Targeting gut health: Probiotics as promising therapeutics in alcohol-related liver disease management

Abstract

Alcohol consumption represents a major global health issue, accounting for approximately 4.7% of annual deaths and 5.1% of the disease burden worldwide. The liver is particularly vulnerable to alcohol-related damage, with chronic alcohol use leading to a spectrum of alcohol-associated liver diseases, including fatty liver, alcohol-associated hepatitis, cirrhosis, and hepatocellular carcinoma. Despite public awareness of the risks associated with excessive alcohol intake, a substantial proportion of the global population continues to consume alcohol, contributing to the increased incidence of liver-related conditions. Dysbiosis of the gut microbiota has emerged as a critical factor in the pathogenesis of alcohol-associated liver diseases, as alcohol consumption alters microbial composition and increases intestinal permeability, which contributes to systemic inflammation and liver injury through the translocation of endotoxins. Recent research into the therapeutic potential of probiotics, prebiotics, and synbiotics highlights their ability to restore microbial balance and enhance intestinal barrier function. Studies demonstrate that these interventions can significantly improve liver enzymes and reduce inflammation, suggesting their complementary role in the management of alcohol-associated liver diseases. However, further research is necessary to elucidate optimal dosing strategies and long-term efficacy. This review underscores the importance of a multifaceted approach toward understanding alcohol-associated liver diseases and the therapeutic potential of modulating the gut-liver axis through microbiota-targeted strategies.

Keywords: alcohol consumption; beneficial bacteria; dysbiosis; intestinal barrier function; liver inflammation; postbiotics; prebiotics; synbiotics.

Figure 1.. ALD progression and gut microbiota changes. ALD progresses through several stages: from steatosis to fibrosis, cirrhosis, and potentially HCC. Alcohol exposure alters the intestinal microbiota both in quantity and diversity, leading to dysbiosis that persists throughout the disease's progression, regardless of the presence of inflammation. The red arrows illustrate disease progression, while the blue arrows indicate reversibility. Genera marked with an asterisk (*) lack consensus regarding their counts' alteration in the literature. The violet box indicates stages with hepatitis, while the green box indicates those with fibrosis.

Figure 2.. Effects of probiotics in ADL. Ethanol contributes to liver injury through multiple mechanisms, including GM modulation, disruption of the intestinal barrier, and increased levels of pro-inflammatory cytokines. Probiotics have emerged as a therapeutic option to mitigate these detrimental effects, demonstrating efficacy in both clinical studies and experimental models of ALD.