Microbial Metabolism Dysfunction and Its Impact on Liver Injury After TACE in Hepatocellular Carcinoma

Introduction

Transarterial chemoembolization (TACE) remains a pivotal treatment modality for patients with unresectable hepatocellular carcinoma (HCC). While effective in tumor management, TACE’s clinical utility is often hampered by its main complication: post-procedural liver injury (TACE-LI). This complication significantly affects long-term outcomes, recurrence rates, and overall survival.

Historically, TACE-induced liver damage was attributed primarily to ischemic necrosis and localized cytotoxic effects. However, recent advances reveal complex underlying mechanisms, including immune responses and, crucially, the role of gut microbiota. This article discusses emerging evidence linking gut microbiota disturbances, specifically the reduction of Limosilactobacillus reuteri (L. reuteri) and its metabolite indole-3-lactic acid (ILA), to the severity of TACE-LI.