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Review of bile acid homeostasis regulation in liver disease and cancer

Review of bile acid homeostasis regulation in liver disease and cancer
Photo by Aakash Dhage / Unsplash
Key Takeaway
Note that this review lacks reported outcomes and safety data for bile acid regulation in liver disease.

This publication is a narrative review rather than a systematic review or meta-analysis. Its scope encompasses the regulation of bile acids homeostasis within a broad range of liver diseases, specifically cholestasis, hepatic fibrosis, cirrhosis, hepatocellular carcinoma, MASLD, and MASH. The text does not provide a defined study population, sample size, or specific intervention details, as these fields are not reported in the source material.

The authors discuss the physiological context of bile acid regulation as it pertains to these conditions. No pooled effect sizes, p-values, or confidence intervals are presented because this is not a quantitative synthesis of primary trials. The review focuses on the conceptual framework of bile acid management in liver pathology rather than reporting specific clinical trial results.

Significant limitations are inherent to the lack of reported data. The source does not detail primary or secondary outcomes, follow-up periods, or specific adverse events. Consequently, the practice relevance and certainty of any conclusions regarding clinical management are not explicitly defined by the authors in this text. Readers should interpret this review as a qualitative overview of a biological mechanism rather than a guide for specific therapeutic decisions.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Homeostatic imbalance of bile acids (BAs) is closely associated with the onset and progression of several liver diseases, including cholestasis, hepatic fibrosis, cirrhosis, hepatocellular carcinoma, and MASLD/MASH. In cholestasis, BAs imbalance induces cellular endoplasmic reticulum stress and mitochondrial dysfunction, which subsequently lead to hepatocellular and cholangiocellular death, exacerbating liver injury. Bile acid imbalance also activates hepatic stellate cells, promoting fibrosis and cirrhosis. During hepatocellular carcinoma development and progression, BAs imbalance favors the survival and proliferation of cancerous hepatocytes. Similarly, in MASLD/MASH, homeostatic BAs imbalance correlates significantly with disease severity. Additionally, BAs, through crosstalk with gut microbes, plays a key role in the development and progression of various liver diseases. This review focuses on each liver disease, summarizing the unique changes in BAs species and their distinct mechanisms of action, while exploring the complex role of BAs throughout the course of liver disease and their potential as diagnostic markers. Importantly, it highlights the therapeutic significance of regulating BA homeostasis in treating liver diseases.
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