[Research progress on the mechanism of hyodeoxycholic acid in the treatment of MASLD through the gut-liver axis].

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a metabolic liver disorder affecting over 30% of the global adult population, with its prevalence and mortality rates continuing to rise. Hyodeoxycholic acid (HDCA), a natural secondary hydrophilic bile acid and the primary active component of traditional Chinese medicine Sus scrofa gallbladder powder, has been demonstrated by multiple studies to ameliorate MASLD and other hepatic metabolic disorders, potentially exhibiting superior efficacy to metformin. This review systematically discusses the multifaceted regulatory mechanisms of HDCA on glucose metabolism, lipid metabolism, and inflammatory responses in the gut-liver axis and peripheral tissues through its interactions with bile acid receptors including farnesoid X receptor (FXR), Takeda G protein-coupled receptor-5 (TGR5), liver X receptor (LXR) and with gut microbiota. The paper aims to provide theoretical foundations and therapeutic targets for the safe treatment of MASLD and metabolic dysfunction-associated steatohepatitis (MASH).