Abstract

Liver diseases have become a serious concern in the health care systems worldwide. There is an association between gut permeability and several liver diseases. Zonulin is recognized as a marker of intestinal permeability. Hence, this study summarizes the current knowledge about the role of zonulin as a prognostic biomarker in liver diseases. The present systematic review was performed according to the guidelines of the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements. Until May 2022, PubMed/Medline, Science Direct, Scopus, and Google Scholar as well as Google databases were searched using the relevant keywords including "Zonulin " and "Liver Diseases ", "Fatty Liver ", "Hepatitis ", "Cirrhosis ", "Carcinoma ", "Liver Steatosis ". Of 279 identified records through database searching, 37 articles were included in this systematic review. The evidence of this review revealed that the level of zonulin as the major biomarker of intestinal permeability increased in various types of liver diseases. Overall, we found that increased level of zonulin is associated with inflammatory responses in liver tissue and development of liver diseases. However, further studies could indicate the diagnostic and therapeutic role of zonulin in liver diseases including non-alcoholic fatty liver disease (NAFLD), Hepatitis, cirrhosis and hepatocellular carcinoma (HCC).