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Lu et al. Microbiome Res Rep 2024;3:17 Microbiome Research
DOI: 10.20517/mrr.2023.44
Reports

Review Open Access

Microbiota-gut-liver-brain axis and hepatic
encephalopathy

Haifeng Lu, Hua Zhang, Zhongwen Wu, Lanjuan Li

State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious
Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of
Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang, China.

Correspondence to: Prof. Lanjuan Li, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road,
Hangzhou 310003, Zhejiang, China. E-mail: ljli@zju.edu.cn

How to cite this article: Lu H, Zhang H, Wu Z, Li L. Microbiota-gut-liver-brain axis and hepatic encephalopathy. Microbiome Res
Rep 2024;3:17. https://dx.doi.org/10.20517/mrr.2023.44

Received: 20 Jul 2023 First Decision: 23 Sep 2023 Revised: 16 Jan 2024 Accepted: 19 Jan 2024 Published: 25 Jan 2024
Academic Editors: Marco Ventura, Chao Zhao Copy Editor: Dong-Li Li Production Editor: Dong-Li Li

Abstract
Hepatic encephalopathy (HE) is a clinical manifestation of neurological and psychiatric abnormalities that are
caused by complications of liver dysfunction including hyperammonemia, hyperuricemia, and portal hypertension.
Accumulating evidence suggests that HE could be reversed through therapeutic modifications of gut microbiota.
Multiple preclinical and clinical studies have indicated that gut microbiome affects the physiological function of the
liver, such as the regulation of metabolism, secretion, and immunity, through the gut-liver crosstalk. In addition, gut
microbiota also influences the brain through the gut-brain crosstalk, altering its physiological functions including
the regulation of the immune, neuroendocrine, and vagal pathways. Thus, key molecules that are involved in the
microbiota-gut-liver-brain axis might be able to serve as clinical biomarkers for early diagnosis of HE, and could be
effective therapeutic targets for clinical interventions. In this review, we summarize the pathophysiology of HE and
further propose approaches modulating the microbiota-gut-liver-brain axis in order to provide a comprehensive
understanding of the prevention and potential clinical treatment for HE with a microbiota-targeted therapy.

Keywords: Hepatic encephalopathy, hyperammonemia, gut microbiota-liver-brain axis, microbiome-targeted
therapy

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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