Gut–Liver Axis in Alcoholic Liver Disease
Open accessAbstract
Alcoholic liver disease (ALD) has been among the leading causes of cirrhosis and liver-related death worldwide for decades. Early discoveries in alcoholic liver disease identified increased levels of bacterial endotoxin in the portal circulation, suggesting a role for gut-derived toxins in ALD. Indeed, alcohol consumption can disrupt the intestinal epithelial barrier and result in increased gut permeability that increasingly is recognized as a major factor in ALD. Bacterial endotoxin, lipopolysaccharide, is a prototypic microbe-derived inflammatory signal that contributes to inflammation in ALD through activation of the Toll-like receptor 4. Recent studies also have shown that alcohol consumption is associated with alterations in the gut microbiome, and the dysbalance of pathogenic and commensal organisms in the intestinal microbiome may contribute to the abnormal gut-liver axis in ALD. Indeed, bacterial decontamination improves ALD both in human and animal models. This short review summarizes recent findings and highlights emerging trends in the gut-liver axis relevant to ALD.
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The gut-liver axis contributes importantly to the development of alcohol-associated liver disease.
“the gut-liver axis has been shown to play an important role in the development of ALD.5,6”
From Opposite regulation of intestinal and intrahepatic CD8 <sup>+</sup> T cells controls alcohol-associated liver disease progression (2025) · cites this paper as [6]
Experimental — accuracy not yet measuredThe gut-microbiota-TLR4 axis makes a key contribution to alcoholic liver disease.
“A number of functional studies have shown a key contribution of the gut-microbiota–TLR4 axis to ALD45:”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [45]
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- Authors
- Szabo, G.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2015-01
- Volume
- 148
- Issue
- 1
- Pages
- 30-36
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC4274189
- OpenAlex
- W2034801500
- Cited by
- 754
- References
- 81
- Citations by year
- 2026: 64 · 2025: 67 · 2024: 72 · 2023: 67 · 2022: 89 · 2021: 77 · 2020: 63 · 2019: 59 · 2018: 67 · 2017: 49 · 2016: 51 · 2015: 28
- FWCI
- 6.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (AA021907, AA017729, AA010744)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- alcoholic liver disease, gut-liver axis, bacterial endotoxin, lipopolysaccharide, intestinal permeability, intestinal epithelial barrier, TLR4, gut microbiota, bacterial decontamination, liver cirrhosis, inflammation
- MeSH terms
- Animals, Bacteria, Humans, Intestinal Mucosa, Intestines, Liver, Liver Diseases, Alcoholic, Permeability, Prognosis, Signal Transduction, Microbiota
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