Targeting the gut microbiota: the application and prospects of probiotics, fecal microbiota transplantation, and natural products in MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as the most prevalent chronic liver condition globally. Studies have revealed distinct differences in the gut microbiota (GM) composition between healthy individuals and MASLD patients, suggesting a crucial role of GM in disease initiation and progression. This review summarizes characteristic gut microbial alterations in MASLD, examines the relationship between GM and their metabolites in MASLD pathogenesis, and discusses potential mechanistic pathways. Furthermore, we summarize the possible therapeutic applications of probiotics, fecal microbiota transplantation (FMT), and natural products in managing MASLD through GM modulation. Although current evidence indicates these interventions may slow or prevent MASLD progression, most research remains limited to animal experiments and small-scale clinical studies. The scarcity of high-quality clinical evidence has created a significant gap between theoretical research and clinical application. Therefore, this article aims to summarize existing findings, explore the prospects of GM-targeted strategies for MASLD treatment, and propose future research directions in this field.