of beneficial functions and an increase in pathobionts. These changes are associated with disease severity and decompensation, due in part to the exacerbation of liver inflammation by an altered microbiome. Microbes or their antigens may translocate to the liver to potentiate the activation of immune cells and thereby contribute to inflammatory injury. Moreover, microbes may aggravate liver disease through the production of toxins or metabolites, via the effects on bile acids or the intestinal immune system.

Keywords: Alcohol-associated hepatitis; Bacterial translocation; Gut-barrier dysfunction; Intestinal microbiota; Liver inflammation.

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Conflict of interest statement

Disclosure B. Schnabl has been consulting for Ambys Medicines, Ferring Research Institute, Gelesis, HOST Therabiomics, Intercept Pharmaceuticals, Mabwell Therapeutics, Patara Pharmaceuticals, Surrozen, and Takeda. B. Schnabl’s institution UC San Diego has received research support from Axial Biotherapeutics, United States, BiomX, CymaBay Therapeutics, United States, Intercept, United States, NGM Biopharmaceuticals, United States, Prodigy Biotech, and Synlogic Operating Company. B. Schnabl is founder of Nterica Bio.

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