The gut-liver/bile axis: Gut microbiota and bacterial extracellular vesicles remodeling hepatobiliary pathogenesis

Global hepatobiliary disease burden is increasing, prompting gut-liver axis research. Gut microbiota-secreted bacterial extracellular vesicles (BEVs) carry bioactive molecules affecting host immunity, inflammation, and metabolism. Whether BEVs actively or passively cause liver damage is unclear. This review suggests gut-derived BEVs trigger hepatic innate immunity and sterile inflammation. By combining current findings on how gut microbes, their BEVs, and hepatobiliary diseases interact, we improve the "gut-liver/bile axis" idea. Acknowledging BEVs' active part in disease offers new ways to use them as diagnostic markers and treatment targets, likely better managing hepatobiliary disorders.