P- Reviewers: Guerra RR, Kc S, Tarantino G S- Editor: Qi Y L- Editor: Kerr C E- Editor: Zhang DN
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7312
Revised: March 16, 2014
Accepted: April 28, 2014
Published online: June 21, 2014
Liver cirrhosis is the final pathological result of various chronic liver diseases, and fibrosis is the precursor of cirrhosis. Many types of cells, cytokines and miRNAs are involved in the initiation and progression of liver fibrosis and cirrhosis. Activation of hepatic stellate cells (HSCs) is a pivotal event in fibrosis. Defenestration and capillarization of liver sinusoidal endothelial cells are major contributing factors to hepatic dysfunction in liver cirrhosis. Activated Kupffer cells destroy hepatocytes and stimulate the activation of HSCs. Repeated cycles of apoptosis and regeneration of hepatocytes contribute to pathogenesis of cirrhosis. At the molecular level, many cytokines are involved in mediation of signaling pathways that regulate activation of HSCs and fibrogenesis. Recently, miRNAs as a post-transcriptional regulator have been found to play a key role in fibrosis and cirrhosis. Robust animal models of liver fibrosis and cirrhosis, as well as the recently identified critical cellular and molecular factors involved in the development of liver fibrosis and cirrhosis will facilitate the development of more effective therapeutic approaches for these conditions.
Core tip: Cirrhosis is the end-stage condition of many types of chronic liver diseases but the underlying mechanisms are far from being clarified. Multiple cellular and molecular factors might be involved in the initiation and progression of cirrhosis. Activation of hepatic stellate cells is a pivotal event in the development of cirrhosis. Animal models are crucial for understanding the pathogenesis and the development of more efficient therapeutic strategies for cirrhosis, with which cirrhosis may become a treatable or even a reversible disease.
Citation: Zhou WC, Zhang QB, Qiao L. Pathogenesis of liver cirrhosis. World J Gastroenterol 2014; 20(23): 7312-7324
Liver cirrhosis is the final common pathological pathway of liver damage arising from a wide variety of chronic liver diseases[1-3]. The etiology of cirrhosis varies geographically, with alcoholism, chronic hepatitis C virus infection, and nonalcoholic fatty lives disease (NAFLD) being the most common causes in western countries[4-6], whereas chronic hepatitis B is the primary cause of liver cirrhosis in the Asia-Pacific region[7-9]. Liver cirrhosis has many other causes, include inherited diseases such as hemochromatosis and Wilson’s disease[10-14], primary biliary cirrhosis, primary sclerosing cholangitis[15-18], and autoimmune hepatitis[14,19]. Some cases are idiopathic or cryptogenic. In recent decades, NAFLD has become a leading cause of chronic liver disease in Western countries such as the United States, with a prevalence of as high as 30% in the general population. Thus, NAFLD has attracted extensive attention as an important cause of chronic liver diseases[21-23].
Although the causes of liver cirrhosis are multifactorial, there are some pathological characteristics that are common to all cases of liver cirrhosis, including degeneration and necrosis of hepatocytes, and replacement of liver parenchyma by fibrotic tissues and regenerative nodules, and loss of liver function[24-27]. Fibrosis as a precursor of cirrhosis is a pivotal pathological process in the evolution of all chronic liver diseases to cirrhosis[2,28]. At present, effective strategies to treat liver cirrhosis are still lacking, partially because of a poor understanding of the molecular mechanisms leading to cirrhosis. Thus, a better understanding of the pathogenesis of liver cirrhosis would facilitate the development of more effective treatment options.
In this review, we aim to summarize the recent advance in the molecular pathogenesis, animal models, and therapeutic strategies for liver cirrhosis.
The liver is formed by parenchymal cells (i.e., hepatocytes) and other cells commonly known as nonparenchymal cells. The walls of hepatic sinusoids are lined by three different nonparenchymal cells: liver sinusoidal endothelial cells (LSECs), Kupffer cells (KCs), and hepatic stellate cells (HSCs). Both hepatic parenchymal and nonparenchymal cells are involved in the initiation and progression of liver fibrosis and cirrhosis.
HSCs, formerly known as fat-storing cells, Ito cells, lipocytes, perisinusoidal cells, or vitamin A-rich cells, reside in the space of Disse in the normal liver and their main function is storage of vitamin A and other retinoids[27,29]. Following multiple injurious insults and/or exposure to inflammatory cytokines such as platelet-derived growth factor (PDGF), transforming growth factor (TGF)-β, tumor necrosis factor (TNF)-α, and interleukin (IL)-1, HSCs undergo the transition from a quiescent to activated state. HSC activation is a pivotal event in initiation and progression of hepatic fibrosis and a major contributor to collagen deposition[30,31]. Activation of HSCs is characterized by cell proliferation and migration, contraction after transforming into myofibroblasts, generation of a large amount of collagen and other extracellular matrix (ECM), ultimately leading to liver fibrosis[32-34].
LSECs constitute the sinusoidal wall, also called the endothelium, or endothelial lining. The structural characteristic of LSECs is the fenestrae on the surface of the endothelium[28,35,36] The endothelial fenestrae measure 150-175 nm in diameter, and act as a dynamic filter facilitating the exchange of fluids, solutes and particles between sinusoidal blood and the parenchymal cells[37-39]. LSECs have high endocytotic capacity[28,40]. Chronic alcohol abuse could result in defenestration, and a decrease in the number of fenestrae[37,41]. In cirrhotic liver, defenestration of sinusoidal endothelium and the presence of a subendothelial basement membrane are frequently present[35,42]. It is known that retinol deficiency can activate and transform HSCs into myofibroblasts with enhanced ECM production, resulting in perisinusoidal fibrosis and ultimately in cirrhosis[24,35]. Defenestration and capillarization of the hepatic endothelium are believed to be important in the initiation of perisinusoidal fibrosis by altering retinol metabolism. Studies in animals and humans have revealed that LSECs can secrete the cytokine IL-33 to activate HSCs and promote fibrosis. Defenestration and capillarization of LSECs lead to impaired substrate exchange and are considered major contributing factors for hepatic dysfunction in liver cirrhosis. On the contrary, differentiated LSECs can promote reversion of activated HSCs to quiescence and thereby accelerate regression and prevent progression of fibrosis through vascular endothelial growth factor (VEGF)-stimulated NO production[44,45].
KCs, also known as Browicz-Kupffer cells and stellate macrophages, are specialized macrophages located in the lining walls of the sinusoids of the liver that form part of the reticuloendothelial system (RES). Studies in animal models have shown that KCs are implicated in the pathogenesis of various liver diseases[47,48]. KCs can be activated by many injurious factors such as viral infection, alcohol, high-fat diet, and iron deposition. Activated KCs destroy hepatocytes by producing harmful soluble mediators and serving as antigen-presenting cells during viral infection. KC-mediated hepatic inflammation is considered to aggravate liver injury and fibrosis[49,50]. KCs are involved in the activation of HSCs and formation of fibrosis. In vitro studies have shown that KC-conditioned medium can promote activation of cultured rat HSCs with enhanced matrix synthesis and cell proliferation by eliciting expression of PDGF receptor in HSCs. KC-derived TGF-β1 stimulates proliferation and collagen formation of HSCs derived from rats fed with high-fat diet and ethanol[52,53]. Alcohol can induce the circulating level of Gram-negative bacterial lipopolysaccharide (LPS), which is a strong activator of KCs. In genetic hemochromatosis, iron overload in KCs could induce the expression of intercellular adhesion molecule (ICAM)-1 on hepatocytes, therefore facilitating activation of HSCs and collagen deposition in the hepatic tissues. Gelatinase secreted by activated KCs triggers the phenotypic change in HSCs by degrading collagen type IV. KCs engulf apoptotic bodies and produce death ligands, including Fas ligand and TNF-α, thereby promotes inflammation and fibrogenesis. In addition, KCs activated by β-glucans increase portal pressure through the release of thromboxane A2 in normal and fibrotic livers.
Hepatocytes are the primary liver parenchymal cells, and play complicated roles in fibrosis and cirrhosis. Hepatocytes are targets for most hepatotoxic agents, including hepatitis viruses, alcohol metabolites, and bile acids. Chronic liver diseases either promotes apoptosis or trigger compensatory regeneration of hepatocytes. Damaged hepatocytes release reactive oxygen species (ROS) and fibrogenic mediators, induce activation of HSCs, and stimulate the fibrogenic actions of myofibroblasts. Apoptosis of hepatocytes is a common event in liver injury and contributes to tissue inflammation, fibrogenesis, and development of cirrhosis. Steatohepatitis enhances Fas-mediated hepatocyte apoptosis, which correlates with active nuclear factor (NF)-κB and disease severity. Both HCV infection and ethanol consumption induce hepatocyte apoptosis in animal models and humans, and induction may be related to downregulation of Bcl-2 signaling. Chronic HCV infection can induce hepatocyte G1 arrest and impair hepatocellular function and limit hepatic regeneration[63,64]. In CCl4-induced liver injury, hepatocyte apoptosis is induced at the early phase, which is followed by constant proliferation and if it persists, liver cirrhosis ensues at a later stage. Hepatocytes are the major sources of matrix metalloproteinases (MMP-2, MMP-3 and MMP-13) and tissue inhibitors of matrix metalloproteinases (TIMP-1 and TIMP-2); all of which are involved in the pathogenesis of liver cirrhosis in CCl4-induced liver cirrhosis in rats. In the last fibrotic stage or cirrhosis, hypoxic hepatocytes become a predominant source of TGF-β1, further exacerbating hepatic fibrogenesis. Recently, it has been shown that hepatocyte telomere shortening and senescence can result in fibrotic scarring at the cirrhosis stage, presenting a novel explanation for the pathophysiology of cirrhosis.
Liver cirrhosis is orchestrated by a complex network of cytokine-mediated signaling pathways regulating the activation of HSCs and fibrogenesis.
PDGF is the strongest mitogen to HSCs among all polypeptide growth factors. PDGF family has four members, PDGF-A, -B, -C and -D. PDGF and its receptors are markedly overexpressed in fibrous tissues, and its activity increases with the degree of liver fibrosis[70-72]. A variety of factors such as viruses, chemicals, or mechanical damage to hepatocytes can induce KCs to synthesize and release PDGF. Upon binding to its specific receptor on the membrane of HSCs, PDGF activates corresponding signal molecules and transcription factors, leading to the activation of its downstream target genes and activation of HSCs[74,75]. PDGF has been shown to upregulate the expression of MMP-2, MMP-9 and TIMP-1, and inhibit the activity of collagenase, thereby reducing ECM degradation[69,75]. PDGF-B and PDGF-D are potent PDGF isoforms in PDGF receptor (PDGFR)β signaling within HSCs, as evidenced by PDGFRβ autophosphorylation and activation of extracellular signal-regulated kinase (ERK)1/2, C-Jun N-terminal kinase (JNK), p38 mitogen-activated protein kinase (MAPK), and protein kinase (PK)B/Akt pathways[75-77]. PDGF-D can activate HSCs and exerts mitogenic and fibrogenic effects, and therefore plays an important role in matrix remodeling in liver fibrosis.
TGF-β is the strongest known inducer of fibrogenesis in hepatic fibrosis[78,79]. TGF-β is mainly synthesized by HSCs/myofibroblasts, KCs, LSECs, and hepatocytes in the liver. The TGF-β1 family is composed of six members, and among them, TGF-β1 has been shown to play a key role in the initiation and maintenance of liver fibrosis[78-82]. The expression level of TGF-β1 is increased in fibrotic liver and reaches a maximum at cirrhosis. The pro-fibrogenesis effect of TGF-β1 is complicated, involving multiple aspects: the primary effect of TGF-β1 is to stimulate activation of HSCs, and the TGF-β1 autocrine loop in activated HSCs is an important positive feedback to the progression of liver fibrosis[80,81]. TGF-β1 induces expression of the matrix-producing genes and inhibits degradation of ECM by downregulating expression of MMPs and promoting TIMP, leading to excessive deposition of collagenous fibers and promoting the development of liver fibrosis[82,83]. In addition, TGF-β1 has been shown to inhibit DNA synthesis and induces apoptosis of hepatocytes. TGF-β1-induced apoptosis is thought to be responsible for tissue loss and decrease in liver size seen in cirrhosis. Given the critical role of TGF-β1 in the pathogenesis of liver cirrhosis, specific blockade of TGF-β1/Smad3 signaling has shown some therapeutic value for liver fibrosis.
TNF-α is mainly produced by monocyte, macrophage, HSCs, and KCs. It has proinflammatory activities and cytotoxic effects in these cells. In the process of liver fibrosis, TNF-α plays an important role in the activation of HSCs and synthesis of ECM[84,85]. TNF-α can reduce the spontaneous apoptosis of activated rat HSCs by upregulating the antiapoptotic factors NF-κB, Bcl-XL and p21WAF1, as well as downregulating the proapoptotic factor p53. However, the effects of TNF-α on HSCs and fibrosis are complicated and even paradoxical, as demonstrated by studies showing that TNF-α could induce apoptosis in HSCs. TNF-α has also been shown to exert antifibrogenic effect in rat HSCs by reducing glutathione and inhibiting pro-collagen α1 expression. In a rat model of nonalcoholic steatohepatitis (NASH), TNF-α antibody was shown to reduce the inflammation, necrosis and fibrosis in liver. TNF-α signaling through activation of KCs plays an essential role in the pathogenesis of liver fibrosis in animal models of NASH.
Interferon (IFN) is a family of soluble extracellular signaling molecules. Leukocytes synthesize IFN-α and IFN-β in response to virus infection, and T cells secrete IFN-γ upon stimulation with various antigens and mitogens. IFNs possess antiviral activity and is well-recognized for their antiviral effects. Patients treated with IFNs exhibit a regression of liver fibrosis even if viral eradication is not achieved, indicating that IFN itself has antifibrotic activity via triggering the apoptosis of HSCs. IFN-β could inactivate HSCs and decrease their production of α-smooth muscle actin (SMA) and collagen through inhibition of the TGF-β and PDGF pathways. Similarly, IFN-γ has been demonstrated to reduce ECM deposition in vivo by inhibiting HSC activation via TGFβ1/Smad3 signaling pathways[94,95]. Treatment of rats with fibrosis by IFN-γ led to a reduced production and deposition of collagen, laminin, fibronectin, and pro-collagen type I in liver. However, the effect of IFNs on fibrosis is not consistent, as demonstrated by a recent study showing that IFN-α and IFN-γ may exert opposite effects on apoptosis in HSCs. IFN-α was shown to elicit an antiapoptotic effect on activated HSCs, whereas IFN-γ was found to exert proapoptotic effect on HSCs by downregulating heat-shock protein 70.
ILs are a group of cytokines initially found to be expressed by leukocytes, but later on were shown to be produced by a wide variety of cells, such as CD4 T lymphocytes, monocytes, macrophages, and endothelial cells. ILs have a complicated role in immune response, inflammation, and liver fibrogenesis.
Pro-fibrogenic ILs: KCs and SECs can rapidly produce ILs in response to liver tissue damage. IL-1 can directly activate HSCs and stimulate them to produce MMP-9, MMP-13 and TIMP-1, resulting in liver fibrogenesis. In contrast, IL-1-receptor-deficient mice are less likely to sustain liver damage and exhibit reduced susceptibility to develop fibrosis. Deficiency of IL-1α or IL-1β also makes the mice less susceptible to develop liver fibrosis in animal models of steatohepatitis. Similarly, IL-1 receptor antagonists were found to protect rats from developing liver fibrosis in response to dimethylnitrosamine, and blocking IL-1 signaling could markedly attenuate alcohol-induced liver inflammation and steatosis. IL-1β was reported to increase the inflammatory and pro-steatotic chemokine monocyte chemoattractant protein-1 in hepatocytes, and augment Toll-like receptor (TLR4)-dependent upregulation of inflammatory signaling in macrophages.
Another profibrotic cytokine is IL-17, whose expression level increases with degree of liver fibrosis[101,102], indicating that IL-17 may be involved in disease progression and chronicity. Studies in mice have shown that IL-17 induces liver fibrosis through multiple mechanisms, including upregulation of TNF-α, TGF-β1, and collagen 1α, which is dependent on signal transducer and activator of transcription (STAT)3 signaling pathway, and promotion of myofibroblast-like change of HSCs[102,103].
Antifibrogenic ILs: IL-10 is a cytokine that downregulates the proinflammatory response and has a modulatory effect on hepatic fibrogenesis[104,105]. IL-10 may have therapeutic potential for patients with HCV-related liver fibrosis who do not respond to IFN-based therapy. IL-10 has been shown to exert antifibrotic effects through inhibiting HSC activity, and this was demonstrated in a rat model in which exogenous IL-10 was shown to reverse CCl4-induced hepatic fibrosis by inhibiting the expression of TGF-β1, MMP-2 and TIMP-1[104,106,107].
IL-22 is known to play a key role in promoting antimicrobial immunity, inflammation, and tissue repair at barrier surfaces. IL-22 has been shown to induce HSC senescence, restrict liver fibrosis, and accelerate the resolution of liver fibrosis during recovery in a mouse model.
IL-6 is a pleiotropic cytokine involved in inflammatory pathways, hematopoiesis and immune regulation. IL-6 can attenuate apoptosis and promote regeneration of hepatocytes through NF-κB signaling and the Ras-MAPK pathway. IL-6 reduces CCl4-induced acute and chronic liver injury and fibrosis. Pretreatment of fibrotic liver with IL-6 improves hepatic microenvironment and primes it for mesenchymal stem cell transplantation, leading to improvement in liver injury after fibrosis. Meanwhile, increased blood level of IL-6 has been found in patients with NAFLD, and IL-6 could induce insulin resistance and inflammation in the liver[112,113], suggesting that IL-6 may play a role in the development of NAFLD.
miRNAs represent a family of small noncoding RNAs controlling translation and transcription of many genes, which have recently emerged as post-transcriptional regulators. miRNAs play a key role in various hepatic pathologies, including hepatitis, cirrhosis and hepatoma[34,114]. miRNAs may play pro- and antifibrogenic roles, depending on cellular context and the nature of the stimuli.
miR-21 has an important role in the pathogenesis and progression of hepatic fibrosis. miR-21 can downregulate TGF-β expression and suppress HSC activation. TGF-β1 induces expression of miR-181a and miR-181b, and the latter can promote HSC proliferation by regulating p27 and the cell cycle. Elevation of serum level of miR-181b is suggested as a potential diagnostic biomarker for patients with cirrhosis.
miR-214-5p can increase expression of fibrosis-related genes (such as MMP-2, MMP-9, α-SMA, and TGF-β1) in LX-2 cells, and therefore, it may play crucial roles in HSC activation and progression of liver fibrosis.
miR-221 and miR222 are upregulated in human liver in a fibrosis progression-dependent manner and in mouse models of liver fibrosis. TGF-α or TNF-α induce expression of miR-222, which can bind to the CDKN1B (p27) 3’-untranslated region (UTR) and regulate expression of the corresponding protein.
Other fibrosis-associated miRNAs have been identified. For example, miR-199a, miR-199a*, miR-200a, and miR-200b were positively and significantly correlated with progression of liver fibrosis in both mouse and human studies. Overexpression of these miRNAs significantly increases the expression of fibrosis-related genes in HSCs. miR-571 is upregulated in human hepatocytes and HSCs in response to TGF-β.
miRNA-150 and miRNA-194 are reduced in HSCs isolated from experimental rats with liver fibrosis. It has been demonstrated that these two miRNAs inhibit HSC activation and ECM production, at least in part, via inhibition of c-myb and rac1 expression. In contrast, several miRNAs such as miR-29, miR 19b, miR-146a, and miR-133a are markedly downregulated in HSCs isolated from experimental animals with liver fibrosis, and restoration of these miRNAs attenuates hepatic fibrogenesis[30,122,123].
It is now thought that miRNAs can serve as biomarkers for HSC activation and liver fibrosis progression, and may represent therapeutic targets for hepatic fibrosis and cirrhosis.
Animal models are crucial to understanding the pathogenesis and development of therapeutic strategies for liver fibrosis and cirrhosis. So far, many types of animal model have been developed in mice, rats, rabbits, and pigs to mimic the complicated process of fibrosis and cirrhosis. Animal models of liver fibrosis and cirrhosis can be induced by one of the following approaches: (1) Fibrosis induced by chemical compounds and toxins. These agents cause direct injury to hepatocytes and trigger secondary inflammatory reaction in the liver, which in turn activate HSCs and result in fibrosis. Commonly used chemical agents include CCl4[124-126], thioacetamide[127,128] dimethylnitrosamine[129,130], dioxin, sodium arsenate, and ethanol[126,133,134]. These agents can be administered to experimental animals alone or in combination; (2) Special diet, such as choline-deficient, L-amino acid-defined, methionine-deficient diet[89,135,136], and high-fat diet[134,137,138]. Animals develop NAFLD and cirrhosis when they are fed these diets alone or in combination with other chemical agents; (3) Physical methods. Bile duct ligation creates obstruction of the extrahepatic bile duct[139,140], leading to cholestasis and subsequent injury to biliary epithelial cells and hepatocytes, infiltration of inflammatory cells in the portal area, fibrous tissue proliferation, and formation of liver fibrosis; (4) Fibrosis induced by immune reaction. Antigen-antibody complexes can provoke type III hypersensitive reactions. Deposition of immune complexes in the portal area and around the central vein area causes allergic reaction and inflammation, stimulating HSCs to secrete collagen, and fibrosis formation. Common immunogens include plant protein concanavalin A and xenogenic serum[142,143], such as serum from pigs, cattle, humans, and schistosoma. It was reported that 85.5% of rats immunized with subcutaneous injection of human serum albumin develop liver fibrosis and cirrhosis. Similarly, injection of the excretory-secretory (ES) antigens of Ascaris suum into golden hamsters also successfully induces hepatic fibrosis; and (5) Genetic modification. Forced overexpression of critical profibrotic genes and/or silencing of antifibrotic genes has been shown to induce cirrhosis in animals. For example, high-speed intravenous injection of naked plasmid DNA of TGF-β1 can induce transient and reversible liver fibrosis in mice. Mice with liver-specific deletion of CYLD exon7/8 [CYLD(FF)xAlbCre] exhibit a prominent biliary phenotype with ductular reaction and biliary-type fibrosis.
Recent developments in our understanding of the process of hepatic fibrogenesis have revealed that the process is dynamic and reversible. Animal and clinical evidence has confirmed that any degree of fibrosis and even cirrhosis are potentially reversible by reasonable therapeutic strategies[147-149]. At present, the therapeutic strategies for liver fibrosis include the following.
Removing the etiological factors is the most direct and perhaps most effective method of treating liver fibrosis. As such, treatments against HBV and HCV infections[150,151], abstinence from alcohol abuse, weight and blood lipid control, chelation of overloaded iron and copper are considered potentially effective therapies for a large proportion of liver fibrosis cases. In particular, the commonly used antiviral agents such as IFN-α, ribavirin, lamivudine, adefovir, entecavir, and especially pegylated IFN-α have been shown to exert antifibrotic effects[91,151,153-156].
Intrahepatic inflammation and immune response are direct causes of injury to hepatocytes and activation of HSCs. Therefore, anti-inflammatory and immunosuppressive therapies are important measures to inhibit fibrogenesis, especially for fibrosis and cirrhosis resulting from viral hepatitis, autoimmune hepatitis, and primary sclerosing cholangitis. The anti-inflammatory drug celecoxib and antioxidative agents taurine and vitamin E[158,159] all show some degree of antifibrotic effect. Likewise, glucocorticoids, azathioprine, colchicines and rapamycin[162,163] appear to exert anti-inflammatory, antifibrotic and immunomodulatory effects, and therefore may potentially be useful in the treatment of liver fibrosis.
HSCs play a critical role in hepatic fibrogenesis, and therefore are potential target cells of antifibrotic therapy. As such, inhibition of HSC activation is an attractive therapeutic approach for liver fibrosis. Inactivation of HSCs can be achieved by inhibiting the TGF-β1 signaling pathway and PDGF-B[165-167], and activated HSCs can be removed by inducing these cells to undergo apoptosis[27,31,164]. Some cytokines and growth factors such as insulin-like growth factor-1, IFN-α and IFN-γ have been found to induce apoptosis of HSCs[90,96,168]. Inhibitors of IκB kinase has also been shown to promote apoptosis of HSCs and exert antifibrotic effectd. Other pharmacological agents such as gliotoxin, sulfasalazine, benzodiazepine ligands, curcumin and tanshinone I have been explored for their effects in inducing HSC apoptosis.
The hepatoprotective agent silymarin has been widely used in the management of chronic liver diseases and cirrhosis[129,169]. Ursodeoxycholic acid and tauroursodeoxycholic acid have shown protective effects against hepatocyte organelle injury, and have been confirmed as effective agents for the treatment of primary sclerosing cholangitis[170,171]. Calcium channel blockers (e.g., verapamil) also show hepatoprotective and antifibrotic effects by stabilizing the hepatic cellular membrane and lowering the portal vein pressure.
Hepatocyte apoptosis is a common event in liver injury and contributes to fibrogenesis and development of cirrhosis. Hence, preventing the hepatocytes from undergoing apoptosis and promoting hepatocytes regeneration can be useful therapeutic strategies for liver fibrosis and cirrhosis. Hepatocyte growth factor (HGF), an antifibrotic growth factor that induces apoptosis in HSCs and stimulates hepatocyte regeneration[173,174], has been attempted as a therapeutic agent for liver cirrhosis. In this respect, infusion of bone-marrow-derived cells and mesenchymal cells have been reported as a potentially effective method for the treatment of liver cirrhosis[175-177], because these cells can differentiate into hepatocyte-like cells in the liver and stimulate proliferation of hepatocytes by secreting some growth factors such as HGF. Furthermore, HGF-overexpressing human umbilical-cord-blood-derived mesenchymal stem cells have shown promising therapeutic effects on liver fibrosis.
Several critical genes implicated in the pathogenesis of liver cirrhosis such as TGF-β, PDGF-β, CTGF, and TIMP have been investigated as therapeutic targets for liver cirrhosis. Antisense oligonucleotides[167,180,181] and siRNAs[182-184] against these genes have been tested in vitro and in vivo. Recently, miRNA has been found to play a regulatory role in the pathogenesis of liver fibrosis and cirrhosis through regulating the expression of profibrotic or antifibrotic genes, and influencing the proliferation and activation of HSCs. As such, miRNA-based therapy can potentially be useful for the treatment of liver fibrosis. Furthermore, in order to target more directly the fibrogenic cells, attempts have been made to target the receptors of the profibrogenic proteins expressed on HSCs[184,186,187].
Evidence indicates that some traditional Chinese herbal medicines are effective in the treatment of liver fibrosis and cirrhosis, and have thus gained popularity worldwide[188,189]. These herbal medicines include the following categories: pure compounds (e.g., salvianolic acid B and oxymatrine). The mechanisms by which tetrandrine, glycyrrhetinic acid and curcumin), single agents (e.g., Salvia miltiorrhiza and Ganoderma lucidum), and composite formulae (e.g., Fuzheng Huayu Capsule, Biejiajian, Yi-Gan-Kang granule and Qinggan Huoxuefang). Chinese herbal medicines exert antifibrotic effect are far from clear but may include antiviral and anti-inflammatory effects, immune regulation, inhibition of HSC activity, and promotion of collagen degradation. Further randomized controlled clinical trials are needed and the possible adverse effects should be carefully evaluated.
In summary, the etiology of cirrhosis is multifactorial and the mechanisms underlying pathogenesis of cirrhosis are far from being clarified. Further studies, particularly with appropriate animal models, to unveil the molecular mechanisms leading to liver fibrosis and cirrhosis are essential for the development of effective therapeutic approaches.
|1.||Melato M, Mucli E. Something new in liver cirrhosis epidemiology. Lancet. 1989;2:395-396. [PubMed] [DOI]|
|2.||Asrani SK, Larson JJ, Yawn B, Therneau TM, Kim WR. Underestimation of liver-related mortality in the United States. Gastroenterology. 2013;145:375-82.e1-2. [PubMed] [DOI]|
|3.||Qua CS, Goh KL. Liver cirrhosis in Malaysia: peculiar epidemiology in a multiracial Asian country. J Gastroenterol Hepatol. 2011;26:1333-1337. [PubMed] [DOI]|
|4.||Naveau S, Perlemuter G, Balian A. [Epidemiology and natural history of cirrhosis]. Rev Prat. 2005;55:1527-1532. [PubMed]|
|5.||Di Bisceglie AM. Natural history of hepatitis C: its impact on clinical management. Hepatology. 2000;31:1014-1018. [PubMed] [DOI]|
|6.||Innes HA, Hutchinson SJ, Barclay S, Cadzow E, Dillon JF, Fraser A, Goldberg DJ, Mills PR, McDonald SA, Morris J. Quantifying the fraction of cirrhosis attributable to alcohol among chronic hepatitis C virus patients: implications for treatment cost-effectiveness. Hepatology. 2013;57:451-460. [PubMed] [DOI]|
|7.||Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med. 2004;350:1118-1129. [PubMed] [DOI]|
|8.||Lv GC, Yao JM, Yang YD, Zheng L, Sheng JF, Chen Y, Li LJ. Efficacy of combined therapy in patients with hepatitis B virus-related decompensated cirrhosis. World J Gastroenterol. 2013;19:3481-3486. [PubMed] [DOI]|
|9.||Liaw YF, Leung N, Kao JH, Piratvisuth T, Gane E, Han KH, Guan R, Lau GK, Locarnini S. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008;2:263-283. [PubMed] [DOI]|
|10.||Britton RS, Brown KE. Genetic hemochromatosis and Wilson’s disease: role for oxidant stress? Hepatology. 1995;21:1195-1197. [PubMed] [DOI]|
|11.||Olynyk JK, Trinder D, Ramm GA, Britton RS, Bacon BR. Hereditary hemochromatosis in the post-HFE era. Hepatology. 2008;48:991-1001. [PubMed] [DOI]|
|13.||Dowling D. Screening for Wilson’s disease in acute liver failure: a comparison of currently available diagnostic tests. Hepatology. 2009;50:329. [PubMed] [DOI]|
|14.||Deutsch M, Emmanuel T, Koskinas J. Autoimmune Hepatitis or Wilson’s Disease, a Clinical Dilemma. Hepat Mon. 2013;13:e7872. [PubMed] [DOI]|
|15.||Wu SJ, Yang YH, Tsuneyama K, Leung PS, Illarionov P, Gershwin ME, Chuang YH. Innate immunity and primary biliary cirrhosis: activated invariant natural killer T cells exacerbate murine autoimmune cholangitis and fibrosis. Hepatology. 2011;53:915-925. [PubMed] [DOI]|
|16.||van Os E, van den Broek WW, Mulder PG, ter Borg PC, Bruijn JA, van Buuren HR. Depression in patients with primary biliary cirrhosis and primary sclerosing cholangitis. J Hepatol. 2007;46:1099-1103. [PubMed] [DOI]|
|17.||Popov Y. Mouse model of primary biliary cirrhosis with progressive fibrosis: are we there yet? Hepatology. 2013;57:429-431. [PubMed] [DOI]|
|18.||Selmi C, Bowlus CL, Gershwin ME, Coppel RL. Primary biliary cirrhosis. Lancet. 2011;377:1600-1609. [PubMed] [DOI]|
|19.||Poupon R, Chazouilleres O, Corpechot C, Chrétien Y. Development of autoimmune hepatitis in patients with typical primary biliary cirrhosis. Hepatology. 2006;44:85-90. [PubMed] [DOI]|
|20.||Lazo M, Hernaez R, Bonekamp S, Kamel IR, Brancati FL, Guallar E, Clark JM. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. BMJ. 2011;343:d6891. [PubMed] [DOI]|
|21.||Ekstedt M, Franzén LE, Mathiesen UL, Thorelius L, Holmqvist M, Bodemar G, Kechagias S. Long-term follow-up of patients with NAFLD and elevated liver enzymes. Hepatology. 2006;44:865-873. [PubMed] [DOI]|
|22.||Tarantino G, Scopacasa F, Colao A, Capone D, Tarantino M, Grimaldi E, Savastano S. Serum Bcl-2 concentrations in overweight-obese subjects with nonalcoholic fatty liver disease. World J Gastroenterol. 2011;17:5280-5288. [PubMed] [DOI]|
|23.||Tarantino G, Colao A, Capone D, Conca P, Tarantino M, Grimaldi E, Chianese D, Finelli C, Contaldo F, Scopacasa F. Circulating levels of cytochrome C, gamma-glutamyl transferase, triglycerides and unconjugated bilirubin in overweight/obese patients with non-alcoholic fatty liver disease. J Biol Regul Homeost Agents. 2011;25:47-56. [PubMed]|
|24.||Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH. The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. J Clin Pathol. 1978;31:395-414. [PubMed]|
|25.||Wanless IR, Nakashima E, Sherman M. Regression of human cirrhosis. Morphologic features and the genesis of incomplete septal cirrhosis. Arch Pathol Lab Med. 2000;124:1599-1607. [PubMed]|
|26.||Ferrell L. Liver pathology: cirrhosis, hepatitis, and primary liver tumors. Update and diagnostic problems. Mod Pathol. 2000;13:679-704. [PubMed] [DOI]|
|27.||Elsharkawy AM, Oakley F, Mann DA. The role and regulation of hepatic stellate cell apoptosis in reversal of liver fibrosis. Apoptosis. 2005;10:927-939. [PubMed] [DOI]|
|28.||Braet F, Wisse E. Structural and functional aspects of liver sinusoidal endothelial cell fenestrae: a review. Comp Hepatol. 2002;1:1. [PubMed] [DOI]|
|29.||Friedman SL. Seminars in medicine of the Beth Israel Hospital, Boston. The cellular basis of hepatic fibrosis. Mechanisms and treatment strategies. N Engl J Med. 1993;328:1828-1835. [PubMed]|
|30.||Lakner AM, Steuerwald NM, Walling TL, Ghosh S, Li T, McKillop IH, Russo MW, Bonkovsky HL, Schrum LW. Inhibitory effects of microRNA 19b in hepatic stellate cell-mediated fibrogenesis. Hepatology. 2012;56:300-310. [PubMed] [DOI]|
|31.||Oakley F, Meso M, Iredale JP, Green K, Marek CJ, Zhou X, May MJ, Millward-Sadler H, Wright MC, Mann DA. Inhibition of inhibitor of kappaB kinases stimulates hepatic stellate cell apoptosis and accelerated recovery from rat liver fibrosis. Gastroenterology. 2005;128:108-120. [PubMed] [DOI]|
|32.||Safadi R, Friedman SL. Hepatic fibrosis--role of hepatic stellate cell activation. MedGenMed. 2002;4:27. [PubMed]|
|33.||Gressner AM, Weiskirchen R. Modern pathogenetic concepts of liver fibrosis suggest stellate cells and TGF-beta as major players and therapeutic targets. J Cell Mol Med. 2006;10:76-99. [PubMed] [DOI]|
|34.||He Y, Huang C, Zhang SP, Sun X, Long XR, Li J. The potential of microRNAs in liver fibrosis. Cell Signal. 2012;24:2268-2272. [PubMed] [DOI]|
|35.||Mori T, Okanoue T, Sawa Y, Hori N, Ohta M, Kagawa K. Defenestration of the sinusoidal endothelial cell in a rat model of cirrhosis. Hepatology. 1993;17:891-897. [PubMed] [DOI]|
|36.||Straub AC, Stolz DB, Ross MA, Hernández-Zavala A, Soucy NV, Klei LR, Barchowsky A. Arsenic stimulates sinusoidal endothelial cell capillarization and vessel remodeling in mouse liver. Hepatology. 2007;45:205-212. [PubMed] [DOI]|
|37.||Okanoue T, Mori T, Sakamoto S, Itoh Y. Role of sinusoidal endothelial cells in liver disease. J Gastroenterol Hepatol. 1995;10 Suppl 1:S35-S37. [PubMed] [DOI]|
|38.||Øie CI, Appa RS, Hilden I, Petersen HH, Gruhler A, Smedsrød B, Hansen JB. Rat liver sinusoidal endothelial cells (LSECs) express functional low density lipoprotein receptor-related protein-1 (LRP-1). J Hepatol. 2011;55:1346-1352. [PubMed] [DOI]|
|39.||Yokomori H, Oda M, Yoshimura K, Hibi T. Recent advances in liver sinusoidal endothelial ultrastructure and fine structure immunocytochemistry. Micron. 2012;43:129-134. [PubMed] [DOI]|
|40.||Wisse E. An electron microscopic study of the fenestrated endothelial lining of rat liver sinusoids. J Ultrastruct Res. 1970;31:125-150. [PubMed] [DOI]|
|41.||Deaciuc IV, D’Souza NB, Fortunato F, Hill DB, Sarphie TG, McClain CJ. Alcohol-induced sinusoidal endothelial cell dysfunction in the mouse is associated with exacerbated liver apoptosis and can be reversed by caspase inhibition. Hepatol Res. 2001;19:85-97. [PubMed] [DOI]|
|42.||Bhunchet E, Fujieda K. Capillarization and venularization of hepatic sinusoids in porcine serum-induced rat liver fibrosis: a mechanism to maintain liver blood flow. Hepatology. 1993;18:1450-1458. [PubMed] [DOI]|
|43.||Marvie P, Lisbonne M, L’helgoualc’h A, Rauch M, Turlin B, Preisser L, Bourd-Boittin K, Théret N, Gascan H, Piquet-Pellorce C. Interleukin-33 overexpression is associated with liver fibrosis in mice and humans. J Cell Mol Med. 2010;14:1726-1739. [PubMed] [DOI]|
|44.||Deleve LD, Wang X, Guo Y. Sinusoidal endothelial cells prevent rat stellate cell activation and promote reversion to quiescence. Hepatology. 2008;48:920-930. [PubMed] [DOI]|
|45.||Xie G, Wang X, Wang L, Wang L, Atkinson RD, Kanel GC, Gaarde WA, Deleve LD. Role of differentiation of liver sinusoidal endothelial cells in progression and regression of hepatic fibrosis in rats. Gastroenterology. 2012;142:918-927.e6. [PubMed] [DOI]|
|46.||Kmieć Z. Cooperation of liver cells in health and disease. Adv Anat Embryol Cell Biol. 2001;161:III-XIII, 1-151. [PubMed] [DOI]|
|47.||Kolios G, Valatas V, Kouroumalis E. Role of Kupffer cells in the pathogenesis of liver disease. World J Gastroenterol. 2006;12:7413-7420. [PubMed]|
|48.||Noda T, Mimura H, Orita K. Assessment of Kupffer cell function in rats with chronic liver injury caused by CCl4. Hepatogastroenterology. 1990;37:319-323. [PubMed]|
|49.||López-Navarrete G, Ramos-Martínez E, Suárez-Álvarez K, Aguirre-García J, Ledezma-Soto Y, León-Cabrera S, Gudiño-Zayas M, Guzmán C, Gutiérrez-Reyes G, Hernández-Ruíz J. Th2-associated alternative Kupffer cell activation promotes liver fibrosis without inducing local inflammation. Int J Biol Sci. 2011;7:1273-1286. [PubMed] [DOI]|
|50.||Vollmar B, Siegmund S, Richter S, Menger MD. Microvascular consequences of Kupffer cell modulation in rat liver fibrogenesis. J Pathol. 1999;189:85-91. [PubMed]|
|51.||Friedman SL, Arthur MJ. Activation of cultured rat hepatic lipocytes by Kupffer cell conditioned medium. Direct enhancement of matrix synthesis and stimulation of cell proliferation via induction of platelet-derived growth factor receptors. J Clin Invest. 1989;84:1780-1785. [PubMed] [DOI]|
|52.||Matsuoka M, Zhang MY, Tsukamoto H. Sensitization of hepatic lipocytes by high-fat diet to stimulatory effects of Kupffer cell-derived factors: implication in alcoholic liver fibrogenesis. Hepatology. 1990;11:173-182. [PubMed] [DOI]|
|53.||Matsuoka M, Tsukamoto H. Stimulation of hepatic lipocyte collagen production by Kupffer cell-derived transforming growth factor beta: implication for a pathogenetic role in alcoholic liver fibrogenesis. Hepatology. 1990;11:599-605. [PubMed]|
|54.||Deaciuc IV, Spitzer JJ. Hepatic sinusoidal endothelial cell in alcoholemia and endotoxemia. Alcohol Clin Exp Res. 1996;20:607-614. [PubMed] [DOI]|
|55.||Stål P, Broomé U, Scheynius A, Befrits R, Hultcrantz R. Kupffer cell iron overload induces intercellular adhesion molecule-1 expression on hepatocytes in genetic hemochromatosis. Hepatology. 1995;21:1308-1316. [PubMed] [DOI]|
|56.||Benyon RC, Hovell CJ, Da Gaça M, Jones EH, Iredale JP, Arthur MJ. Progelatinase A is produced and activated by rat hepatic stellate cells and promotes their proliferation. Hepatology. 1999;30:977-986. [PubMed] [DOI]|
|57.||Canbay A, Feldstein AE, Higuchi H, Werneburg N, Grambihler A, Bronk SF, Gores GJ. Kupffer cell engulfment of apoptotic bodies stimulates death ligand and cytokine expression. Hepatology. 2003;38:1188-1198. [PubMed] [DOI]|
|58.||Steib CJ, Gerbes AL, Bystron M, Op den Winkel M, Härtl J, Roggel F, Prüfer T, Göke B, Bilzer M. Kupffer cell activation in normal and fibrotic livers increases portal pressure via thromboxane A(2). J Hepatol. 2007;47:228-238. [PubMed] [DOI]|
|60.||Schattenberg JM, Nagel M, Kim YO, Kohl T, Wörns MA, Zimmermann T, Schad A, Longerich T, Schuppan D, He YW. Increased hepatic fibrosis and JNK2-dependent liver injury in mice exhibiting hepatocyte-specific deletion of cFLIP. Am J Physiol Gastrointest Liver Physiol. 2012;303:G498-G506. [PubMed] [DOI]|
|61.||Ribeiro PS, Cortez-Pinto H, Solá S, Castro RE, Ramalho RM, Baptista A, Moura MC, Camilo ME, Rodrigues CM. Hepatocyte apoptosis, expression of death receptors, and activation of NF-kappaB in the liver of nonalcoholic and alcoholic steatohepatitis patients. Am J Gastroenterol. 2004;99:1708-1717. [PubMed] [DOI]|
|62.||Pianko S, Patella S, Sievert W. Alcohol consumption induces hepatocyte apoptosis in patients with chronic hepatitis C infection. J Gastroenterol Hepatol. 2000;15:798-805. [PubMed] [DOI]|
|63.||Marshall A, Rushbrook S, Davies SE, Morris LS, Scott IS, Vowler SL, Coleman N, Alexander G. Relation between hepatocyte G1 arrest, impaired hepatic regeneration, and fibrosis in chronic hepatitis C virus infection. Gastroenterology. 2005;128:33-42. [PubMed] [DOI]|
|64.||Lunz JG, Tsuji H, Nozaki I, Murase N, Demetris AJ. An inhibitor of cyclin-dependent kinase, stress-induced p21Waf-1/Cip-1, mediates hepatocyte mito-inhibition during the evolution of cirrhosis. Hepatology. 2005;41:1262-1271. [PubMed] [DOI]|
|65.||Chen L, Yang Z, Qiu F. Studies on hepatocyte apoptosis, proliferation and oncogene c-fos expression in carbon tetrachloride-induced cirrhotic rat liver. J Tongji Med Univ. 1999;19:53-55. [PubMed] [DOI]|
|66.||Garcíade León Mdel C, Montfort I, Tello Montes E, López Vancell R, Olivos García A, González Canto A, Nequiz-Avendaño M, Pérez-Tamayo R. Hepatocyte production of modulators of extracellular liver matrix in normal and cirrhotic rat liver. Exp Mol Pathol. 2006;80:97-108. [PubMed] [DOI]|
|67.||Jeong WI, Do SH, Yun HS, Song BJ, Kim SJ, Kwak WJ, Yoo SE, Park HY, Jeong KS. Hypoxia potentiates transforming growth factor-beta expression of hepatocyte during the cirrhotic condition in rat liver. Liver Int. 2004;24:658-668. [PubMed] [DOI]|
|68.||Wiemann SU, Satyanarayana A, Tsahuridu M, Tillmann HL, Zender L, Klempnauer J, Flemming P, Franco S, Blasco MA, Manns MP. Hepatocyte telomere shortening and senescence are general markers of human liver cirrhosis. FASEB J. 2002;16:935-942. [PubMed] [DOI]|
|69.||Martin IV, Borkham-Kamphorst E, Zok S, van Roeyen CR, Eriksson U, Boor P, Hittatiya K, Fischer HP, Wasmuth HE, Weiskirchen R. Platelet-derived growth factor (PDGF)-C neutralization reveals differential roles of PDGF receptors in liver and kidney fibrosis. Am J Pathol. 2013;182:107-117. [PubMed] [DOI]|
|70.||Thieringer F, Maass T, Czochra P, Klopcic B, Conrad I, Friebe D, Schirmacher P, Lohse AW, Blessing M, Galle PR. Spontaneous hepatic fibrosis in transgenic mice overexpressing PDGF-A. Gene. 2008;423:23-28. [PubMed] [DOI]|
|71.||Cao S, Yaqoob U, Das A, Shergill U, Jagavelu K, Huebert RC, Routray C, Abdelmoneim S, Vasdev M, Leof E. Neuropilin-1 promotes cirrhosis of the rodent and human liver by enhancing PDGF/TGF-beta signaling in hepatic stellate cells. J Clin Invest. 2010;120:2379-2394. [PubMed] [DOI]|
|72.||Borkham-Kamphorst E, van Roeyen CR, Ostendorf T, Floege J, Gressner AM, Weiskirchen R. Pro-fibrogenic potential of PDGF-D in liver fibrosis. J Hepatol. 2007;46:1064-1074. [PubMed] [DOI]|
|73.||Borkham-Kamphorst E, Herrmann J, Stoll D, Treptau J, Gressner AM, Weiskirchen R. Dominant-negative soluble PDGF-beta receptor inhibits hepatic stellate cell activation and attenuates liver fibrosis. Lab Invest. 2004;84:766-777. [PubMed] [DOI]|
|74.||Pinzani M. PDGF and signal transduction in hepatic stellate cells. Front Biosci. 2002;7:d1720-d1726. [PubMed]|
|75.||Czochra P, Klopcic B, Meyer E, Herkel J, Garcia-Lazaro JF, Thieringer F, Schirmacher P, Biesterfeld S, Galle PR, Lohse AW. Liver fibrosis induced by hepatic overexpression of PDGF-B in transgenic mice. J Hepatol. 2006;45:419-428. [PubMed] [DOI]|
|76.||Foo NP, Lin SH, Lee YH, Wu MJ, Wang YJ. α-Lipoic acid inhibits liver fibrosis through the attenuation of ROS-triggered signaling in hepatic stellate cells activated by PDGF and TGF-β. Toxicology. 2011;282:39-46. [PubMed] [DOI]|
|77.||Ogawa S, Ochi T, Shimada H, Inagaki K, Fujita I, Nii A, Moffat MA, Katragadda M, Violand BN, Arch RH. Anti-PDGF-B monoclonal antibody reduces liver fibrosis development. Hepatol Res. 2010;40:1128-1141. [PubMed] [DOI]|
|78.||Kirmaz C, Terzioglu E, Topalak O, Bayrak P, Yilmaz O, Ersoz G, Sebik F. Serum transforming growth factor-beta1(TGF-beta1) in patients with cirrhosis, chronic hepatitis B and chronic hepatitis C [corrected]. Eur Cytokine Netw. 2004;15:112-116. [PubMed]|
|79.||Schuppan D, Krebs A, Bauer M, Hahn EG. Hepatitis C and liver fibrosis. Cell Death Differ. 2003;10 Suppl 1:S59-S67. [PubMed] [DOI]|
|80.||Wells RG, Kruglov E, Dranoff JA. Autocrine release of TGF-beta by portal fibroblasts regulates cell growth. FEBS Lett. 2004;559:107-110. [PubMed] [DOI]|
|81.||Cui X, Shimizu I, Lu G, Itonaga M, Inoue H, Shono M, Tamaki K, Fukuno H, Ueno H, Ito S. Inhibitory effect of a soluble transforming growth factor beta type II receptor on the activation of rat hepatic stellate cells in primary culture. J Hepatol. 2003;39:731-737. [PubMed] [DOI]|
|82.||Liu X, Hu H, Yin JQ. Therapeutic strategies against TGF-beta signaling pathway in hepatic fibrosis. Liver Int. 2006;26:8-22. [PubMed] [DOI]|
|83.||Cui Q, Wang Z, Jiang D, Qu L, Guo J, Li Z. HGF inhibits TGF-β1-induced myofibroblast differentiation and ECM deposition via MMP-2 in Achilles tendon in rat. Eur J Appl Physiol. 2011;111:1457-1463. [PubMed] [DOI]|
|84.||Connolly MK, Bedrosian AS, Mallen-St Clair J, Mitchell AP, Ibrahim J, Stroud A, Pachter HL, Bar-Sagi D, Frey AB, Miller G. In liver fibrosis, dendritic cells govern hepatic inflammation in mice via TNF-alpha. J Clin Invest. 2009;119:3213-3225. [PubMed] [DOI]|
|85.||Crespo J, Rivero M, Fábrega E, Cayón A, Amado JA, García-Unzeta MT, Pons-Romero F. Plasma leptin and TNF-alpha levels in chronic hepatitis C patients and their relationship to hepatic fibrosis. Dig Dis Sci. 2002;47:1604-1610. [PubMed]|
|86.||Saile B, Matthes N, El Armouche H, Neubauer K, Ramadori G. The bcl, NFkappaB and p53/p21WAF1 systems are involved in spontaneous apoptosis and in the anti-apoptotic effect of TGF-beta or TNF-alpha on activated hepatic stellate cells. Eur J Cell Biol. 2001;80:554-561. [PubMed] [DOI]|
|87.||Taimr P, Higuchi H, Kocova E, Rippe RA, Friedman S, Gores GJ. Activated stellate cells express the TRAIL receptor-2/death receptor-5 and undergo TRAIL-mediated apoptosis. Hepatology. 2003;37:87-95. [PubMed] [DOI]|
|88.||Varela-Rey M, Fontán-Gabás L, Blanco P, López-Zabalza MJ, Iraburu MJ. Glutathione depletion is involved in the inhibition of procollagen alpha1(I) mRNA levels caused by TNF-alpha on hepatic stellate cells. Cytokine. 2007;37:212-217. [PubMed] [DOI]|
|89.||Koca SS, Bahcecioglu IH, Poyrazoglu OK, Ozercan IH, Sahin K, Ustundag B. The treatment with antibody of TNF-alpha reduces the inflammation, necrosis and fibrosis in the non-alcoholic steatohepatitis induced by methionine- and choline-deficient diet. Inflammation. 2008;31:91-98. [PubMed] [DOI]|
|90.||Tomita K, Tamiya G, Ando S, Ohsumi K, Chiyo T, Mizutani A, Kitamura N, Toda K, Kaneko T, Horie Y. Tumour necrosis factor alpha signalling through activation of Kupffer cells plays an essential role in liver fibrosis of non-alcoholic steatohepatitis in mice. Gut. 2006;55:415-424. [PubMed] [DOI]|
|91.||Poynard T, Massard J, Rudler M, Varaud A, Lebray P, Moussalli J, Munteanu M, Ngo Y, Thabut D, Benhamou Y. Impact of interferon-alpha treatment on liver fibrosis in patients with chronic hepatitis B: an overview of published trials. Gastroenterol Clin Biol. 2009;33:916-922. [PubMed] [DOI]|
|92.||Ogawa T, Kawada N, Ikeda K. Effect of natural interferon α on proliferation and apoptosis of hepatic stellate cells. Hepatol Int. 2009;3:497-503. [PubMed] [DOI]|
|93.||Rao HY, Wei L, Wang JH, Fei R, Jiang D, Zhang Q, Chen HS, Cong X. Inhibitory effect of human interferon-beta-1a on activated rat and human hepatic stellate cells. J Gastroenterol Hepatol. 2010;25:1777-1784. [PubMed] [DOI]|
|94.||Baroni GS, D’Ambrosio L, Curto P, Casini A, Mancini R, Jezequel AM, Benedetti A. Interferon gamma decreases hepatic stellate cell activation and extracellular matrix deposition in rat liver fibrosis. Hepatology. 1996;23:1189-1199. [PubMed] [DOI]|
|95.||Du S, Li H, Cui Y, Yang L, Wu J, Huang H, Chen Y, Huang W, Zhang R, Yang J. Houttuynia cordata inhibits lipopolysaccharide-induced rapid pulmonary fibrosis by up-regulating IFN-γ and inhibiting the TGF-β1/Smad pathway. Int Immunopharmacol. 2012;13:331-340. [PubMed] [DOI]|
|96.||Saile B, Eisenbach C, Dudas J, El-Armouche H, Ramadori G. Interferon-gamma acts proapoptotic on hepatic stellate cells (HSC) and abrogates the antiapoptotic effect of interferon-alpha by an HSP70-dependant pathway. Eur J Cell Biol. 2004;83:469-476. [PubMed] [DOI]|
|97.||Gieling RG, Wallace K, Han YP. Interleukin-1 participates in the progression from liver injury to fibrosis. Am J Physiol Gastrointest Liver Physiol. 2009;296:G1324-G1331. [PubMed] [DOI]|
|98.||Kamari Y, Shaish A, Vax E, Shemesh S, Kandel-Kfir M, Arbel Y, Olteanu S, Barshack I, Dotan S, Voronov E. Lack of interleukin-1α or interleukin-1β inhibits transformation of steatosis to steatohepatitis and liver fibrosis in hypercholesterolemic mice. J Hepatol. 2011;55:1086-1094. [PubMed] [DOI]|
|99.||Mancini R, Benedetti A, Jezequel AM. An interleukin-1 receptor antagonist decreases fibrosis induced by dimethylnitrosamine in rat liver. Virchows Arch. 1994;424:25-31. [PubMed] [DOI]|
|100.||Petrasek J, Bala S, Csak T, Lippai D, Kodys K, Menashy V, Barrieau M, Min SY, Kurt-Jones EA, Szabo G. IL-1 receptor antagonist ameliorates inflammasome-dependent alcoholic steatohepatitis in mice. J Clin Invest. 2012;122:3476-3489. [PubMed] [DOI]|
|101.||Du WJ, Zhen JH, Zeng ZQ, Zheng ZM, Xu Y, Qin LY, Chen SJ. Expression of interleukin-17 associated with disease progression and liver fibrosis with hepatitis B virus infection: IL-17 in HBV infection. Diagn Pathol. 2013;8:40. [PubMed] [DOI]|
|102.||Hara M, Kono H, Furuya S, Hirayama K, Tsuchiya M, Fujii H. Interleukin-17A plays a pivotal role in cholestatic liver fibrosis in mice. J Surg Res. 2013;183:574-582. [PubMed] [DOI]|
|103.||Meng F, Wang K, Aoyama T, Grivennikov SI, Paik Y, Scholten D, Cong M, Iwaisako K, Liu X, Zhang M. Interleukin-17 signaling in inflammatory, Kupffer cells, and hepatic stellate cells exacerbates liver fibrosis in mice. Gastroenterology. 2012;143:765-766.e1-3. [PubMed] [DOI]|
|104.||Chou WY, Lu CN, Lee TH, Wu CL, Hung KS, Concejero AM, Jawan B, Wang CH. Electroporative interleukin-10 gene transfer ameliorates carbon tetrachloride-induced murine liver fibrosis by MMP and TIMP modulation. Acta Pharmacol Sin. 2006;27:469-476. [PubMed] [DOI]|
|105.||Nelson DR, Lauwers GY, Lau JY, Davis GL. Interleukin 10 treatment reduces fibrosis in patients with chronic hepatitis C: a pilot trial of interferon nonresponders. Gastroenterology. 2000;118:655-660. [PubMed] [DOI]|
|106.||Zhang LJ, Zheng WD, Chen YX, Huang YH, Chen ZX, Zhang SJ, Shi MN, Wang XZ. Antifibrotic effects of interleukin-10 on experimental hepatic fibrosis. Hepatogastroenterology. 2007;54:2092-2098. [PubMed]|
|107.||Huang YH, Shi MN, Zheng WD, Zhang LJ, Chen ZX, Wang XZ. Therapeutic effect of interleukin-10 on CCl4-induced hepatic fibrosis in rats. World J Gastroenterol. 2006;12:1386-1391. [PubMed]|
|108.||Kong X, Feng D, Wang H, Hong F, Bertola A, Wang FS, Gao B. Interleukin-22 induces hepatic stellate cell senescence and restricts liver fibrosis in mice. Hepatology. 2012;56:1150-1159. [PubMed] [DOI]|
|109.||Kishimoto T. IL-6: from its discovery to clinical applications. Int Immunol. 2010;22:347-352. [PubMed] [DOI]|
|110.||Kovalovich K, DeAngelis RA, Li W, Furth EE, Ciliberto G, Taub R. Increased toxin-induced liver injury and fibrosis in interleukin-6-deficient mice. Hepatology. 2000;31:149-159. [PubMed] [DOI]|
|111.||Nasir GA, Mohsin S, Khan M, Shams S, Ali G, Khan SN, Riazuddin S. Mesenchymal stem cells and Interleukin-6 attenuate liver fibrosis in mice. J Transl Med. 2013;11:78. [PubMed] [DOI]|
|112.||Tarantino G, Conca P, Pasanisi F, Ariello M, Mastrolia M, Arena A, Tarantino M, Scopacasa F, Vecchione R. Could inflammatory markers help diagnose nonalcoholic steatohepatitis? Eur J Gastroenterol Hepatol. 2009;21:504-511. [PubMed] [DOI]|
|113.||Tarantino G, Savastano S, Colao A. Hepatic steatosis, low-grade chronic inflammation and hormone/growth factor/adipokine imbalance. World J Gastroenterol. 2010;16:4773-4783. [PubMed] [DOI]|
|114.||Trebicka J, Anadol E, Elfimova N, Strack I, Roggendorf M, Viazov S, Wedemeyer I, Drebber U, Rockstroh J, Sauerbruch T. Hepatic and serum levels of miR-122 after chronic HCV-induced fibrosis. J Hepatol. 2013;58:234-239. [PubMed] [DOI]|
|115.||Zhang Z, Gao Z, Hu W, Yin S, Wang C, Zang Y, Chen J, Zhang J, Dong L. 3,3’-Diindolylmethane ameliorates experimental hepatic fibrosis via inhibiting miR-21 expression. Br J Pharmacol. 2013;170:649-660. [PubMed] [DOI]|
|116.||Wang B, Li W, Guo K, Xiao Y, Wang Y, Fan J. miR-181b promotes hepatic stellate cells proliferation by targeting p27 and is elevated in the serum of cirrhosis patients. Biochem Biophys Res Commun. 2012;421:4-8. [PubMed] [DOI]|
|117.||Iizuka M, Ogawa T, Enomoto M, Motoyama H, Yoshizato K, Ikeda K, Kawada N. Induction of microRNA-214-5p in human and rodent liver fibrosis. Fibrogenesis Tissue Repair. 2012;5:12. [PubMed] [DOI]|
|118.||Ogawa T, Enomoto M, Fujii H, Sekiya Y, Yoshizato K, Ikeda K, Kawada N. MicroRNA-221/222 upregulation indicates the activation of stellate cells and the progression of liver fibrosis. Gut. 2012;61:1600-1609. [PubMed] [DOI]|
|119.||Murakami Y, Toyoda H, Tanaka M, Kuroda M, Harada Y, Matsuda F, Tajima A, Kosaka N, Ochiya T, Shimotohno K. The progression of liver fibrosis is related with overexpression of the miR-199 and 200 families. PLoS One. 2011;6:e16081. [PubMed] [DOI]|
|120.||Roderburg C, Mollnow T, Bongaerts B, Elfimova N, Vargas Cardenas D, Berger K, Zimmermann H, Koch A, Vucur M, Luedde M. Micro-RNA profiling in human serum reveals compartment-specific roles of miR-571 and miR-652 in liver cirrhosis. PLoS One. 2012;7:e32999. [PubMed] [DOI]|
|121.||Venugopal SK, Jiang J, Kim TH, Li Y, Wang SS, Torok NJ, Wu J, Zern MA. Liver fibrosis causes downregulation of miRNA-150 and miRNA-194 in hepatic stellate cells, and their overexpression causes decreased stellate cell activation. Am J Physiol Gastrointest Liver Physiol. 2010;298:G101-G106. [PubMed] [DOI]|
|122.||Roderburg C, Urban GW, Bettermann K, Vucur M, Zimmermann H, Schmidt S, Janssen J, Koppe C, Knolle P, Castoldi M. Micro-RNA profiling reveals a role for miR-29 in human and murine liver fibrosis. Hepatology. 2011;53:209-218. [PubMed] [DOI]|
|123.||Roderburg C, Luedde M, Vargas Cardenas D, Vucur M, Mollnow T, Zimmermann HW, Koch A, Hellerbrand C, Weiskirchen R, Frey N. miR-133a mediates TGF-β-dependent derepression of collagen synthesis in hepatic stellate cells during liver fibrosis. J Hepatol. 2013;58:736-742. [PubMed] [DOI]|
|124.||Zhang JJ, Meng XK, Dong C, Qiao JL, Zhang RF, Yue GQ, Zhong HY. Development of a new animal model of liver cirrhosis in swine. Eur Surg Res. 2009;42:35-39. [PubMed] [DOI]|
|125.||Hong RT, Xu JM, Mei Q. Melatonin ameliorates experimental hepatic fibrosis induced by carbon tetrachloride in rats. World J Gastroenterol. 2009;15:1452-1458. [PubMed] [DOI]|
|126.||Wang JY, Guo JS, Li H, Liu SL, Zern MA. Inhibitory effect of glycyrrhizin on NF-kappaB binding activity in CCl4- plus ethanol-induced liver cirrhosis in rats. Liver. 1998;18:180-185. [PubMed] [DOI]|
|127.||Karantonis HC, Gribilas G, Stamoulis I, Giaginis C, Spiliopoulou C, Kouraklis G, Demopoulos C, Theocharis SE. Platelet-activating factor involvement in thioacetamide-induced experimental liver fibrosis and cirrhosis. Dig Dis Sci. 2010;55:276-284. [PubMed] [DOI]|
|128.||Chen IS, Chen YC, Chou CH, Chuang RF, Sheen LY, Chiu CH. Hepatoprotection of silymarin against thioacetamide-induced chronic liver fibrosis. J Sci Food Agric. 2012;92:1441-1447. [PubMed] [DOI]|
|129.||Lee MF, Liu ML, Cheng AC, Tsai ML, Ho CT, Liou WS, Pan MH. Pterostilbene inhibits dimethylnitrosamine-induced liver fibrosis in rats. Food Chem. 2013;138:802-807. [PubMed] [DOI]|
|130.||Lee MF, Tsai ML, Sun PP, Chien LL, Cheng AC, Ma NJ, Ho CT, Pan MH. Phyto-power dietary supplement potently inhibits dimethylnitrosamine-induced liver fibrosis in rats. Food Funct. 2013;4:470-475. [PubMed] [DOI]|
|131.||Pierre S, Chevallier A, Teixeira-Clerc F, Ambolet-Camoit A, Bui LC, Bats AS, Fournet JC, Fernandez-Salguero P, Aggerbeck M, Lotersztajn S. Aryl hydrocarbon receptor-dependent induction of liver fibrosis by dioxin. Toxicol Sci. 2014;137:114-124. [PubMed] [DOI]|
|132.||Wu J, Cheng ML, Li L, Li CX, Jiang L, Zhang Y, Ou B. [Model establishment of liver fibrosis in oral arsenic solution exposed mice]. Zhonghua Yixue Zazhi. 2009;89:1455-1459. [PubMed]|
|133.||Su X, Wang Y, Zhou G, Yang X, Yu R, Lin Y, Zheng C. Probucol attenuates ethanol-induced liver fibrosis in rats by inhibiting oxidative stress, extracellular matrix protein accumulation and cytokine production. Clin Exp Pharmacol Physiol. 2014;41:73-80. [PubMed] [DOI]|
|134.||Tan TC, Crawford DH, Jaskowski LA, Subramaniam VN, Clouston AD, Crane DI, Bridle KR, Anderson GJ, Fletcher LM. Excess iron modulates endoplasmic reticulum stress-associated pathways in a mouse model of alcohol and high-fat diet-induced liver injury. Lab Invest. 2013;93:1295-1312. [PubMed] [DOI]|
|135.||Kawaguchi K, Sakaida I, Tsuchiya M, Omori K, Takami T, Okita K. Pioglitazone prevents hepatic steatosis, fibrosis, and enzyme-altered lesions in rat liver cirrhosis induced by a choline-deficient L-amino acid-defined diet. Biochem Biophys Res Commun. 2004;315:187-195. [PubMed] [DOI]|
|136.||Ibañez P, Solis N, Pizarro M, Aguayo G, Duarte I, Miquel JF, Accatino L, Arrese M. Effect of losartan on early liver fibrosis development in a rat model of nonalcoholic steatohepatitis. J Gastroenterol Hepatol. 2007;22:846-851. [PubMed] [DOI]|
|137.||Mazo DF, de Oliveira MG, Pereira IV, Cogliati B, Stefano JT, de Souza GF, Rabelo F, Lima FR, Ferreira Alves VA, Carrilho FJ. S-nitroso-N-acetylcysteine attenuates liver fibrosis in experimental nonalcoholic steatohepatitis. Drug Des Devel Ther. 2013;7:553-563. [PubMed] [DOI]|
|138.||Jia X, Naito H, Yetti H, Tamada H, Kitamori K, Hayashi Y, Wang D, Yanagiba Y, Wang J, Ikeda K. Dysregulated bile acid synthesis, metabolism and excretion in a high fat-cholesterol diet-induced fibrotic steatohepatitis in rats. Dig Dis Sci. 2013;58:2212-2222. [PubMed] [DOI]|
|139.||Yang L, Kwon J, Popov Y, Gajdos GB, Ordog T, Brekken RA, Mukhopadhyay D, Schuppan D, Bi Y, Simonetto D. Vascular endothelial growth factor promotes fibrosis resolution and repair in mice. Gastroenterology. 2014;146:1339-50.e1. [PubMed] [DOI]|
|140.||Wang X, Lopategi A, Ge X, Lu Y, Kitamura N, Urtasun R, Leung TM, Fiel MI, Nieto N. Osteopontin induces ductular reaction contributing to liver fibrosis. Gut. 2014;Epub ahead of print. [PubMed] [DOI]|
|141.||Liang J, Zhang B, Shen RW, Liu JB, Gao MH, Li Y, Li YY, Zhang W. Preventive effect of halofuginone on concanavalin A-induced liver fibrosis. PLoS One. 2013;8:e82232. [PubMed] [DOI]|
|142.||Wu CS, Piao XX, Piao DM, Jin YR, Li CH. Treatment of pig serum-induced rat liver fibrosis with Boschniakia rossica, oxymatrine and interferon-alpha. World J Gastroenterol. 2005;11:122-126. [PubMed]|
|143.||Wang BE. [Animals with liver fibrosis induced by albumin immunization]. Zhonghua Yixue Zazhi. 1989;69:503-505, 36. [PubMed]|
|144.||Santra A, Chowdhury A, Ghosh A, Mazumder DN. Development of an animal model of hepatic fibrosis by excretory-secretory antigen of Ascaris suum. Indian J Gastroenterol. 2000;19:119-121. [PubMed]|
|145.||Yang KL, Hung KC, Chang WT, Li EI. Establishment of an early liver fibrosis model by the hydrodynamics-based transfer of TGF-beta1 gene. Comp Hepatol. 2007;6:9. [PubMed] [DOI]|
|146.||Urbanik T, Boger RJ, Longerich T, Becker K, Ehrenberg KR, Hövelmeyer N, Hahn M, Schuchmann M, Jäger D, Waisman A. Liver specific deletion of CYLDexon7/8 induces severe biliary damage, fibrosis and increases hepatocarcinogenesis in mice. J Hepatol. 2012;57:995-1003. [PubMed] [DOI]|
|147.||Sohrabpour AA, Mohamadnejad M, Malekzadeh R. Review article: the reversibility of cirrhosis. Aliment Pharmacol Ther. 2012;36:824-832. [PubMed]|
|148.||Gieling RG, Burt AD, Mann DA. Fibrosis and cirrhosis reversibility - molecular mechanisms. Clin Liver Dis. 2008;12:915-937, xi. [PubMed] [DOI]|
|149.||Arthur MJ. Reversibility of liver fibrosis and cirrhosis following treatment for hepatitis C. Gastroenterology. 2002;122:1525-1528. [PubMed] [DOI]|
|150.||Başar O, Yimaz B, Ekiz F, Giniş Z, Altinbaş A, Aktaş B, Tuna Y, Çoban S, Delibaş N, Yüksel O. Non-invasive tests in prediction of liver fibrosis in chronic hepatitis B and comparison with post-antiviral treatment results. Clin Res Hepatol Gastroenterol. 2013;37:152-158. [PubMed] [DOI]|
|151.||Berenguer M, Schuppan D. Progression of liver fibrosis in post-transplant hepatitis C: mechanisms, assessment and treatment. J Hepatol. 2013;58:1028-1041. [PubMed] [DOI]|
|152.||Hou G, Dick R, Brewer GJ. Improvement in dissolution of liver fibrosis in an animal model by tetrathiomolybdate. Exp Biol Med (Maywood). 2009;234:662-665. [PubMed] [DOI]|
|153.||Kim SU, Park JY, Kim do Y, Ahn SH, Choi EH, Seok JY, Lee JM, Park YN, Chon CY, Han KH. Non-invasive assessment of changes in liver fibrosis via liver stiffness measurement in patients with chronic hepatitis B: impact of antiviral treatment on fibrosis regression. Hepatol Int. 2010;4:673-680. [PubMed] [DOI]|
|154.||Ying C, Colonno R, De Clercq E, Neyts J. Ribavirin and mycophenolic acid markedly potentiate the anti-hepatitis B virus activity of entecavir. Antiviral Res. 2007;73:192-196. [PubMed] [DOI]|
|155.||Degertekin B, Lok AS. Update on viral hepatitis: 2007. Curr Opin Gastroenterol. 2008;24:306-311. [PubMed] [DOI]|
|156.||Tasci I, Mas MR, Vural SA, Deveci S, Comert B, Alcigir G, Mas N, Akay C, Bozdayi M, Yurdaydin C. Pegylated interferon-alpha plus taurine in treatment of rat liver fibrosis. World J Gastroenterol. 2007;13:3237-3244. [PubMed]|
|157.||Chávez E, Segovia J, Shibayama M, Tsutsumi V, Vergara P, Castro-Sánchez L, Salazar EP, Moreno MG, Muriel P. Antifibrotic and fibrolytic properties of celecoxib in liver damage induced by carbon tetrachloride in the rat. Liver Int. 2010;30:969-978. [PubMed] [DOI]|
|158.||Refik Mas M, Comert B, Oncu K, Vural SA, Akay C, Tasci I, Ozkomur E, Serdar M, Mas N, Alcigir G. The effect of taurine treatment on oxidative stress in experimental liver fibrosis. Hepatol Res. 2004;28:207-215. [PubMed] [DOI]|
|159.||Wang X, Zhang R, Du J, Hu Y, Xu L, Lu J, Ye S. Vitamin E reduces hepatic fibrosis in mice with Schistosoma japonicum infection. Mol Med Rep. 2012;5:465-468. [PubMed] [DOI]|
|160.||Mohamadnejad M, Malekzadeh R, Nasseri-Moghaddam S, Hagh-Azali S, Rakhshani N, Tavangar SM, Sedaghat M, Alimohamadi SM. Impact of immunosuppressive treatment on liver fibrosis in autoimmune hepatitis. Dig Dis Sci. 2005;50:547-551. [PubMed] [DOI]|
|161.||Nikolaidis N, Kountouras J, Giouleme O, Tzarou V, Chatzizisi O, Patsiaoura K, Papageorgiou A, Leontsini M, Eugenidis N, Zamboulis C. Colchicine treatment of liver fibrosis. Hepatogastroenterology. 2006;53:281-285. [PubMed]|
|162.||Biecker E, De Gottardi A, Neef M, Unternährer M, Schneider V, Ledermann M, Sägesser H, Shaw S, Reichen J. Long-term treatment of bile duct-ligated rats with rapamycin (sirolimus) significantly attenuates liver fibrosis: analysis of the underlying mechanisms. J Pharmacol Exp Ther. 2005;313:952-961. [PubMed] [DOI]|
|163.||Neef M, Ledermann M, Saegesser H, Schneider V, Reichen J. Low-dose oral rapamycin treatment reduces fibrogenesis, improves liver function, and prolongs survival in rats with established liver cirrhosis. J Hepatol. 2006;45:786-796. [PubMed] [DOI]|
|164.||Bataller R, Brenner DA. Hepatic stellate cells as a target for the treatment of liver fibrosis. Semin Liver Dis. 2001;21:437-451. [PubMed] [DOI]|
|165.||Klironomos S, Notas G, Sfakianaki O, Kiagiadaki F, Xidakis C, Kouroumalis E. Octreotide modulates the effects on fibrosis of TNF-α, TGF-β and PDGF in activated rat hepatic stellate cells. Regul Pept. 2014;188:5-12. [PubMed] [DOI]|
|166.||Tao YY, Wang QL, Shen L, Fu WW, Liu CH. Salvianolic acid B inhibits hepatic stellate cell activation through transforming growth factor beta-1 signal transduction pathway in vivo and in vitro. Exp Biol Med (Maywood). 2013;238:1284-1296. [PubMed] [DOI]|
|167.||Borkham-Kamphorst E, Stoll D, Gressner AM, Weiskirchen R. Antisense strategy against PDGF B-chain proves effective in preventing experimental liver fibrogenesis. Biochem Biophys Res Commun. 2004;321:413-423. [PubMed] [DOI]|
|168.||Saile B, DiRocco P, Dudas J, El-Armouche H, Sebb H, Eisenbach C, Neubauer K, Ramadori G. IGF-I induces DNA synthesis and apoptosis in rat liver hepatic stellate cells (HSC) but DNA synthesis and proliferation in rat liver myofibroblasts (rMF). Lab Invest. 2004;84:1037-1049. [PubMed] [DOI]|
|169.||Saller R, Meier R, Brignoli R. The use of silymarin in the treatment of liver diseases. Drugs. 2001;61:2035-2063. [PubMed] [DOI]|
|170.||Mas N, Tasci I, Comert B, Ocal R, Mas MR. Ursodeoxycholic acid treatment improves hepatocyte ultrastructure in rat liver fibrosis. World J Gastroenterol. 2008;14:1108-1111. [PubMed] [DOI]|
|171.||Pan XL, Zhao L, Li L, Li AH, Ye J, Yang L, Xu KS, Hou XH. Efficacy and safety of tauroursodeoxycholic acid in the treatment of liver cirrhosis: a double-blind randomized controlled trial. J Huazhong Univ Sci Technolog Med Sci. 2013;33:189-194. [PubMed] [DOI]|
|172.||Xu D, Wu Y, Liao ZX, Wang H. Protective effect of verapamil on multiple hepatotoxic factors-induced liver fibrosis in rats. Pharmacol Res. 2007;55:280-286. [PubMed] [DOI]|
|173.||Zhang SH, Wen KM, Wu W, Li WY, Zhao JN. Efficacy of HGF carried by ultrasound microbubble-cationic nano-liposomes complex for treating hepatic fibrosis in a bile duct ligation rat model, and its relationship with the diffusion-weighted MRI parameters. Clin Res Hepatol Gastroenterol. 2013;37:602-607. [PubMed] [DOI]|
|174.||Wang ZX, Wang ZG, Ran HT, Ren JL, Zhang Y, Li Q, Zhu YF, Ao M. The treatment of liver fibrosis induced by hepatocyte growth factor-directed, ultrasound-targeted microbubble destruction in rats. Clin Imaging. 2009;33:454-461. [PubMed] [DOI]|
|175.||Inagaki Y, Higashiyama R, Okazaki I. Treatment strategy for liver fibrosis through recruitment and differentiation of bone marrow stem/progenitor cells. Hepatol Res. 2007;37:991-993. [PubMed] [DOI]|
|176.||Tsai PC, Fu TW, Chen YM, Ko TL, Chen TH, Shih YH, Hung SC, Fu YS. The therapeutic potential of human umbilical mesenchymal stem cells from Wharton’s jelly in the treatment of rat liver fibrosis. Liver Transpl. 2009;15:484-495. [PubMed] [DOI]|
|177.||Terai S, Takami T, Yamamoto N, Fujisawa K, Ishikawa T, Urata Y, Tanimoto H, Iwamoto T, Mizunaga Y, Matsuda T. Status and prospects of liver cirrhosis treatment by using bone marrow-derived cells and mesenchymal cells. Tissue Eng Part B Rev. 2014;20:206-210. [PubMed] [DOI]|
|178.||Seo KW, Sohn SY, Bhang DH, Nam MJ, Lee HW, Youn HY. Therapeutic effects of hepatocyte growth factor-overexpressing human umbilical cord blood-derived mesenchymal stem cells on liver fibrosis in rats. Cell Biol Int. 2014;38:106-116. [PubMed] [DOI]|
|179.||Cheng K, Mahato RI. Gene modulation for treating liver fibrosis. Crit Rev Ther Drug Carrier Syst. 2007;24:93-146. [PubMed] [DOI]|
|180.||Doh KO, Jung HK, Moon IJ, Kang HG, Park JH, Park JG. Prevention of CCl4-induced liver cirrhosis by ribbon antisense to transforming growth factor-beta1. Int J Mol Med. 2008;21:33-39. [PubMed]|
|181.||Nie QH, Zhu CL, Zhang YF, Yang J, Zhang JC, Gao RT. Inhibitory effect of antisense oligonucleotide targeting TIMP-2 on immune-induced liver fibrosis. Dig Dis Sci. 2010;55:1286-1295. [PubMed] [DOI]|
|182.||Lang Q, Liu Q, Xu N, Qian KL, Qi JH, Sun YC, Xiao L, Shi XF. The antifibrotic effects of TGF-β1 siRNA on hepatic fibrosis in rats. Biochem Biophys Res Commun. 2011;409:448-453. [PubMed] [DOI]|
|183.||Li G, Xie Q, Shi Y, Li D, Zhang M, Jiang S, Zhou H, Lu H, Jin Y. Inhibition of connective tissue growth factor by siRNA prevents liver fibrosis in rats. J Gene Med. 2006;8:889-900. [PubMed] [DOI]|
|184.||Park K, Hong SW, Hur W, Lee MY, Yang JA, Kim SW, Yoon SK, Hahn SK. Target specific systemic delivery of TGF-β siRNA/(PEI-SS)-g-HA complex for the treatment of liver cirrhosis. Biomaterials. 2011;32:4951-4958. [PubMed] [DOI]|
|185.||Chen SL, Zheng MH, Shi KQ, Yang T, Chen YP. A new strategy for treatment of liver fibrosis: letting MicroRNAs do the job. BioDrugs. 2013;27:25-34. [PubMed] [DOI]|
|186.||Daneshpour N, Griffin M, Collighan R, Perrie Y. Targeted delivery of a novel group of site-directed transglutaminase inhibitors to the liver using liposomes: a new approach for the potential treatment of liver fibrosis. J Drug Target. 2011;19:624-631. [PubMed] [DOI]|
|187.||Li F, Wang JY. Targeted delivery of drugs for liver fibrosis. Expert Opin Drug Deliv. 2009;6:531-541. [PubMed] [DOI]|
|188.||Luk JM, Wang X, Liu P, Wong KF, Chan KL, Tong Y, Hui CK, Lau GK, Fan ST. Traditional Chinese herbal medicines for treatment of liver fibrosis and cancer: from laboratory discovery to clinical evaluation. Liver Int. 2007;27:879-890. [PubMed] [DOI]|
|189.||Feng Y, Cheung KF, Wang N, Liu P, Nagamatsu T, Tong Y. Chinese medicines as a resource for liver fibrosis treatment. Chin Med. 2009;4:16. [PubMed] [DOI]|
|190.||Liu P, Hu YY, Liu C, Zhu DY, Xue HM, Xu ZQ, Xu LM, Liu CH, Gu HT, Zhang ZQ. Clinical observation of salvianolic acid B in treatment of liver fibrosis in chronic hepatitis B. World J Gastroenterol. 2002;8:679-685. [PubMed]|
|191.||Chen YW, Wu JX, Chen YW, Li DG, Lu HM. Tetrandrine inhibits activation of rat hepatic stellate cells in vitro via transforming growth factor-beta signaling. World J Gastroenterol. 2005;11:2922-2926. [PubMed]|
|192.||Zhang QS, Yuan RH, Zhang J, Tian GY. [Targeted glycyrrhetinic acid to receptors of hepatic stellate cells for the treatment of rat liver fibrosis: a pilot study]. Zhonghua Ganzangbing Zazhi. 2004;12:512. [PubMed]|
|193.||Chuang SE, Cheng AL, Lin JK, Kuo ML. Inhibition by curcumin of diethylnitrosamine-induced hepatic hyperplasia, inflammation, cellular gene products and cell-cycle-related proteins in rats. Food Chem Toxicol. 2000;38:991-995. [PubMed] [DOI]|
|194.||Hsu YC, Lin YL, Chiu YT, Shiao MS, Lee CY, Huang YT. Antifibrotic effects of Salvia miltiorrhiza on dimethylnitrosamine-intoxicated rats. J Biomed Sci. 2005;12:185-195. [PubMed] [DOI]|
|195.||Wu YW, Fang HL, Lin WC. Post-treatment of Ganoderma lucidum reduced liver fibrosis induced by thioacetamide in mice. Phytother Res. 2010;24:494-499. [PubMed] [DOI]|
|196.||Liu P. Fuzheng huayu capsule in the treatment of liver fibrosis: clinical evidence and mechanism of action. Chin J Integr Med. 2012;18:398-400. [PubMed] [DOI]|
|197.||Yao L, Yao ZM, Weng H, Zhao GP, Zhou YJ, Yu T. Effect of rat serum containing Biejiajian oral liquid on proliferation of rat hepatic stellate cells. World J Gastroenterol. 2004;10:1911-1913. [PubMed]|
|198.||Yao XX, Jiang SL, Tang YW, Yao DM, Yao X. Efficacy of Chinese medicine Yi-gan-kang granule in prophylaxis and treatment of liver fibrosis in rats. World J Gastroenterol. 2005;11:2583-2590. [PubMed]|
|199.||Ji G, Wang L, Zhang SH, Liu JW, Zheng PY, Liu T. Effect of Chinese medicine Qinggan Huoxuefang on inducing HSC apoptosis in alcoholic liver fibrosis rats. World J Gastroenterol. 2006;12:2047-2052. [PubMed]|