Intestinal homeostasis in autoimmune liver diseases

Intestinal homeostasis depends on complex interactions between the gut microbiota and host immune system. Emerging evidence indicates that the intestinal microbiota is a key player in autoimmune liver disease (AILD). Autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and IgG4-related sclerosing cholangitis have been linked to gut dysbiosis. Diverse mechanisms contribute to disturbances in intestinal homeostasis in AILD. Bacterial translocation and molecular mimicry can lead to hepatic inflammation and immune activation. Additionally, the gut and liver are continuously exposed to microbial metabolic products, mediating variable effects on liver immune pathologies. Importantly, microbiota-specific or associated immune responses, either hepatic or systemic, are abnormal in AILD. Comprehensive knowledge about host-microbiota interactions, included but not limited to this review, facilitates novel clinical practice from a microbiome-based perspective. However, many challenges and controversies remain in the microbiota field of AILD, and there is an urgent need for future investigations.

Automated summary

Intestinal homeostasis relies on the interaction between the gut microbiota and the immune system. Evidence suggests that the gut microbiota plays a crucial role in autoimmune liver disease (AILD). Various mechanisms contribute to disruptions in intestinal homeostasis in AILD, including bacterial translocation and molecular mimicry. The gut and liver are exposed to microbial metabolic products, which can have different effects on liver immune pathologies. Abnormal microbiota-specific or associated immune responses are observed in AILD. Understanding the host-microbiota interactions is important for clinical practice in AILD, but challenges and controversies remain in this field.