Current concepts and controversies in the treatment of alcoholic hepatitis

Table 1 Immunologic responses and directed therapies in alcoholic hepatitis

Cytokines	Mechanism	Mediators	Treatment
Cytokines
TNFα	Via TNFR1 signaling in hepatocytes and Kupffer cells (KC)	Apoptosis, necrosis, KC production of cytokines, potential cytoprotective effect	Glucocorticoids; Pentoxifylline; Infliximab
IL-6, 8	Lymphocyte and neutrophil activation, release of acute phase reactants	Inflammation, fibrosis	Glucocorticoids
Antigenic adduct	Oxidation of ethanol, binding to proteins forming antigenic adducts	Adaptive immunity	Glucocorticoids
Chemokines	Attract leukocytes and increase adhesion molecules	Inflammation	Glucocorticoids
Oxidative Injury
S-adenosyl-methionine (SAMe)	Precursor for glutathione, defense mechanism against oxidative stress, increase methylation	Protective role of SAMe	SAMe
Hypoxia/ischemic injury	Hypermetabolic state	Insufficient oxygen	Propylthiouracil