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Figure 2. Gut-liver axis in MASH. High-fat diets and environmental factors can induce dysregulation of intestinal flora, bacterial metabolites, and bacterial exosomes. Through the gut-liver axis, these changes promote hepatic lipid overload and inflammatory responses, thereby inducing MASH. As MASH progresses, the liver can further exacerbate intestinal flora dysbiosis and impair the intestinal barrier, which in turn aggravates MASH. Created in BioRender. Fu R (2025) https://app.biorender.com/citation/690b2a930ef7786c9a5418b7. MASH: Metabolic dysfunction-associated steatohepatitis; LPS: lipopolysaccharide; SCFAs: short-chain fatty acids; EVs: extracellular vehicles; MAFL: metabolic-associated fatty liver; MASH: metabolic-associated steatohepatitis; TNF: tumor necrosis factor; IL: interleukin.