Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2025; 17(8): 108845
Published online Aug 27, 2025. doi: 10.4254/wjh.v17.i8.108845
Duodenal mucosal ablation by irreversible electroporation: Modulating the gut-liver axis in metabolic steatotic liver disease
Mariana M Ramírez-Mejía, Nahum Méndez-Sánchez
Mariana M Ramírez-Mejía, Plan of Combined Studies in Medicine, Faculty of Medicine, National Autonomous University of Mexico, Mexico City 04360, Mexico
Nahum Méndez-Sánchez, Liver Research Unit, Medica Sur Clinic and Foundation, Mexico City 14050, Mexico
Author contributions: Ramírez-Mejía MM was responsible for writing original draft, and visualization; Méndez-Sánchez N was responsible for conceptualization, supervision, writing review and editing; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nahum Méndez-Sánchez, MD, MSc, PhD, AGAF, FAASLD, FACG, Liver Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150, Col. Toriello Guerra, Mexico City 14050, Mexico. nah@unam.mx
Received: April 25, 2025
Revised: May 22, 2025
Accepted: July 25, 2025
Published online: August 27, 2025
Processing time: 125 Days and 7.6 Hours
Abstract

Targeting the gut-liver axis has emerged as a promising strategy in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), a condition that currently represents the most common cause of chronic liver disease worldwide. Within this axis, the duodenum serves not only as a site of nutrient absorption but also as a metabolic sensor capable of influencing systemic and hepatic homeostasis. We have read with great interest the recent study by Yu et al, investigating the effects of duodenal mucosal ablation (DMA) by irreversible electroporation in a rat model of MASLD. The authors reported remarkable reductions in hepatic lipid content, improvements in serum lipid profiles, and both structural and functional changes in the intestinal mucosa, including alterations in enteroendocrine signaling. These results corroborate the pivotal role of the gut-liver axis in the pathogenesis of MASLD and highlight the potential of minimally invasive approaches targeting the proximal intestine. In this letter, we discuss the broader implications of these findings, emphasizing the translational relevance of intestinal modulation strategies in the comprehensive treatment of MASLD.

Keywords: Gut-liver axis; Metabolic dysfunction-associated steatotic liver disease; Duodenal mucosa ablation; Intestinal permeability; Lipids

Core Tip: Duodenal mucosal ablation (DMA) via irreversible electroporation has emerged as a novel strategy to modulate the gut–liver axis in metabolic dysfunction-associated steatotic liver disease (MASLD). In this letter, we analyzed recent preclinical evidence from Yu et al, who reported that DMA leads to reduced hepatic steatosis, improved lipid profiles, and enhanced intestinal barrier integrity. We contextualize these findings within the physiology of the duodenum and explore their translational potential as a minimally invasive therapeutic approach in MASLD.