Gut-liver axis and intestinal microbiota: Key targets of herbal medicines in treatment of MASLD/MASH

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) represent globally prevalent chronic hepatic conditions, in which gut dysbiosis acts as a key pathogenic driver through dysregulation of the gut-liver axis. Herbal medicines (HMs) are increasingly recognized as viable therapeutic candidates for MASLD/MASH, primarily through their ameliorative properties on gut-liver axis and pathophysiological pathways of intestinal microbiota. This review summarizes the pathogenesis of MASLD/MASH and the application of HMs in their treatment from the perspective of the gut-liver axis and intestinal microbiota. The progression of MASLD/MASH involves several pathological processes marked by modifications in the gut-liver axis, including compromised gut barrier function and increased intestinal permeability causing endotoxemia and inflammation, along with alterations in microbiota composition and gut microbiota-derived metabolites. This review further delineates the shared mechanisms within each class of compounds in HMs for ameliorating MASLD/MASH, highlights recent advances in the combined use of HMs and probiotics, and discusses the key issues and challenges associated with the clinical translation of HM-based preparations. These insights potentially catalyze the advancement of novel therapeutics targeting MASLD/MASH, while providing a translational framework for clinical application of HMs.