Microscopic hosts, huge impact: How close are we to applying the human microbiome to the diagnosis and prognosis of MASLD and diabetes?

Abstract

Evidence accumulated in recent years has revealed a close relationship between an unfavorable imbalance within the gut microbiome (dysbiosis) and the development of metabolic diseases such as metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus.

Several studies have demonstrated that changes in the composition and function of the microbiome contribute to insulin resistance, systemic inflammation, and liver fat accumulation by producing metabolites, short-chain fatty acids, and other bioactive compounds. This evidence has fueled interest in using the microbiome as a tool for the early diagnosis, risk stratification, prognosis, and treatment of these diseases¹.

However, although the results are promising, the clinical application of the microbiome still faces significant challenges. The high variability among individuals and the influence of factors such as diet, antibiotic use, lifestyle, and environment make it difficult to identify universal and reproducible biomarkers. Standardization of sampling, sequencing, and data analysis techniques are still needed to ensure consistent results. Furthermore, a rigorous process is required to convert a newly discovered microbial signature into an analytically valid and useful test for clinical practice in MASLD, which delays its incorporation into patient management².

Currently, the microbiome represents one of the most innovative areas of precision medicine. Its integration with genetic, clinical, and metabolomic information could significantly improve the detection, monitoring, and treatment of MASLD and diabetes¹.

This dissertation presents an overview of the current state of this field and a roadmap for improving research on microbiome-derived biomarkers for MASLD², as well as novel therapeutic strategies aimed at safely and effectively modulating the microbiome³.