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To the Editor, We read with great interest the study by Tornai et al. [1] proposing serum villin-1 as a marker of gut barrier damage and predictor of mortality in acute decompensation (AD) and acute-on-chronic liver failure (ACLF). The authors deserve recognition for addressing this unmet clinical need [2].
Gut barriers are comprised of multiple layers, including mucus, the epithelium, a network of mononuclear phagocytes, and cells of the endothelium, which form a gut–vascular barrier (GVB) to the circulatory system. In patients with cirrhosis, gut dysbiosis, increased intestinal permeability (IP), and an impaired immune system lead to a ‘leaky gut’.
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