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Acute liver failure (ALF) is a severe condition characterized by rapid liver damage and multi-organ failure. Despite treatment, mortality rates remain high, highlighting the need for alternative therapies. The gut-liver axis theory suggests that the gut microbiome plays a crucial role in liver health and disease. Microbial therapeutics, including probiotics, fecal microbiota transplantation (FMT), and precision medicines, have shown promise in managing liver diseases.

This review discusses the potential of microbial therapies in ALF, examining the mechanisms underlying their use in prevention, treatment, and prognosis. Probiotics alter the composition and behavior of gut bacteria, reducing gut dysbiosis and promoting beneficial bacteria. FMT transfers fecal microbiota from a healthy donor to a recipient, restoring the balance of gut microbiota. The link between gut microbiota and liver disease is complex, with gut bacteria producing bioactive compounds, metabolism, and immune responses affecting liver function.

Research highlights the importance of gut microbiota in ALF, with studies showing that changes in gut bacteria and metabolites are associated with liver injury and recovery. Studying the gut-liver axis can provide insights into the pathogenesis of ALF and identify new therapeutic targets. The review concludes that microbial therapies hold promise in managing ALF, and further research is needed to understand their mechanisms and efficacy in this condition.

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