Abstract
Globally, liver disease caused by alcohol is becoming more prevalent each year. Misuse
of alcohol causes a spectrum of liver diseases, such as liver steatosis, steatohepatitis,
fibrosis, cirrhosis, and hepatocellular carcinoma. The cornerstone of treatment is
abstinence from alcohol. In spite of this, available treatment for alcohol-associated
liver disease (ALD) shows limited effectiveness currently. There are numerous ways
in which alcohol disrupts the gut–liver axis, including dysbiosis of the gut microbiome,
disruption of mucus and epithelial cell barriers, impaired production of antimicrobial
molecules, and dysfunction of the immune system, causing translocation of viable microbes
and microbial products to the liver and systemic circulation. Microbial exposure results
in not only inflammation and progression of liver disease but also infections in late-stage
ALD. This led scientists to focus their therapeutic strategies and targets for ALD
on the gut microbiome. Throughout this review, we address the role of gut microbiome–centered
therapeutic approaches for ALD focusing predominantly on randomized controlled trials.
We will summarize the latest clinical trials using probiotics, antibiotics, and fecal
microbial transplants in modulating the gut–liver axis and for improvement of ALD.
Keywords
alcoholic liver disease - liver steatosis - hepatocellular carcinoma - microbiota
