{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T05:00:32Z","timestamp":1783227632410,"version":"3.54.6"},"reference-count":81,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide, distinguished by pronounced clinical heterogeneity and a frequent dissociation between metabolic risk factors and the degree of hepatic injury. These observations, together with the limited contribution of genetic heritability, have prompted a re-evaluation of the traditional conceptual framework of the disease. In this context, the question has emerged as to whether MASLD could be, at least in part, a transmissible condition. While there is no evidence to suggest that MASLD is contagious in humans, as no data support person-to-person transmission, gnotobiotic animal studies demonstrate that human gut microbiota can transfer susceptibility to steatosis, inflammation, and systemic metabolic disturbances through immunometabolic mechanisms, independent of host genetics. In parallel, human studies involving microbiota-targeted interventions support the concept that the gut ecosystem is a modifiable determinant of metabolic and hepatic phenotypes. Crucially, these findings do not imply natural transmission of disease, but rather underscore the functional plasticity of microbiota-host interactions. This narrative review integrates epidemiological, experimental, and clinical data to explore the hypothesis that MASLD may be functionally transmissible. MASLD is increasingly recognized as an eco-biological disease, where liver disease risk is not only shaped by host genetics and environment, but also by the ecological configuration and functional outputs of the gut microbiome. This perspective redefines disease susceptibility as, in part, context-dependent and microbiota-mediated, without implying infectiousness in the traditional sense.<\/jats:p>","DOI":"10.3390\/jcm15041325","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:15:54Z","timestamp":1770624954000},"page":"1325","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["MASLD Under the Umbrella of the Microbiota: A Narrative Review on Ecological Risk and Functional Transmissibility"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8248-0172","authenticated-orcid":false,"given":"Javier","family":"Crespo","sequence":"first","affiliation":[{"name":"School of Medicine, University of Cantabria, 39005 Santander, Spain"},{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9688-9159","authenticated-orcid":false,"given":"Paula","family":"Argos V\u00e9lez","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0934-2202","authenticated-orcid":false,"given":"Marta","family":"Alonso-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"},{"name":"Departament of Anatomy and Cellular Biology, University of Cantabria, 39005 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Cay\u00f3n","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6255-4074","authenticated-orcid":false,"given":"Carolina","family":"Jim\u00e9nez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9476-1801","authenticated-orcid":false,"given":"Paula","family":"Iruzubieta","sequence":"additional","affiliation":[{"name":"Clinical and Translational Research in Digestive Diseases, Gastroenterology and Hepatology Department, Valdecilla Research Institute (IDIVAL), Marqu\u00e9s de Valdecilla University Hospital, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jhep.2018.05.036","article-title":"Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016\u20132030","volume":"69","author":"Estes","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Younossi, Z.M., de Avila, L., Petta, S., Hagstr\u00f6m, H., Kim, S.U., Nakajima, A., Crespo, J., Castera, L., Alkhouri, N., and Zheng, M.H. (2025). Predictors of fibrosis, clinical events and mortality in MASLD: Data from the Global-MASLD study. Hepatology, Epub ahead of print.","DOI":"10.1097\/HEP.0000000000001617"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Younossi, Z.M., Paik, J.M., Lazarus, J.V., Burra, P., Eguchi, Y., Tacke, F., Crespo, J., Villela-Nogueira, C.A., Brennan, P.N., and Al-Omar, H.A. (Clin. Gastroenterol. Hepatol., 2025). Projected Global Clinical, Humanistic, and Economic Impact of Metabolic Dysfunction-Associated Steatohepatitis (MASH): The Cost of Inaction Based on Data From Nine Countries, Clin. Gastroenterol. Hepatol., in press.","DOI":"10.1016\/j.cgh.2025.09.002"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1055\/s-0041-1730927","article-title":"Insights into Nonalcoholic Fatty-Liver Disease Heterogeneity","volume":"41","author":"Arrese","year":"2021","journal-title":"Semin. Liver Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1055\/s-0039-1679920","article-title":"Genetics of Nonalcoholic Fatty Liver Disease: From Pathogenesis to Therapeutics","volume":"39","author":"Sookoian","year":"2019","journal-title":"Semin. Liver Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1002\/hep.32427","article-title":"Metabolic subtypes of patients with NAFLD exhibit distinctive cardiovascular risk profiles","volume":"76","author":"Bruzzone","year":"2022","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e9302","DOI":"10.15252\/emmm.201809302","article-title":"The role of the microbiome in NAFLD and NASH","volume":"11","author":"Kolodziejczyk","year":"2019","journal-title":"EMBO Mol. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abdelhameed, F., Mustafa, A., Kite, C., Lagojda, L., Dallaway, A., Than, N.N., Kassi, E., Kyrou, I., and Randeva, H.S. (2025). Gut Microbiota and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): Emerging Pathogenic Mechanisms and Therapeutic Implications. Livers, 5.","DOI":"10.3390\/livers5010011"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"275","DOI":"10.17235\/reed.2019.6068\/2018","article-title":"An altered fecal microbiota profile in patients with non-alcoholic fatty liver disease (NAFLD) associated with obesity","volume":"111","author":"Nistal","year":"2019","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100322","DOI":"10.1016\/j.jhepr.2021.100322","article-title":"Non-alcoholic fatty liver disease: A patient guideline","volume":"3","author":"Francque","year":"2021","journal-title":"JHEP Rep."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bahitham, W., Banoun, Y., Aljahdali, M., Almuaiqly, G., Bahshwan, S.M., Aljahdali, L., Sanai, F.M., Rosado, A.S., and Sergi, C.M. (2025). \u201cTrust your gut\u201d: Exploring the connection between gut microbiome dysbiosis and the advancement of Metabolic Associated Steatosis Liver Disease (MASLD)\/Metabolic Associated Steatohepatitis (MASH): A systematic review of animal and human studies. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1637071"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lanthier, N., and Delzenne, N. (2022). Targeting the Gut Microbiome to Treat Metabolic Dysfunction-Associated Fatty Liver Disease: Ready for Prime Time?. Cells, 11.","DOI":"10.3390\/cells11172718"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1038\/s41577-019-0198-4","article-title":"The intestinal microbiota fuelling metabolic inflammation","volume":"20","author":"Tilg","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.cmet.2022.03.001","article-title":"Liver microbes controlling immunity: Facts and pitfalls","volume":"34","author":"Tilg","year":"2022","journal-title":"Cell Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/j.cmet.2019.08.018","article-title":"Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae","volume":"30","author":"Yuan","year":"2019","journal-title":"Cell Metab."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Iruzubieta, P., Medina, J.M., Fern\u00e1ndez-L\u00f3pez, R., Crespo, J., and de la Cruz, F. (2020). A Role for Gut Microbiome Fermentative Pathways in Fatty Liver Disease Progression. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051369"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1038\/s41586-025-09263-w","article-title":"Imidazole propionate is a driver and therapeutic target in atherosclerosis","volume":"645","author":"Mastrangelo","year":"2025","journal-title":"Nature"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1136\/gutjnl-2023-330410","article-title":"Interplay between diet, circulating indolepropionate concentrations and cardiometabolic health in US populations","volume":"72","author":"Hu","year":"2023","journal-title":"Gut"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e186423","DOI":"10.1172\/JCI186423","article-title":"Metabolic dysfunction-associated steatotic liver disease and the gut microbiome: Pathogenic insights and therapeutic innovations","volume":"135","author":"Schnabl","year":"2025","journal-title":"J. Clin. Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1111\/liv.14571","article-title":"Bacterial antigen translocation and age as BMI-independent contributing factors on systemic inflammation in NAFLD patients","volume":"40","author":"Zapater","year":"2020","journal-title":"Liver Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4630","DOI":"10.1038\/s41467-022-31973-2","article-title":"Acetate reprograms gut microbiota during alcohol consumption","volume":"13","author":"Martino","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1038\/s41575-020-0269-9","article-title":"Gut microbiota and human NAFLD: Disentangling microbial signatures from metabolic disorders","volume":"17","author":"Vigliotti","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Santos-Laso, A., Guti\u00e9rrez-Larra\u00f1aga, M., Alonso-Pe\u00f1a, M., Medina, J.M., Iruzubieta, P., Arias-Loste, M.T., L\u00f3pez-Hoyos, M., and Crespo, J. (2021). Pathophysiological Mechanisms in Non-Alcoholic Fatty Liver Disease: From Drivers to Targets. Biomedicines, 10.","DOI":"10.3390\/biomedicines10010046"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1038\/s41575-025-01089-1","article-title":"Gut microbiome in metabolic dysfunction-associated steatotic liver disease and associated hepatocellular carcinoma","volume":"22","author":"Lau","year":"2025","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1093\/aje\/kws005","article-title":"Epidemiology and the People\u2019s Health: By Nancy Krieger","volume":"175","author":"Galea","year":"2012","journal-title":"Am. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1158\/1055-9965.EPI-05-0456","article-title":"Complementing the genome with an \u201cexposome\u201d: The outstanding challenge of environmental exposure measurement in molecular epidemiology","volume":"14","author":"Wild","year":"2005","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1038\/nrclinonc.2010.227","article-title":"Predictive, personalized, preventive, participatory (P4) cancer medicine","volume":"8","author":"Hood","year":"2011","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"6068","DOI":"10.1038\/s41467-022-33609-x","article-title":"The intestinal clock drives the microbiome to maintain gastrointestinal homeostasis","volume":"13","author":"Heddes","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Medina-M\u00e9ndez, J.M., Iruzubieta, P., Fern\u00e1ndez-L\u00f3pez, R., Crespo, J., and de la Cruz, F. (2025). Bacterial metabolic signatures in MASLD predicted through gene-centric studies in stool metagenomes. BMC Microbiol., 26.","DOI":"10.1186\/s12866-025-04549-5"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1136\/gutjnl-2012-303816","article-title":"Intestinal microbiota determines development of non-alcoholic fatty liver disease in mice","volume":"62","author":"Llopis","year":"2013","journal-title":"Gut"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1038\/nature10809","article-title":"Inflammasome-mediated dysbiosis regulates progression of NAFLD and obesity","volume":"482","author":"Elinav","year":"2012","journal-title":"Nature"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e151725","DOI":"10.1172\/JCI151725","article-title":"Intrahepatic microbes govern liver immunity by programming NKT cells","volume":"132","author":"Leinwand","year":"2022","journal-title":"J. Clin. Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1241214","DOI":"10.1126\/science.1241214","article-title":"Gut microbiota from twins discordant for obesity modulate metabolism in mice","volume":"341","author":"Ridaura","year":"2013","journal-title":"Science"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1038\/ismej.2012.153","article-title":"An opportunistic pathogen isolated from the gut of an obese human causes obesity in germfree mice","volume":"7","author":"Fei","year":"2013","journal-title":"ISME J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1002\/hep.32705","article-title":"Enhanced mitochondrial activity reshapes a gut microbiota profile that delays NASH progression","volume":"77","author":"Porras","year":"2023","journal-title":"Hepatology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6862","DOI":"10.1038\/s41467-022-34671-1","article-title":"Disulfiram ameliorates nonalcoholic steatohepatitis by modulating the gut microbiota and bile acid metabolism","volume":"13","author":"Lei","year":"2022","journal-title":"Nat. Commun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1038\/s41598-017-01751-y","article-title":"Total fecal microbiota transplantation alleviates high-fat diet-induced steatohepatitis in mice via beneficial regulation of gut microbiota","volume":"7","author":"Zhou","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wang, R., Li, H., Yang, X., Xue, X., Deng, L., Shen, J., Zhang, M., Zhao, L., and Zhang, C. (2018). Genetically Obese Human Gut Microbiota Induces Liver Steatosis in Germ-Free Mice Fed on Normal Diet. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01602"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.jhep.2022.02.028","article-title":"Transcriptional switch of hepatocytes initiates macrophage recruitment and T-cell suppression in endotoxemia","volume":"77","author":"Sun","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1053\/j.gastro.2012.06.031","article-title":"Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome","volume":"143","author":"Vrieze","year":"2012","journal-title":"Gastroenterology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.cmet.2017.09.008","article-title":"Improvement of Insulin Sensitivity after Lean Donor Feces in Metabolic Syndrome Is Driven by Baseline Intestinal Microbiota Composition","volume":"26","author":"Kootte","year":"2017","journal-title":"Cell Metab."},{"key":"ref_43","first-page":"1","article-title":"Fecal microbiota transplantation improves metabolic syndrome parameters: Systematic review with meta-analysis based on randomized clinical trials","volume":"83","author":"Allegretti","year":"2020","journal-title":"Nutr. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1053\/j.gastro.2019.01.033","article-title":"Long-term Outcomes of Fecal Microbiota Transplantation in Patients With Cirrhosis","volume":"156","author":"Bajaj","year":"2019","journal-title":"Gastroenterology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1016\/j.jhep.2022.11.028","article-title":"NAFLD and NASH biomarker qualification in the LITMUS consortium\u2014Lessons learned","volume":"78","author":"Rasmussen","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Yang, W., Jin, Q., Xiao, D., Li, X., and Huang, D. (2025). Interaction mechanism and intervention strategy between metabolic dysfunction-associated steatotic liver disease and intestinal microbiota. Front. Microbiol., 16.","DOI":"10.3389\/fmicb.2025.1597995"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2541035","DOI":"10.1080\/19490976.2025.2541035","article-title":"Consecutive fecal microbiota transplantation for metabolic dysfunction-associated steatotic liver disease: A randomized controlled trial","volume":"17","author":"Groenewegen","year":"2025","journal-title":"Gut Microbes"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Del Barrio, M., Lav\u00edn, L., Santos-Laso, \u00c1., Arias-Loste, M.T., Odriozola, A., Rodriguez-Duque, J.C., Rivas, C., Iruzubieta, P., and Crespo, J. (2023). Faecal Microbiota Transplantation, Paving the Way to Treat Non-Alcoholic Fatty Liver Disease. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24076123"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.cmet.2018.03.001","article-title":"Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1","volume":"27","author":"Drucker","year":"2018","journal-title":"Cell Metab."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Dulai, A.S., Min, M., and Sivamani, R.K. (2024). The Gut Microbiome\u2019s Influence on Incretins and Impact on Blood Glucose Control. Biomedicines, 12.","DOI":"10.3390\/biomedicines12122719"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Jing, M., and Jiang, Y. (2025). Microbiome-mediated crosstalk between T2DM and MASLD: A translational review focused on function. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1677175"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Zhang, W., and Hu, H. (2025). The Emerging Therapeutic Promise of SGLT2 Inhibitors in Metabolic Dysfunction-Associated Steatotic Liver Disease. Dig. Dis. Sci., Epub ahead of print.","DOI":"10.1007\/s10620-025-09464-3"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Suki, M., Imam, A., Amer, J., Milgrom, Y., Massarwa, M., Hazou, W., Tiram, Y., Perzon, O., Sharif, Y., and Sackran, J. (2025). SGLT2 Inhibitors in MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) Associated with Sustained Hepatic Benefits, Besides the Cardiometabolic. Pharmaceuticals, 18.","DOI":"10.3390\/ph18081118"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1001\/jama.2025.19615","article-title":"Metabolic Dysfunction-Associated Steatotic Liver Disease in Adults: A Review","volume":"335","author":"Tilg","year":"2025","journal-title":"JAMA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e00458","DOI":"10.7554\/eLife.00458","article-title":"Cohabiting family members share microbiota with one another and with their dogs","volume":"2","author":"Song","year":"2013","journal-title":"eLife"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1038\/s41598-018-37298-9","article-title":"Close social relationships correlate with human gut microbiota composition","volume":"9","author":"Tang","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1038\/nature25973","article-title":"Environment dominates over host genetics in shaping human gut microbiota","volume":"555","author":"Rothschild","year":"2018","journal-title":"Nature"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1053\/j.gastro.2020.07.005","article-title":"Intestinal Virome Signature Associated With Severity of Nonalcoholic Fatty Liver Disease","volume":"159","author":"Lang","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Odriozola, A., Santos-Laso, A., Del Barrio, M., Cabezas, J., Iruzubieta, P., Arias-Loste, M.T., Rivas, C., Duque, J.C.R., Ant\u00f3n, \u00c1., and F\u00e1brega, E. (2023). Fatty Liver Disease, Metabolism and Alcohol Interplay: A Comprehensive Review. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24097791"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.chom.2018.01.003","article-title":"Strain Tracking Reveals the Determinants of Bacterial Engraftment in the Human Gut Following Fecal Microbiota Transplantation","volume":"23","author":"Smillie","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.chom.2024.01.013","article-title":"Donor-recipient intermicrobial interactions impact transfer of subspecies and fecal microbiota transplantation outcome","volume":"32","author":"Chen","year":"2024","journal-title":"Cell Host Microbe"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"100695","DOI":"10.1016\/j.gastha.2025.100695","article-title":"Fecal Butyrate and Deoxycholic Acid Concentrations Correlate With Mortality in Patients With Liver Disease","volume":"4","author":"Odenwald","year":"2025","journal-title":"Gastro. Hep. Adv."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1126\/science.abo2366","article-title":"Local barriers configure systemic communications between the host and microbiota","volume":"376","author":"Lu","year":"2022","journal-title":"Science"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2451","DOI":"10.1136\/gutjnl-2021-326482","article-title":"Unfavourable intrauterine environment contributes to abnormal gut microbiome and metabolome in twins","volume":"71","author":"Yang","year":"2022","journal-title":"Gut"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1161\/ATVBAHA.124.322346","article-title":"Gut Microbial Metabolite Imidazole Propionate Impairs Endothelial Cell Function and Promotes the Development of Atherosclerosis","volume":"45","author":"Nageswaran","year":"2025","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Xu, Q., Wang, W., Li, Y., and Liu, Y. (2024). Imidazole propionate in type 2 diabetes mellitus and cardiovascular diseases: A mini review. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1454210"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.2337\/dc24-2816","article-title":"Diet, Gut Microbiota, and Histidine Metabolism Toward Imidazole Propionate Production in Relation to Type 2 Diabetes","volume":"48","author":"Yang","year":"2025","journal-title":"Diabetes Care"},{"key":"ref_68","unstructured":"Crespo, J., Iruzubieta, P., Alonso-Pe\u00f1a, M., Jim\u00e9nez-Gonz\u00e1lez, C., Argos V\u00e9lez, P., and Mart\u00ednez-Chantar, M. (2026). The Histidine Crossroad: An Integrative Theory of the Gut\u2013Liver\u2013Vascular Axis in MASLD, Liver Disease Lab, CICbiogune. manuscript in preparation: to be submitted."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1101\/gr.216242.116","article-title":"Microbial strain-level population structure and genetic diversity from metagenomes","volume":"27","author":"Truong","year":"2017","journal-title":"Genome Res."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Anyansi, C., Straub, T.J., Manson, A.L., Earl, A.M., and Abeel, T. (2020). Computational Methods for Strain-Level Microbial Detection in Colony and Metagenome Sequencing Data. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.01925"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"4921","DOI":"10.1016\/j.cell.2022.11.023","article-title":"Mobile genetic elements from the maternal microbiome shape infant gut microbial assembly and metabolism","volume":"185","author":"Vatanen","year":"2022","journal-title":"Cell"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1136\/gutjnl-2022-328970","article-title":"Microbial transmission, colonisation and succession: From pregnancy to infancy","volume":"72","author":"Xiao","year":"2023","journal-title":"Gut"},{"key":"ref_73","first-page":"709","article-title":"The liver as a thermometer of cardiometabolic health: Time to prioritize MASLD in Global Health Policy","volume":"117","author":"Crespo","year":"2025","journal-title":"Rev. Esp. Enferm. Dig."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1053\/j.gastro.2020.10.056","article-title":"Chronic Liver Diseases and the Microbiome-Translating Our Knowledge of Gut Microbiota to Management of Chronic Liver Disease","volume":"160","author":"Acharya","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jceh.2021.08.027","article-title":"Gut Barrier and Microbiota in Cirrhosis","volume":"12","author":"Philips","year":"2022","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1016\/j.jhep.2020.11.013","article-title":"The microbiota in cirrhosis and its role in hepatic decompensation","volume":"75","author":"Trebicka","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1093\/ije\/14.1.32","article-title":"Sick individuals and sick populations","volume":"14","author":"Rose","year":"1985","journal-title":"Int. J. Epidemiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1016\/S2468-1253(25)00226-2","article-title":"Overlooked determinants and unequal outcomes: Rethinking metabolic dysfunction-associated steatotic liver disease beyond the biomedical model","volume":"10","author":"Iruzubieta","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-Gonz\u00e1lez, C., Alonso-Pe\u00f1a, M., Argos V\u00e9lez, P., Crespo, J., and Iruzubieta, P. (2025). Unraveling MASLD: The Role of Gut Microbiota, Dietary Modulation, and AI-Driven Lifestyle Interventions. Nutrients, 17.","DOI":"10.3390\/nu17091580"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2574","DOI":"10.1136\/gutjnl-2021-326575","article-title":"Diet fuelling inflammatory bowel diseases: Preclinical and clinical concepts","volume":"71","author":"Adolph","year":"2022","journal-title":"Gut"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1038\/s41575-023-00869-x","article-title":"Fermented foods and gastrointestinal health: Underlying mechanisms","volume":"21","author":"Mukherjee","year":"2024","journal-title":"Nat. Rev. Gastroenterol. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1325\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T05:20:06Z","timestamp":1770700806000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,7]]},"references-count":81,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041325"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041325","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,7]]}}}