Tang TC, Ming RX, Liu YM, Li B. Letter to the Editor: Lianhe Xiaozhi ointment for metabolic dysfunction-associated steatotic liver disease - a gut-liver-brain axis perspective. World J Gastroenterol 2026; 32(32): 118636 [DOI: 10.3748/wjg.118636]
Corresponding Author of This Article
Bin Li, PhD, Assistant Professor, Institute of Comparative Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, No. 88 Daxue South Road, Yangzhou 225009, Jiangsu Province, China. 008480@yzu.edu.cn
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Cell Biology
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letter
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Tang TC, Ming RX, Liu YM, Li B. Letter to the Editor: Lianhe Xiaozhi ointment for metabolic dysfunction-associated steatotic liver disease - a gut-liver-brain axis perspective. World J Gastroenterol 2026; 32(32): 118636 [DOI: 10.3748/wjg.118636]
World J Gastroenterol. Aug 28, 2026; 32(32): 118636 Published online Aug 28, 2026. doi: 10.3748/wjg.118636
Letter to the Editor: Lianhe Xiaozhi ointment for metabolic dysfunction-associated steatotic liver disease - a gut-liver-brain axis perspective
Tian-Ci Tang, Rui-Xi Ming, Yu-Meng Liu, Bin Li
Tian-Ci Tang, Rui-Xi Ming, Yu-Meng Liu, Bin Li, Institute of Comparative Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou 225009, Jiangsu Province, China
Tian-Ci Tang, Institute for Clinical and Experimental Surgery, Saarland University, Homburg 66424, Saarland, Germany
Bin Li, Department of Molecular Physiology, Center for Integrative Physiology and Molecular Medicine, University of Saarland, Homburg 66424, Saarland, Germany
Author contributions: Tang TC, and Li B contributed to the manuscript writing and conceptualization; Li B contributed to project administration; Li B, Tang TC, Ming RX, and Liu YM contributed to the manuscript reviewing, and editing and they participated in the formal analysis; all authors participated in manuscript discussions.
Supported by National Natural Science Foundation of China, No. 82504755; Natural Science Foundation of Jiangsu Province, No. BK20240907; the “Lv Yang Jin Feng” Outstanding Doctor of Yangzhou; and the Top-level Talents Support Program of Yangzhou University.
Conflict-of-interest statement: Authors report no relevant conflicts of interest for this article.
Corresponding author: Bin Li, PhD, Assistant Professor, Institute of Comparative Medicine, Jiangsu Co-innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, No. 88 Daxue South Road, Yangzhou 225009, Jiangsu Province, China. 008480@yzu.edu.cn
Received: January 7, 2026 Revised: February 14, 2026 Accepted: February 28, 2026 Published online: August 28, 2026 Processing time: 207 Days and 0.3 Hours
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is a growing global health burden with limited approved therapies. In a recent article published in the World Journal of Gastroenterology, Nie et al reported that Lianhe Xiaozhi ointment (LXO)—a patented traditional Chinese medicine (TCM) formulation derived from Huanglian Wendan decoction—markedly ameliorates MASLD in high-fat diet models through activation of the peroxisome proliferator-activated receptor alpha (PPARα) pathway. This letter commends the comprehensive multi-omics and in vivo approach of Nie et al, emphasizes its concordance with prior findings on PPARα’s central role in hepatic lipid metabolism, and discusses how LXO’s gut microbiota-PPARα-inflammation axis introduces a novel therapeutic dimension for MASLD. We provide a comparative analysis of LXO’s effects vs established MASLD interventions, noting concordant improvements in weight gain, metabolic indices, liver injury, and inflammation. We also offer a constructive critique of the study’s limitations, including the need for causal validation (e.g., Ppara knockout models) and translational investigation (bioactive compound pharmacokinetics and human trials). Finally, we expand on mechanistic hypotheses suggested by the authors, proposing exploration of the gut-liver-brain axis and associated neuroimmune outcomes in MASLD and outlining future research directions such as PPARα-targeted validation, serum pharmacochemistry, and neuroinflammatory profiling. This commentary affirms the hypothesis-defining and field-advancing significance of Nie et al’s work, demonstrating how integrating TCM insights with cutting-edge mechanistic studies can drive innovative MASLD therapies.
Core Tip: Lianhe Xiaozhi ointment (LXO), a multi-herb formulation, profoundly improved experimental metabolic dysfunction-associated steatotic liver disease (MASLD) through a unique mechanism linking gut microbiota modulation to peroxisome proliferator-activated receptor alpha (PPARα) activation in the liver. This letter commends the study’s comprehensive strategy (network pharmacology, omics, in vivo or in vitro validation) and positions the findings in the context of emerging MASLD therapies. By comparing LXO’s outcomes to prior interventions and proposing next-step studies (e.g., Ppara knockout validation, metabolite profiling, brain inflammation assays), we underscore LXO as a concept-proof therapy that opens new avenues via the gut-PPARα-liver axis for metabolic liver disease.
