Fecal Microbiota Transplantation Combined with Lifestyle Modification

Introduction

Metabolic dysfunction-associated fatty liver illness (MAFLD) represents probably the most prevalent power liver dysfunction in growing nations. In 2020, the International Expert Consensus Panel proposed the terminology shift from nonalcoholic fatty liver illness (NAFLD) to MAFLD, which has sparked in depth discussions amongst specialists, clinicians, and the scientific group. The pathogenesis of MAFLD stays unclear and includes quite a lot of elements, together with genetics, weight-reduction plan, and surroundings. Patients with MAFLD are at elevated threat of cardiovascular occasions, stroke, power kidney illness, sleep apnea syndrome, and malignancies. The mortality charges associated to most cancers, cardiovascular illnesses, and total mortality are additionally elevated. Compared with NAFLD, the nomenclature of MAFLD highlights the numerous position of metabolic disturbances within the pathogenesis and development of the illness, which is extra consistent with the traits of the situation. In its early levels, the situation presents as hepatic steatosis and will progress to cirrhosis or hepatocellular carcinoma in superior levels. In addition to genetic predisposition, disruptions in lipid and bile acid homeostasis, in addition to carbohydrate metabolism, play a job in its growth. Gut microbiome dysbiosis has been recognized as a major contributor to the pathogenesis of MAFLD.¹ The situation is related to alterations within the composition of intestine microbiota and in microbial metabolites, together with ethanol, choline, bile acids, and short-chain fatty acids.² Both animal experiments and scientific investigations have examined the therapeutic potential of intestine microbiome- focused therapies within the administration of MAFLD. Although there have been scientific and animal experimental research on the remedy of MAFLD based mostly on intestine microbiota modulation, together with probiotics, prebiotics containing dietary fiber, and nonabsorbable oral antibiotics, these research are restricted by means of single strains, inadequate bacterial portions, small pattern sizes, and inconclusive outcomes.

Fecal microbiota transplantation (FMT) is a method that includes the switch of a wholesome particular person’s intestine microbiota into the gastrointestinal tract of a affected person to revive regular intestine microbial operate. Currently, there are few scientific research making use of FMT for the remedy of MAFLD, and its potential on this therapeutic space warrants additional exploration. Lifestyle modification is the cornerstone of MAFLD administration. A substantial variety of sufferers with MAFLD can obtain important enchancment of their situation by means of life-style interventions reminiscent of dietary management, elevated bodily exercise, and enhanced consciousness. However, some sufferers nonetheless have poor outcomes regardless of standard life-style modifications and pharmacological therapies. In these instances, FMT based mostly on intestine microbiota modulation, presents a brand new therapeutic goal for MAFLD. Moreover, steady life-style adjustments are additionally essential to consolidate the therapeutic results of FMT. Therefore, this paper experiences on the therapeutic results of FMT mixed with life-style modification in two sufferers with MAFLD, offering a brand new strategy for the remedy of MAFLD.

Case Data

Case 1

An 18-year-old male, with a 10-year historical past of MAFLD, offered to the gastroenterology outpatient clinic on February 6, 2024. At the time of analysis, anthropometric measurements revealed a peak of 182 cm, weight of 120 kg, and physique mass index (BMI) of 36.2 kg/m². Comprehensive biochemical and imaging assessments had been carried out. Laboratory findings included alanine aminotransferase (ALT) of 34.3 U/L [9–50U/L], aspartate aminotransferase (AST) of 24.1 U/L [15–40U/L], fasting plasma glucose of 6.4 mmol/L [3.9–6.1mmol/L], triglycerides (TG) of three.51 mmol/L [0.4–1.82mmol/L], whole ldl cholesterol (TC) of 6.3 mmol/L [3.1–5.2mmol/L], low-density lipoprotein ldl cholesterol (LDL) of 4.03 mmol/L [2.62–3.41mmol/L], high-density lipoprotein ldl cholesterol (HDL) of 1.10 mmol/L [1.16–1.42 mmol/L], and uric acid (UA) of 616 µmol/L [208–428umol/L]. Abdominal ultrasonography confirmed fatty liver illness. Noninvasive liver fibrosis testing demonstrated a liver stiffness worth of 8.1, similar to a Metavir stage of F2–F3.

Gut microbiome evaluation indicated a intestine microbiome well being index of −0.78, intestinal anti-inflammatory capability of 44, intestinal immunity of 35, intestine microbiome species rely of 962, intestine microbiome range index of seven.26, intestine microbiome colonization resistance (B/E) of 0.15, and a Firmicutes/Bacteroidetes (F/B) ratio of 1.19. Enterotype evaluation categorized the microbiome as kind II with a predominance of Prevotella species. The most plentiful pathogenic micro organism recognized had been Salmonella (1.89), Streptococcus (0.69), Clostridium (0.53), and Mycobacterium (0.2). The main opportunistic pathogens had been Bacteroides (8.04), Escherichia (3.1), Veillonella (0.96), and Enterococcus (0.74). The most plentiful probiotics had been Faecalibacterium (11.12), Bacteroides (8.04), Rothia (4.29), and Blautia (0.98).

Lifestyle interventions had been initiated, consisting of cognitive schooling, dietary planning, and bodily train. The intervention program included the next parts:

(1) Cognitive schooling: The affected person was knowledgeable concerning the dangers related to weight problems and the significance of weight administration, with emphasis on the problems related to MAFLD. Educational periods had been carried out biweekly and included question-and-answer discussions, expertise sharing, and sensible coaching. (2) Dietary planning: A standardized dietary program was designed by a scientific nutritionist. The program centered on caloric restriction, emphasizing the consumption of high-quality proteins, and limiting carbohydrate consumption. Saturated fat and trans fatty acids had been minimized, whereas the consumption of greens and fruits was inspired. Nutrient distribution consisted of > 20% protein, < 40% carbohydrates, and < 30% fats. (3) Physical train: A mix of cardio and resistance coaching was advisable. Moderate depth cardio actions reminiscent of rope skipping, jogging, or swimming had been advisable for 60 minutes per session, which may very well be divided into two 30-minute periods with a 10-minute relaxation interval, to be carried out not less than 3 times per week. Resistance coaching, together with workout routines reminiscent of push-ups, dumbbell exercises, and elastic band coaching, had been advisable in units of eight repetitions not less than 3 times per week.

Following eight weeks of adherence to the approach to life intervention program, together with dietary modifications and common train, the affected person’s weight decreased to 116 kg. However, imaging confirmed the persistence of extreme fatty liver illness. Following a dialogue concerning dangers and advantages, and after acquiring knowledgeable consent, the affected person underwent routine assessments to exclude contraindications for FMT. On April 20, 2024, the affected person acquired 20 oral fecal microbial capsules (Treatgut Biotechnology Co., Ltd). No antagonistic reactions, reminiscent of belly ache, diarrhea, or fever, had been reported following administration. Lifestyle interventions had been continued all through the post-FMT interval.

At six months post-FMT, the affected person’s weight had decreased to 95 kg, with a BMI of 28.7 kg/m². Biochemical and imaging evaluations demonstrated marked enhancements: ALT 16.8 U/L, AST 12.8 U/L, fasting plasma glucose 4.9 mmol/L, TG 1.23 mmol/L, TC 3.7 mmol/L, LDL 3.25 mmol/L, HDL 2.42 mmol/L, and UA 458 μmol/L. Liver stiffness measurement had decreased to six.3 kPa, in line with a Metavir fibrosis stage of F1–F2. Gut microbiome evaluation demonstrated a intestine microbiome well being index of −0.24, intestinal anti-inflammatory capability of 58, intestinal immunity of 62, intestine microbiome species rely of 1027, intestine microbiome range index of 8.21. The B/E ratio had improved to 0.57, and the F/B ratio had elevated to 1.57. The microbiome remained categorized as enterotype II, with a continued predominance of Prevotella species. The most continuously detected pathogenic micro organism had been Salmonella (0.05), Clostridium perfringens (0.34), Shigella (0.21), and Actinomyces (0.15). The main opportunistic pathogens included Bacteroides (8.04), Veillonella (2.52), Klebsiella (1.82), and Enterococcus (0.21). The most prevalent probiotics had been Prevotella (9.25), Phascolarctobacterium (7.52), Lactobacillus (5.82), and Faecalibacterium (2.52).

Case 2

A 38-year-old male with a three-year historical past of MAFLD and a background of recurrent hyperlipidemic pancreatitis for multiple yr, requiring a number of hospitalizations, was evaluated on the gastroenterology division on June 20, 2024. Anthropometric measurements confirmed a peak of 183 cm, weight of 87.2 kg, and BMI of 26 kg/m². A follow-up examination was carried out on the gastroenterology outpatient clinic. Biochemical and ultrasound assessments demonstrated ALT of 30.8 U/L [9–50U/L], AST of 17.9 U/L [15–40U/L], fasting plasma glucose of 4.85 mmol/L [3.9–6.1mmol/L], TG of 8.64 mmol/L [0.4–1.82mmol/L], TC of 5.31 mmol/L [3.1–5.2mmol/L], LDL ldl cholesterol of 5.84 mmol/L [2.62–3.41mmol/L], and HDL ldl cholesterol of two.27 mmol/L [1.16–1.42 mmol/L]. Abdominal ultrasonography confirmed fatty liver and pancreatic fatty infiltration. Liver stiffness measurement was 6.2 kPa, similar to a Metavir fibrosis stage of F1–F2.

Gut microbiome evaluation demonstrated a intestine microbiome well being index of −0.69, intestinal anti-inflammatory capability of 23, intestinal immunity of 52, intestine microbiome species rely of 372, intestine microbiome range index of 1.53, B/E 0.14, and a F/B ratio of 0.08. Enterotype classification recognized the microbiota as kind I, with a predominance of Bacteroides species. The solely pathogenic organism recognized was Streptococcus pneumoniae (0.0025). Dominant opportunistic pathogens included Bacteroides vulgatus (12.37), Sutterella (1.61), Collinsella (1.44), and Streptococcus (0.64). The most plentiful probiotics included Bifidobacterium (2.80), Megamonas (1.36), Lachnospira (0.59), and Faecalibacterium (0.5).

Lifestyle interventions had been initiated, consisting of cognitive schooling, dietary planning, and train. The structured plan included:

(1) Cognitive schooling: The affected person was educated about metabolic syndrome, fatty liver, and fatty pancreas, with emphasis on the dangers of MAFLD and recurrent hyperlipidemic pancreatitis. Educational content material was delivered by means of WeChat, Douyin, and affected person schooling platforms. (2) Dietary planning: For administration of metabolic syndrome and hypertriglyceridemia, a standardized dietary plan was developed by a nutritionist. The plan emphasised high-quality protein sources (reminiscent of soy, milk, fish, and eggs), complicated carbohydrates (reminiscent of buckwheat, millet, and oats), and unsaturated fatty acids (reminiscent of olive oil, rapeseed oil, and walnut oil). Nutrient distribution consisted of > 30% protein, < 40% carbohydrates, and < 20% fats. (3)Physical train: Moderate-intensity cardio train was prescribed, with periods lasting 60 minutes, carried out not less than 3 times weekly.

The affected person had beforehand undergone life-style intervention and remedy with fenofibrate and evolocumab, with restricted effectiveness (Fenofibrate capsules 200 mg, oral administration, as soon as every day, for steady use over 6 months. Lipid management remained suboptimal. Subsequently, evolocumab 140 mg was added, administered through subcutaneous injection, each 2 weeks, for a further 3 months. However, the therapeutic impact was nonetheless unsatisfactory). Following knowledgeable consent and the exclusion of contraindications, the affected person acquired 20 oral fecal microbial capsules (Treatgut Biotechnology Co., Ltd.) on October 10, 2024. The process was effectively tolerated, with no antagonistic reactions, and life-style interventions had been maintained.

At follow-up on March 28, 2025, laboratory investigations revealed enchancment in biochemical markers: ALT was 22.4 U/L, AST 14.7 U/L, fasting plasma glucose 4.3 mmol/L, TG 2.23 mmol/L, TC 3.21 mmol/L, LDL 2.74 mmol/L, and HDL 2.58 mmol/L. Liver stiffness measurement had decreased to 4.7 kPa, in line with a Metavir fibrosis stage of F1–F2. Gut microbiome evaluation demonstrated notable adjustments, together with a intestine microbiome well being index of 0.25, intestinal anti-inflammatory capability of 58, intestinal immunity of 67, intestine microbiome species rely of 667, intestine microbiome range index of 5.87. The B/E ratio had improved to 0.47, and the F/B ratio had elevated to 2.89. Enterotype I used to be retained, with a predominance of Bacteroides. The most continuously recognized pathogenic micro organism had been Salmonella (0.85), Proteus vulgaris (0.68), Campylobacter jejuni (0.55), and Streptococcus cholerae (0.42). The main opportunistic pathogens included Bacteroides vulgatus (3.21), Megamonas (2.52), Lachnospira (1.52), and Coprococcus (1.25). The most prevalent probiotics had been Prevotella (2.75), Rothia (2.52), Bacteroides (2.25), and Lactobacillus (1.57).

The fecal materials was obtained from a single donor as recent yellow, shaped delicate stool weighing 2–20 grams. Fecal microbiota capsules had been ready and saved at –80°C for later use. Neither of the 2 sufferers underwent bowel preparation earlier than FMT, and the transplantation was carried out through oral administration.

This research was carried out with approval from the Ethics Committee of Hebei General Hospital (Approval Number: 2022–203), all members had signed written knowledgeable consent for participation on this research and publication of any case particulars and/or photographs. We report this case report consistent with the CARE tips.

Literature Review

Search Process

To consider the efficacy of FMT within the administration of MAFLD, a scientific search was carried out throughout a number of databases, together with PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP, and Wanfang. The search technique employed combos of the next key phrases: “non-alcoholic fatty liver disease”, “nonalcoholic fatty liver disease”, “nonalcoholic fatty liver”, “fatty liver”, “NAFLD”, “non-alcoholic steatohepatitis”, “nonalcoholic steatohepatitis”, “NASH”, “metabolic dysfunction-associated fatty liver disease”, “MAFLD”, “metabolic dysfunction-associated steatotic liver disease”, and “MASLD”. Terms associated to FMT included: “fecal microbiota transplantation”, “fecal microbiome transplantation”, “fecal microbiota transplant”, “fecal microbiota transfusion”, “fecal microbiota transfer”, “donor feces infusion”, “FMT”, “stool microbiota transplantation”, “stool microbiota transfusion”, “bacteriotherapy”, “fecal therapy”, “fecal bacteriotherapy”, “intestinal microbiota transplantation”, “intestinal microbiota transfer”, “intestinal microbiome transplantation”, “intestinal microbiota transplant”, “intestinal microbiome transplant”, “fecal transplant”, “fecal transfusion”, “fecal implantation”, “fecal implant”, “fecal instillation”, and “fecal reconstitution”.

Eligibility standards had been outlined utilizing the PICOS framework (Population, Intervention, Comparator, Outcomes, Study design). Studies had been included in the event that they met the next standards: (1) randomized managed trial (RCT) design; (2) prognosis of MAFLD confirmed by liver histology or noninvasive imaging modalities (reminiscent of belly ultrasound, CT and MRI); and (3) reporting of not less than two of the next outcomes: serum ranges of TC, TG, ALT, AST, gamma-glutamyl transpeptidase (GGT), LDL ldl cholesterol, HDL ldl cholesterol, homeostasis mannequin evaluation of insulin resistance (HOMA-IR), BMI, or histological adjustments evaluated by liver biopsy, magnetic resonance imaging (MRI), or ultrasound elastography. Histological outcomes included the NAFLD exercise rating (NAS), steatosis, exercise, and fibrosis (SAF) rating, necro-inflammatory rating, fibrosis rating, or steatosis rating. MRI-based outcomes included estimated fibrosis staging, whereas elastography outcomes evaluated parameters reminiscent of fats attenuation and fibrosis stage.

Exclusion standards had been as follows: (1) research involving members underneath 18 years of age; (2) research together with people with extreme comorbidities unrelated to MAFLD, together with however not restricted to extreme coronary heart illness, respiratory failure, liver and kidney failure, malignant tumors, extreme infections, blood system illnesses, autoimmune illnesses, psychological problems, and many others.; (3) sufferers who’re presently taking hormones, antibiotics, gastrointestinal motility medication, conventional Chinese medicines or microecological preparations and (4) research with incomplete knowledge. A complete of 1918 references had been initially retrieved, and following an in depth assessment, seven RCTs met the inclusion standards and had been included within the remaining evaluation.^3–9

Study Characteristics

A complete of seven RCTs had been included within the evaluation, comprising three double-blind trials, one single-blind trial, and three open-label trials, with a mixed whole of 288 members. Six research reported together with each female and male members, whereas one research didn’t present demographic knowledge concerning participant intercourse. Geographically, 4 research had been carried out in China, one in Canada, one within the Netherlands, and one didn’t specify its research location or participant demographics. FMT administration routines diversified throughout research: colonoscopy was utilized in three trials, gastroscopy in two, a mix of gastroscopy and duodenal tube in a single, and a gastric tube in a single. Microbial preparations had been derived from recent feces in two research and frozen feces in a single, whereas 4 research didn’t describe stool traits. The fecal microbiota pattern dimension ranged from 2 to 100 g. Pre-transplantation bowel preparation was reported in three research. Among these, one research employed proton pump inhibitors with flushing, whereas three research didn’t specify whether or not bowel preparation was carried out. Four research reported utilizing a number of donors, three research didn’t specify whether or not donors had been single or a number of, and two research particularly employed associated donors. Donor screening standards had been described in 4 research, though just one offered detailed details about donor profiles (see Table 1).

Table 1 Clinical Parameters and Outcomes of Seven RCTs on FMT in MAFLD

Discussion

Growing evidence indicates that individuals with MAFLD present with gut microbiome dysbiosis. A recent meta-analysis reported reduced α and β diversity in the gut microbiota of individuals with MAFLD, accompanied by decreased levels of anti-inflammatory bacteria such as Ruminococcus and Coprococcus, and increased levels of pro-inflammatory bacteria including Fusobacterium and Escherichia.¹⁰ These alterations are thought to affect the manufacturing of pro-inflammatory bacterial parts and metabolites, thereby contributing to elevated intestinal permeability. Individuals with MAFLD additionally exhibit elevated ranges of endogenous ethanol, circulating endotoxins, and abnormalities in bile acid metabolism. Translocation of those elements through the portal circulation to hepatocytes might promote insulin resistance, hepatic lipid accumulation, irritation, and fibrosis, finally exacerbating liver harm.¹¹ Consequently, therapeutic methods geared toward restoring and supplementing intestine microbial stability might present scientific advantages for people with MAFLD. While numerous interventions, together with probiotics, prebiotics, artificial probiotics, and antibiotics, have been investigated for his or her capability to modulate the intestine microbiota, present proof means that probiotic supplementation alone doesn’t considerably enhance scientific outcomes of MAFLD.¹² This restricted efficacy could also be attributed to constraints in microbial range, low bacterial load, and restricted colonization functionality.

FMT, a novel therapeutic modality, is designed to revive the intestinal microbial ecosystem by means of the switch of an entire microbial group from wholesome donors, has been proposed as a doubtlessly more practical intervention. Clinical investigations have begun to discover its potential position within the administration of MAFLD.

Evaluation of scientific efficacy throughout the included research primarily centered on post-FMT adjustments in biochemical parameters, imaging outcomes, intestinal permeability, and liver histology. Commonly assessed indicators included liver operate assessments, serum lipid profiles, fasting plasma glucose, HOMA-IR, hepatic fats content material (as assessed by imaging), intestinal permeability, and histopathological findings. Among these, 5 research reported liver operate outcomes, with 4 documenting enhancements after transplantation. Blood lipid alterations had been evaluated in 5 research, with three indicating reductions in lipid ranges. Two research assessed fasting plasma glucose and HOMA-IR, with no important adjustments recognized. Imaging-based assessments of hepatic fats content material had been described in two research. In the research by Lanfeng et al, a discount in fats attenuation index (FAI) was noticed amongst people with MAFLD with out weight problems, in comparison with these with weight problems. In distinction, the research carried out by Craven et al didn’t reveal statistically important variations in hepatic proton density and fats fraction. Liver histology was evaluated in just one research, which revealed no important variations in NAS, steatosis grade, or fibrosis rating earlier than and after transplantation. However, necro-inflammatory scores exhibited a development towards enchancment within the allogeneic FMT group.

Two research evaluated adjustments in small intestinal permeability utilizing the urinary lactulose/mannitol ratio. In the research by Craven et al, all seven people within the allogeneic FMT group with baseline permeability abnormalities demonstrated reductions, with normalization noticed in two instances. Within the autologous FMT group, one particular person exhibited decreased permeability, whereas one other demonstrated elevated permeability. In the research by Parvathy, the allogeneic FMT group demonstrated the next price of enchancment in small intestinal permeability in comparison with the autologous group, with all three people demonstrating decreases in gastric permeability. Overall, FMT was related to modest enhancements in biochemical markers, imaging findings, and intestinal permeability relative to pre-treatment values, though these results didn’t attain statistical significance. No substantial adjustments in liver histology had been noticed, indicating a possible unfavorable development. These findings might have been influenced by small pattern sizes and heterogeneity in FMT protocols.

In the current research, two sufferers with MAFLD who demonstrated insufficient responses to standard life-style interventions underwent FMT. These two interventions are complementary. Lifestyle modification serves because the cornerstone of MAFLD remedy. Building on this basis, FMT can improve its therapeutic results and assist preserve the efficacy of FMT. Post-treatment assessments indicated important enhancements in lipid profiles, together with notable reductions in fatty liver severity and liver stiffness. Follow-up microbial evaluation demonstrated elevated intestine microbiome range, enhanced proliferation of probiotics, and improved intestine microbiome colonization resistance. No antagonistic reactions had been noticed, supporting the protection and potential efficacy of FMT within the administration of MAFLD.

This research utilized a personalised oral capsule formulation ready by a microbiota transplantation supplier. This supply methodology streamlined the transplantation course of, improved affected person compliance, and facilitated ongoing monitoring. Nevertheless, capsule-based supply presents sure limitations, together with challenges in dosage management and bacterial pressure specificity. The relative therapeutic efficacy of higher versus decrease gastrointestinal administration routes stays unsure. Although a single FMT administration has been efficient most often of recurrent Clostridium difficile an infection (CDI), rising proof means that its results in power metabolic problems could also be transient.¹³ In this research, a single high-dose FMT was administered, and follow-up over six months demonstrated sustained scientific enchancment; nonetheless, the sturdiness of those results requires additional analysis.

For security concerns, a single donor preparation was chosen. Current donor screening usually emphasizes scientific phenotypes related to helpful microbiomes. Although donor choice doesn’t seem to considerably affect outcomes in recurrent CDI, its position could also be extra important in situations reminiscent of inflammatory bowel illness and metabolic syndrome. In these contexts, donor microbiota enriched with butyrate-producing taxa might present larger advantages.^14,15

Furthermore, a meta-analysis by Levast et al indicated that multi-donor preparations had been related to larger scientific remission charges in people with ulcerative colitis in contrast with single-donor preparations.¹⁶ Multi-donor methods additionally supply benefits in standardization, discount of inter-batch variability, and enhancement of microbial range, benefits that will not persistently achievable with single-donor formulations. However, the applicability of this strategy to MAFLD and its potential impression on antagonistic response charges warrant additional investigation.

Although FMT has produced favorable scientific outcomes in recurrent CDI and sure types of inflammatory bowel illness, its therapeutic worth in metabolic problems, together with MAFLD, stays underneath investigation. Current proof is essentially restricted to case experiences, with greater than ten registered scientific trials underway. Large-scale, standardized scientific research are important to determine the efficacy of FMT on this inhabitants. Additionally, each instances reported on this paper had been male. Therefore, warning ought to be exercised when extrapolating the outcomes to the feminine MAFLD inhabitants. Future research with rigorous designs and the flexibility to conduct gender subgroup analyses are wanted to additional validate the efficacy of FMT.

Conclusion

The scientific and intestine microbiome profiles of two sufferers with MAFLD handled with FMT together with life-style intervention demonstrated important post-treatment enhancements. These included reductions in BMI, transaminase ranges, serum lipid profiles, uric acid concentrations, and liver stiffness measurements. Gut microbiome evaluation additional indicated elevated microbial range, enhanced intestinal anti-inflammatory capability, improved colonization resistance, decreased abundance of pathogenic and opportunistic taxa, and an elevated abundance of probiotic microorganisms. However, these promising findings should be interpreted with warning because of the inherent limitations of a case-report design, together with the small pattern dimension and lack of a management group.

A assessment of related Chinese and worldwide literature signifies that FMT together with life-style modification, is mostly related to enhancements in biochemical parameters, imaging parameters, and intestinal permeability in people with MAFLD. These findings spotlight the therapeutic potential of microbiome-based interventions within the scientific administration of MAFLD. However, additional knowledge from large-scale, randomized managed trials are wanted to substantiate the efficacy, sturdiness, and long-term security of this therapeutic strategy. Future research also needs to concentrate on establishing standardized FMT protocols and evaluating the efficacy of various supply strategies.

Abbreviations

MAFLD, Metabolic related fatty liver illness; NAFLD, Nonalcoholic fatty liver illness; FMT, Fecal microbiota transplantation; FAI, Fat attenuation index; BMI, Body mass index; NAS, NAFLD Activity Score; SAF, Steatosis Activity Fibrosis; CDI, clostridium difficile an infection; ALT, Alanine aminotransferase; AST, Aspartate transaminase; ALP, Alkaline phosphatase; GGT, Gamma-glutamyl transpeptidase; ALB, Albumin; TG, Triglyceride; TC, Total ldl cholesterol; LDL-C, Low-density lipoprotein ldl cholesterol; HDL-C, High-density lipoprotein ldl cholesterol; UA, Uric acid; HOME-IR, Homeostasis mannequin evaluation for insulin resistance; Cr, Creatin; F/B, Firmicutes/Bacteroidetes; B/E, Bacteroidetes/Eukaryotes; FPG, Fasting plasma glucose; FIN, Fasting serum insulin; TNF-α, Tumor necrosis factor-α; PDFF, Proton density fats fraction; SIP, Small intestinal permeability; GP, Gastric permeability.

Data Sharing Statement

The datasets used and/or analyzed throughout the present research can be found from the corresponding writer upon affordable request.

Ethics Approval and Consent to Participate

This research was carried out with approval from the Ethics Committee of Hebei General Hospital (Approval Number: 2022-203). This research was carried out in accordance with the declaration of Helsinki. Written knowledgeable consent was obtained from all members.

Consent for Publication

All members signed a doc of knowledgeable consent for publication of any case particulars and/or photographs.

Author Contributions

Conceptualization: Na Liu, Chun-Lan Lv.

Data curation: Na Liu, Ding-Xin Wang, Jing-Xia Hao.

Formal Analysis: Ding-Xin Wang, Xiao-Feng Yan, Jian-Guo Yan.

Funding acquisition: Na Liu, Chun-Lan Lv, Gai-Fang Liu.

Software: Jing-Xia Hao, Xiao-Feng Yan, Jian-Guo Yan.

Writing – unique draft: Na Liu, Chun-Lan Lv.

Writing – assessment & enhancing: Na Liu, Xiao-Feng Yan, Chun-Lan Lv, Gai-Fang Liu.

All authors took half in drafting, revising or critically reviewing the article; gave remaining approval of the model to be revealed; have agreed on the journal to which the article has been submitted; and comply with be accountable for all elements of the work.

Funding

This research was funded by the Funding Project of Health Commission of Hebei Province (Grant Number: 20230346). The funding physique had no position within the design of the research and assortment, evaluation, and interpretation of knowledge and in writing the paper.

Disclosure

The authors declare that they don’t have any battle of pursuits.

References

1. Portincasa P, Khalil M, Mahdi L, et al. Metabolic dysfunction-associated steatotic liver illness: from pathogenesis to present therapeutic choices. Int J Mol Sci. 2024;25(11):5640. doi:10.3390/ijms25115640

2. Popov J, Despot T, Avelar Rodriguez D, et al. Implications of microbiota and immune system in growth and development of metabolic dysfunction-associated steatotic liver illness. Nutrients. 2024;16(11):1668. doi:10.3390/nu16111668

3. Xue L, Deng Z, Luo W, He X, Chen Y. Effect of fecal microbiota transplantation on non-alcoholic fatty liver illness: a randomized scientific trial. Front Cell Infect Microbiol. 2022;12:759306. doi:10.3389/fcimb.2022.759306

4. Lin X, Qiu ML, Wang WW. Study on the impact of FMT on bettering glucose metabolism in sufferers with non-alcoholic fatty liver illness. Chin Foreign Med Treat. 2022;41(13):1–5,64. doi:10.16662/j.cnki.1674-0742.2022.13.001

5. Witjes JJ, Smits LP, Pekmez CT, et al. Donor fecal microbiota transplantation alters intestine microbiota and metabolites in overweight people with steatohepatitis. Hepatol Commun. 2020;4(11):1578–1590. doi:10.1002/hep4.1601

6. Craven L, Rahman A, Nair Parvathy S, et al. Allogenic fecal microbiota transplantation in sufferers with nonalcoholic fatty liver illness improves irregular small intestinal permeability: a randomized management trial. Am J Gastroenterol. 2020;115(7):1055–1065. doi:10.14309/ajg.0000000000000661

7. Ye Y, Chen YC, Lan QL, Zheng L. The affect of metagenomic sequencing fecal microbiota transplantation on the intestinal flora of sufferers with non-alcoholic fatty liver illness. Chin Pharm Clin. 2019;19(22):3892–3894. doi:10.11655/zgywylc2019.22.023

8. Ye Y, Zheng L, Zheng ED, Xu BB. Study on the adjustments of intestinal flora in non-alcoholic fatty liver illness and the therapeutic impact of fecal microbiota transplantation. Chin J Integr Tradit West Med Digest. 2019;27(10):758–763. doi:10.3969/j.issn.1671-038X.2019.10.09

9. Parvathy S, Meaton M, Medding J, et al. Su1553 – impression of fecal microbial transplantation on intestinal permeability in non alcoholic fatty liver illness. Gastroenterol. 2018;154(6):S–1176–S–1177. doi:10.1016/S0016-5085(18)33894-0

10. Su X, Chen S, Liu J, et al. Composition of intestine microbiota and non-alcoholic fatty liver illness: a scientific assessment and meta-analysis. Obes Rev. 2024;25(1):e13646. doi:10.1111/obr.13646

11. Milosevic I, Vujovic A, Barac A, et al. Gut-liver axis, intestine microbiota, and its modulation within the administration of liver illnesses: a assessment of the literature. Int J Mol Sci. 2019;20(2):395. doi:10.3390/ijms20020395

12. Wu J, Chen X, Qian J, Li G. Clinical enchancment impact of regulating intestine microbiota on metabolic dysfunction-associated steatotic liver illness: systematic assessment and meta-analysis of randomized managed trials. Clin Res Hepatol Gastroenterol. 2024;48(7):102397. doi:10.1016/j.clinre.2024.102397

13. Kootte RS, Levin E, Salojärvi J, et al. Improvement of insulin sensitivity after lean donor feces in metabolic syndrome is pushed by baseline intestinal microbiota composition. Cell Metab. 2017;26(4):611–619.e6. doi:10.1016/j.cmet.2017.09.008

14. Wilson BC, Vatanen T, Cutfield WS, O’Sullivan JM. The super-donor phenomenon in fecal microbiota transplantation. Front Cell Infect Microbiol. 2019;9:2. doi:10.3389/fcimb.2019.00002

15. Huang J, Li M, Zhou WJ, et al. Integrated miRNAand mRNAanalysisidentified potential mechanisms and targets of qianggan extracts in stopping nonalcoholic steatohepatitis. World J Tradit Chin Med. 2022;8(1):77–86. doi:10.4103/wjtcm.wjtcm_48_21

16. Levast B, Fontaine M, Nancey S, Dechelotte P, Doré J, Lehert P. Single-donor and pooling methods for fecal microbiota switch product preparation in ulcerative colitis: a scientific assessment and meta-analysis. Clin Transl Gastroenterol. 2023;14(5):e00568. doi:10.14309/ctg.0000000000000568