Bile Acid-microbiota Interactions in Acute-on-chronic Liver Failure: Mechanistic Insights and Therapeutic Strategies

Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome characterized by the sudden deterioration of liver function in patients with chronic liver disease, frequently progressing to multi-organ failure. Despite advances in supportive therapies, the underlying pathogenesis remains poorly understood, and effective pharmacological treatments are still lacking. Bile acids (BAs) and the intestinal microbiota interact dynamically, and disruptions in their homeostasis are closely linked to the progression of ACLF. This review summarizes current understanding of bile acid metabolism and gut microbiota dysbiosis in ACLF, explores the reciprocal regulatory mechanisms between them, and discusses emerging therapeutic strategies targeting this axis. The goal is to identify novel approaches that may improve clinical outcomes for patients with ACLF.