Clinical Relevance of Bile Acid and Bile Acid-Related Therapy in Liver Cirrhosis: A Review

06/08/2026

AI Summary

Dysregulation of bile acid metabolism is a key driver in liver cirrhosis pathogenesis and progression to hepatic decompensation.
Elevated total bile acid levels correlate with hepatic dysfunction, fibrosis severity and adverse outcomes including hepatocellular carcinoma, acute on chronic liver failure and mortality.
Bile acid related therapies and modulators show promise as therapeutic options for cirrhosis assessment and treatment, warranting further clinical evaluation.

AI Summary

Total bile acid (TBA) levels are often elevated in patients with liver cirrhosis and are associated with hepatic dysfunction, severity of fibrosis, and specific clinical outcomes, including hepatocellular carcinoma, acute-on-chronic liver failure, hepatic encephalopathy, and short-term survival or mortality.

Therefore, bile acid, particularly total bile acid, may serve as potential biomarkers for evaluating the severity, progression, and prognosis of liver cirrhosis.

This paper aims to review the biosynthesis and metabolic mechanisms of bile acid, as well as their characteristic changes in viral, cholestatic, alcoholic, and metabolic dysfunction-associated steatotic liver disease, and discuss the impact of bile acid in the assessment of hepatocellular carcinoma, acute-on-chronic liver failure, and other hepatic decompensation events.

Basic summary

Adv Ther. 2026 Aug 5. doi: 10.1007/s12325-026-03696-z. Online ahead of print.

ABSTRACT

Cirrhosis, the end stage of various chronic liver diseases, is characterized by complex pathophysiologies and poor outcomes. Recently, dysregulation of bile acid metabolism has been increasingly recognized as a key factor in the development and progression of liver cirrhosis and decompensation. Total bile acid (TBA) levels are often elevated in patients with liver cirrhosis and are associated with hepatic dysfunction, severity of fibrosis, and specific clinical outcomes, including hepatocellular carcinoma, acute-on-chronic liver failure, hepatic encephalopathy, and short-term survival or mortality. Therefore, bile acid, particularly total bile acid, may serve as potential biomarkers for evaluating the severity, progression, and prognosis of liver cirrhosis. This paper aims to review the biosynthesis and metabolic mechanisms of bile acid, as well as their characteristic changes in viral, cholestatic, alcoholic, and metabolic dysfunction-associated steatotic liver disease, and discuss the impact of bile acid in the assessment of hepatocellular carcinoma, acute-on-chronic liver failure, and other hepatic decompensation events. Meanwhile, recent advances in bile acid-related therapeutic strategies and their potential application in liver cirrhosis are briefly summarized.Infographic available for this article https://doi.org/10.6084/m9.figshare.32716986 . INFOGRAPHIC.

PMID:42554950 | DOI:10.1007/s12325-026-03696-z

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