Gut microbiota and metabolites in acute lung injury: mechanisms and therapeutic perspectives.

Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), represent a clinical syndrome with high mortality, characterized by excessive pulmonary inflammation and oxidative stress. Despite advancements in conventional supportive care, mortality rates for ALI/ARDS remain persistently high (30%-50%). In recent years, increasing attention has focused on the regulatory mechanisms of the gut microbiota and their metabolites in ALI through the bidirectional ‘gut-lung axis’ interaction. This paper systematically reviews the mechanisms by which gut dysbiosis exacerbates lung inflammation and barrier damage via immune cell migration, inflammatory pathway activation, and metabolite imbalance. It also explores the potential of microbiome-based interventions—including probiotics, fecal microbiota transplantation (FMT), and dietary modification—for ALI treatment. This review not only elucidates the complex link between the gut microbiota and lung disease but also provides a theoretical basis for developing novel diagnostic and therapeutic approaches targeting the gut-lung axis. These insights hold significant implications for improving ALI patient prognosis and advancing precision medicine.