Potential application of the simulator of the human intestinal microbial ecosystem in metabolic dysfunction-associated steatotic liver disease

INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a growing global health concern, as it has become the most prevalent chronic liver condition worldwide, currently estimated to affect up to 38% of the adult population.EVIDENCE ACQUISITION: MASLD is a complex disease impacting multiple systems, where systemic insulin resistance and related metabolic dysfunction play a pathogenic role in its development and progression of the disease. Despite its prevalence, MASLD is frequently under-recognized due to the lack of reliable non-invasive biomarkers for accurate diagnosis and staging, and effective treatments remain elusive.EVIDENCE SYNTHESIS: Growing evidence suggests that the gut microbiome significantly influences the occurrence and progression of MASLD due to gut dysbiosis. The Simulator of the Human Intestinal Microbial Ecosystem® (SHIME®) is a sophisticated gut models that mimics the entire gastrointestinal tract, incorporating stomach, small intestine, and different colon regions, each characterized by distinct physiology, anatomy, and microbial community.CONCLUSIONS: The SHIME® model emerges as a valuable tool for exploring therapeutic approaches based on gut microbiota management. This gastrointestinal simulator offers a unique platform for studying the complex interactions within the gut-liver axis. The ongoing development of this technology is expected to yield further insights into effective strategies for managing MASLD, improving patient outcomes through targeted microbiota interventions.