Gut microbiota in acute lung injury/acute respiratory distress syndrome: mechanistic insights and therapeutic opportunities via the gut-lung axis.

Acute lung injury (ALI) is a severe clinical syndrome involving inflammatory damage to pulmonary cells, often progressing to acute respiratory distress syndrome (ARDS) with a crude incidence and mortality rate. Despite advances in supportive care, no definitive pharmacological treatment exists. The role of the gut microbiota in immune homeostasis and the gut-lung axis have motivated research into its association with ALI/ARDS. Probiotics, prebiotics, and traditional Chinese herbal medicines have been shown to alleviate ALI/ARDS by modulating gut microbiota. However, the variability among individuals and the complexity of the microbial ecosystem present significant challenges to research and drug development. The integration of multi-omics with artificial intelligence (AI) holds considerable potential for identifying therapeutic targets. This review summarizes the interactions between the gut microbiota and the gut-lung axis in cases of ALI and ARDS. It also discusses the mechanisms through which probiotics, prebiotics, fecal microbiota transplantation (FMT), and traditional Chinese herbal medicines (TCHMs) can intervene, with the aim of developing safer and more effective therapeutic strategies.