期刊
FRONTIERS IN IMMUNOLOGY
卷 10, 期 -, 页码 -出版社
FRONTIERS MEDIA SA
DOI: 10.3389/fimmu.2019.00973
关键词
ACFL; systemic inflammation; cirrhosis-associated immune dysfunction; immune paralysis; liver; cirrhosis
类别
资金
- Ministerio de Sanidad, Consumo y Bienestar Social, Instituto de Salud Carlos III (CIBERehd) [PI051871]
- Ministerio de Ciencia e Innovacion [SAF 2017-86343-R]
- Instituto de Salud Carlos III
- European Development Regional Fund A way to achieve Europe (ERDF)
Acute-on-chronic liver failure (ACLF) is characterized by the acute decompensation of cirrhosis associated with organ failure and high short-term mortality. The key event in the pathogenesis is a dysfunctional immune response arising from exacerbation of the two main immunological alterations already present in cirrhosis: systemic inflammation and immune cell paralysis. High-grade systemic inflammation due to predominant activation and dysregulation of the innate immune response leads to the massive release of cytokines. Recognition of acutely increased pathogen and damage-associated molecular patterns by specific receptors underlies its pathogenesis and contributes to tissue damage and organ failure. In addition, an inappropriate compensatory anti-inflammatory response over the course of ACLF, along with the exhaustion and dysfunction of both the innate and adaptive immune systems, leads to functional immune cell paralysis. This entails a high risk of infection and contributes to a poor prognosis. Therapeutic approaches seeking to counteract the immune alterations present in ACLF are currently under investigation.
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