Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.11904
Peer-review started: April 15, 2015
First decision: May 18, 2015
Revised: June 3, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: November 14, 2015
Core tip: Acute alcoholic hepatitis (AAH) has high short-term mortality and is challenging to treat with only glucocorticoids demonstrating proven survival benefit. Development of other effective treatment requires a clear understanding of the mechanisms of immune dysfunction in AAH. Here, we review recent progress in the field and identify areas in need of further research; particularly the role of gut dysbiosis in allowing presentation of pathogen associated molecular patterns to innate receptors on myeloid cells and the subsequent recruitment of immune cell subsets. Recent data demonstrating that T cells have an exhausted phenotype and result in impaired antimicrobial defence is also discussed.