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Usnea ethanol extract (UEE) is a botanical preparation derived from lichens of the genus *Usnea*, containing a complex mixture of bioactive compounds including usnic acid. It is primarily investigated for its anti-atherosclerotic, anti-inflammatory, and lipid-modulating effects. The extract's mechanism of action involves the modulation of gut microbiota, specifically increasing the *Bacteroidetes* to *Verrucomicrobiota* ratio. This shift leads to a reduction in trimethylamine oxide (TMAO) levels through the downregulation of hepatic flavin monooxygenase 3 (FMO3) and an enhancement of bile acid synthesis via the upregulation of cholesterol 7α-hydroxylase (CYP7A1). Furthermore, UEE improves intestinal barrier integrity by increasing the expression of tight junction proteins such as zonula occludens-1 (ZO-1) and occludin, which reduces the systemic absorption of pro-inflammatory lipopolysaccharides (LPS).
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