{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:09:01Z","timestamp":1785431341785,"version":"3.56.0"},"reference-count":115,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"crossref","award":["2025ZFJH03"],"award-info":[{"award-number":["2025ZFJH03"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100011441","name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases","doi-asserted-by":"crossref","award":["zz202321"],"award-info":[{"award-number":["zz202321"]}],"id":[{"id":"10.13039\/501100011441","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100011441","name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases","doi-asserted-by":"crossref","award":["zz202408"],"award-info":[{"award-number":["zz202408"]}],"id":[{"id":"10.13039\/501100011441","id-type":"DOI","asserted-by":"crossref"}]},{"award":["zz202321"],"award-info":[{"award-number":["zz202321"]}],"id":[{"id":"https:\/\/ror.org\/00325dg83","id-type":"ROR","asserted-by":"publisher"}]},{"award":["zz202408"],"award-info":[{"award-number":["zz202408"]}],"id":[{"id":"https:\/\/ror.org\/00325dg83","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Biliary atresia (BA) is a progressive fibroinflammatory cholangiopathy of infancy that rapidly advances to cholestasis, fibrosis, cirrhosis, and liver failure if bile drainage is not restored early. Although Kasai hepatoportoenterostomy (KPE) remains the standard first\u2013line operation, many children still develop recurrent cholangitis, persistent cholestasis, and progressive native liver injury. Increasing evidence indicates that the gut microbiota participates in this clinical course through the gut\u2013liver axis. In BA, dysbiosis may weaken the intestinal barrier, increase translocation of microbe\u2013associated molecular patterns (MAMPs), amplify innate and adaptive immune activation, disturb bile acid signaling, and promote fibrogenic and ferroptosis\u2013related injury. In contrast, beneficial taxa and their metabolites may preserve epithelial integrity, support immune tolerance, maintain bile acid homeostasis, and constrain oxidative stress. This review summarizes current evidence on these contrasting harmful and protective effects, stage\u2013specific microbiome signatures reported before and after KPE, and critically evaluates the present status of microbiota\u2013based biomarkers and interventions. We emphasize that although several microbial signatures and therapeutic approaches are promising, they are not yet ready for routine clinical implementation and require prospective validation with standardized endpoints.<\/jats:p>","DOI":"10.3390\/microorganisms14051076","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T10:50:52Z","timestamp":1778496652000},"page":"1076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Dual Roles of Gut Microbiota in Biliary Atresia: Mechanisms, Biomarker Potential, and Therapeutic Implications"],"prefix":"10.3390","volume":"14","author":[{"given":"Jianing","family":"Yan","sequence":"first","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Jiang","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yating","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Lv","sequence":"additional","affiliation":[{"name":"Health Promotion Center, Zhejiang Provincial People\u2019s Hospital, People\u2019s Hospital of Hangzhou Medical College, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenrui","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liya","family":"Yang","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianing","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2518-3389","authenticated-orcid":false,"given":"Ding","family":"Shi","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1016\/S0140-6736(09)60946-6","article-title":"Biliary atresia","volume":"374","author":"Hartley","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1038\/s41572-024-00533-x","article-title":"Biliary atresia","volume":"10","author":"Tam","year":"2024","journal-title":"Nat. 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