Semin Liver Dis 2007; 27(4): 339-350
DOI: 10.1055/s-2007-991511
© Thieme Medical Publishers

Innate Immune Response and Hepatic Inflammation

Gyongyi Szabo1 , Pranoti Mandrekar1 , Angela Dolganiuc1
  • 1Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
Further Information

Publication History

Publication Date:
02 November 2007 (online)

ABSTRACT

Inflammation is a pathogenic component of various types of acute and chronic liver diseases, and it contributes to progressive liver damage and fibrosis. Cells of the innate immune system initiate and maintain hepatic inflammation though mediator production as a result of their activation by pathogen-derived products recognized by pattern recognition receptors. Innate immune cells, particularly dendritic cells, have a pivotal role in sensing pathogens and initiating adaptive immune responses by activation and regulation of T-lymphocyte responses. Although the liver provides a “tolerogenic” immune environment for antigen-specific T-cells, activation of Kupffer cells, recruited macrophages, and inflammatory cells results in production of cytokines and chemokines that can lead to prolonged inflammation, hepatocyte damage, and/or cholestasis. The specificity of Toll-like receptors and the mechanisms of innate immune cell activation are discussed in relation to acute and chronic liver injury including viral, alcoholic, nonalcoholic, and drug-induced hepatitis.

REFERENCES

  • 1 Szabo G, Dolganiuc A, Mandrekar P. Pattern recognition receptors: a contemporary view on liver diseases.  Hepatology. 2006;  44 287-298
  • 2 Schwabe R F, Seki E, Brenner D A. Toll-like receptor signaling in the liver.  Gastroenterology. 2006;  130 1886-1900
  • 3 Takeda K, Akira S. Toll-like receptors in innate immunity.  Int Immunol. 2005;  17 1-14
  • 4 Zarember K A, Godowski P J. Tissue expression of human Toll-like receptors and differential regulation of Toll-like receptor mRNAs in leukocytes in response to microbes, their products, and cytokines.  J Immunol. 2002;  168 554-561
  • 5 Vodovotz Y, Liu S, McCloskey C et al.. The hepatocyte as a microbial product-responsive cell.  J Endotoxin Res. 2001;  7 365-373
  • 6 Paik Y H, Schwabe R F, Bataller R et al.. Toll-like receptor 4 mediates inflammatory signaling by bacterial lipopolysaccharide in human hepatic stellate cells.  Hepatology. 2003;  37 1043-1055
  • 7 Yumoto H, Chou H H, Takahashi Y et al.. Sensitization of human aortic endothelial cells to lipopolysaccharide via regulation of Toll-like receptor 4 by bacterial fimbria-dependent invasion.  Infect Immun. 2005;  73 8050-8059
  • 8 Matsumura T, Ito A, Takii T, Hayashi H, Onozaki K. Endotoxin and cytokine regulation of toll-like receptor (TLR) 2 and TLR4 gene expression in murine liver and hepatocytes.  J Interferon Cytokine Res. 2000;  20 915-921
  • 9 Akira S. TLR signaling.  Curr Top Microbiol Immunol. 2006;  311 1-16
  • 10 Seth R B, Sun L, Chen Z J. Antiviral innate immunity pathways.  Cell Res. 2006;  16 141-147
  • 11 Heil F, Hemmi H, Hochrein H et al.. Species-specific recognition of single-stranded RNA via toll-like receptor 7 and 8.  Science. 2004;  303 1526-1529
  • 12 Sen G C, Sarkar S N. Transcriptional signaling by double-stranded RNA: role of TLR3.  Cytokine Growth Factor Rev. 2005;  16 1-14
  • 13 Jiang Z, Georgel P, Du X et al.. CD14 is required for MyD88-independent LPS signaling.  Nat Immunol. 2005;  6 565-570
  • 14 Gorden K K, Qiu X, Battiste J J et al.. Oligodeoxynucleotides differentially modulate activation of TLR7 and TLR8 by imidazoquinolines.  J Immunol. 2006;  177 8164-8170
  • 15 Bekeredjian-Ding I, Roth S I, Gilles S et al.. T cell-independent, TLR-induced IL-12p70 production in primary human monocytes.  J Immunol. 2006;  176 7438-7446
  • 16 Creagh E M, O'Neill L A. TLRs, NLRs and RLRs: a trinity of pathogen sensors that co-operate in innate immunity.  Trends Immunol. 2006;  27 352-357
  • 17 Meylan E, Tschopp J. Toll-like receptors and RNA helicases: two parallel ways to trigger antiviral responses.  Mol Cell. 2006;  22 561-569
  • 18 Bowie A G, Fitzgerald K A. RIG-I: tri-ing to discriminate between self and non-self RNA.  Trends Immunol. 2007 Feb 15 (Epub ahead of print); 
  • 19 Saito T, Hirai R, Loo Y M et al.. Regulation of innate antiviral defenses through a shared repressor domain in RIG-I and LGP2.  Proc Natl Acad Sci U S A. 2007;  104 582-587
  • 20 Kato H, Takeuchi O, Sato S et al.. Differential roles of MDA5 and RIG-I helicases in the recognition of RNA viruses.  Nature. 2006;  441 101-105
  • 21 Seth R B, Sun L, Ea C K, Chen Z J. Identification and characterization of MAVS, a mitochondrial antiviral signaling protein that activates NF-kappaB and IRF 3.  Cell. 2005;  122 669-682
  • 22 Meylan E, Curran J, Hofmann K et al.. Cardif is an adaptor protein in the RIG-I antiviral pathway and is targeted by hepatitis C virus.  Nature. 2005;  437 1167-1172
  • 23 Kawai T, Takahashi K, Sato S et al.. IPS-1, an adaptor triggering RIG-I- and Mda5-mediated type I interferon induction.  Nat Immunol. 2005;  6 981-988
  • 24 Xu L G, Wang Y Y, Han K J et al.. VISA is an adapter protein required for virus-triggered IFN-beta signaling.  Mol Cell. 2005;  19 727-740
  • 25 Saito T, Hirai R, Loo Y M et al.. Regulation of innate antiviral defenses through a shared repressor domain in RIG-I and LGP2.  Proc Natl Acad Sci U S A. 2007;  104 582-587
  • 26 Paz S, Sun Q, Nakhaei P et al.. Induction of IRF-3 and IRF-7 phosphorylation following activation of the RIG-I pathway.  Cell Mol Biol. 2006;  52 17-28
  • 27 Kamada N, Davies H S, Roser B. Reversal of transplantation immunity by liver grafting.  Nature. 1981;  292 840-842
  • 28 Lang K S, Georgiev P, Recher M et al.. Immunoprivileged status of the liver is controlled by Toll-like receptor 3 signaling.  J Clin Invest. 2006;  116 2456-2463
  • 29 De Creus A, Abe M, Lau A H et al.. Low TLR4 expression by liver dendritic cells correlates with reduced capacity to activate allogeneic T cells in response to endotoxin.  J Immunol. 2005;  174 2037-2045
  • 30 Parker G A, Picut C A. Liver immunobiology.  Toxicol Pathol. 2005;  33 52-62
  • 31 Hiraoka A, Horiike N, Akbar S M et al.. Expression of CD163 in the liver of patients with viral hepatitis.  Pathol Res Pract. 2005;  201 379-384
  • 32 Roberts R A, Ganey P E, Ju C et al.. Role of the Kupffer cell in mediating hepatic toxicity and carcinogenesis.  Toxicol Sci. 2007;  96 2-15
  • 33 Jiang W, Sun R, Wei H, Tian Z. Toll-like receptor 3 ligand attenuates LPS-induced liver injury by down-regulation of toll-like receptor 4 expression on macrophages.  Proc Natl Acad Sci U S A. 2005;  102 17077-17082
  • 34 Ojaniemi M, Liljeroos M, Harju K et al.. TLR-2 is upregulated and mobilized to the hepatocyte plasma membrane in the space of Disse and to the Kupffer cells TLR-4 dependently during acute endotoxemia in mice.  Immunol Lett. 2006;  102 158-168
  • 35 Thobe B M, Frink M, Hildebrand F et al.. The role of MAPK in Kupffer cell toll-like receptor (TLR) 2-, TLR4-, and TLR9-mediated signaling following trauma-hemorrhage.  J Cell Physiol. 2007;  210 667-675
  • 36 Vega V L, Maldonado M, Mardones L et al.. Role of Kupffer cells and PMN leukocytes in hepatic and systemic oxidative stress in rats subjected to tourniquet shock.  Shock. 1999;  11 403-410
  • 37 Yamashiro S, Kamohara H, Wang J M et al.. Phenotypic and functional change of cytokine-activated neutrophils: inflammatory neutrophils are heterogeneous and enhance adaptive immune responses.  J Leukoc Biol. 2001;  69 698-704
  • 38 Wagner J G, Roth R A. Neutrophil migration during endotoxemia.  J Leukoc Biol. 1999;  66 10-24
  • 39 Jaeschke H. Mechanisms of liver injury. II. Mechanisms of neutrophil-induced liver cell injury during hepatic ischemia-reperfusion and other acute inflammatory conditions.  Am J Physiol Gastrointest Liver Physiol. 2006;  290 G1083-G1088
  • 40 Wu L, Dakic A. Development of dendritic cell system.  Cell Mol Immunol. 2004;  1 112-118
  • 41 Steinman R M, Hemmi H. Dendritic cells: translating innate to adaptive immunity.  Curr Top Microbiol Immunol. 2006;  311 17-58
  • 42 Yoneyama H, Ichida T. Recruitment of dendritic cells to pathological niches in inflamed liver.  Med Mol Morphol. 2005;  38 136-141
  • 43 Matsuno K, Nomiyama H, Yoneyama H, Uwatoku R. Kupffer cell-mediated recruitment of dendritic cells to the liver crucial for a host defense.  Dev Immunol. 2002;  9 143-149
  • 44 Kudo S, Matsuno K, Ezaki T, Ogawa M. A novel migration pathway for rat dendritic cells from the blood: hepatic sinusoids-lymph translocation.  J Exp Med. 1997;  185 777-784
  • 45 Bosma B M, Metselaar H J, Mancham S et al.. Characterization of human liver dendritic cells in liver grafts and perfusates.  Liver Transpl. 2006;  12 384-393
  • 46 Steinbach F, Krause B, Blass S, Burmester G R, Hiepe F. Development of accessory phenotype and function during the differentiation of monocyte-derived dendritic cells.  Res Immunol. 1998;  149 627-632
  • 47 Hemmi H, Akira S. TLR signalling and the function of dendritic cells.  Chem Immunol Allergy. 2005;  86 120-135
  • 48 Seeds R E, Gordon S, Miller J L. Receptors and ligands involved in viral induction of type I interferon production by plasmacytoid dendritic cells.  Immunobiology. 2006;  211 525-535
  • 49 Lee H K, Lund J M, Ramanathan B, Mizushima N, Iwasaki A. Autophagy-Dependent Viral Recognition by Plasmacytoid Dendritic Cell. Science. 2007 Feb 1 (Epub ahead of print)
  • 50 Dolganiuc A, Chang S, Kodys K et al.. Hepatitis C virus (HCV) core protein-induced, monocyte-mediated mechanisms of reduced IFN-alpha and plasmacytoid dendritic cell loss in chronic HCV infection.  J Immunol. 2006;  177 6758-6768
  • 51 Loseke S, Grage-Griebenow E, Heine H et al.. In vitro-generated viral double-stranded RNA in contrast to polyinosinic:polycytidylic acid induces interferon-alpha in human plasmacytoid dendritic cells.  Scand J Immunol. 2006;  63 264-274
  • 52 Kingham T P, Chaudhry U I, Plitas G et al.. Murine liver plasmacytoid dendritic cells become potent immunostimulatory cells after Flt-3 ligand expansion.  Hepatology. 2007;  45 445-454
  • 53 Ahmad A, Alvarez F. Role of NK and NKT cells in the immunopathogenesis of HCV-induced hepatitis.  J Leukoc Biol. 2004;  76 743-759
  • 54 Doherty D G, O'Farrelly C. Innate and adaptive lymphoid cells in the human liver.  Immunol Rev. 2000;  174 5-20
  • 55 Siegmund S V, Dooley S, Brenner D A. Molecular mechanisms of alcohol-induced hepatic fibrosis.  Dig Dis. 2005;  23 264-274
  • 56 Pennington H L, Wilce P A, Worrall S. Chemokine and cell adhesion molecule mRNA expression and neutrophil infiltration in lipopolysaccharide-induced hepatitis in ethanol-fed rats.  Alcohol Clin Exp Res. 1998;  22 1713-1718
  • 57 Jaeschke H, Smith C W. Mechanisms of neutrophil-induced parenchymal cell injury.  J Leukoc Biol. 1997;  61 647-653
  • 58 Jaeschke H, Farhood A, Fisher M A, Smith C W. Sequestration of neutrophils in the hepatic vasculature during endotoxemia is independent of beta 2 integrins and intercellular adhesion molecule-1.  Shock. 1996;  6 351-356
  • 59 Jaeschke H, Smith C W, Clemens M G, Ganey P E, Roth R A. Related mechanisms of inflammatory liver injury: adhesion molecules and cytotoxicity of neutrophils.  Toxicol Appl Pharmacol. 1996;  139 213-226
  • 60 Kobayashi A, Imamura H, Isobe M et al.. Mac-1 (CD11b/CD18) and intercellular adhesion molecule-1 in ischemia-reperfusion injury of rat liver.  Am J Physiol Gastrointest Liver Physiol. 2001;  281 G577-G585
  • 61 Lalor P F, Shields P, Grant A, Adams D H. Recruitment of lymphocytes to the human liver.  Immunol Cell Biol. 2002;  80 52-64
  • 62 Ajuebor M N, Carey J A, Swain M G. CCR5 in T cell-mediated liver diseases: what's going on?.  J Immunol. 2006;  177 2039-2045
  • 63 Su G L. Lipopolysaccharides in liver injury: molecular mechanisms of Kupffer cell activation.  Am J Physiol Gastrointest Liver Physiol. 2002;  283 G256-G265
  • 64 Zhong J, Deaciuc I V, Burikhanov R, de Villiers W J. Lipopolysaccharide-induced liver apoptosis is increased in interleukin-10 knockout mice.  Biochim Biophys Acta. 2006;  1762 468-477
  • 65 McClain C J, Hill D B, Song Z, Deaciuc I, Barve S. Monocyte activation in alcoholic liver disease.  Alcohol. 2002;  27 53-61
  • 66 Louis H, Le Moine O, Goldman M, Deviere J. Modulation of liver injury by interleukin-10.  Acta Gastroenterol Belg. 2003;  66 7-14
  • 67 Bataller R, Brenner D A. Liver fibrosis.  J Clin Invest. 2005;  115 209-218
  • 68 Roth S, Michel K, Gressner A M. (Latent) transforming growth factor beta in liver parenchymal cells, its injury-dependent release, and paracrine effects on rat hepatic stellate cells.  Hepatology. 1998;  27 1003-1012
  • 69 Knittel T, Mehde M, Kobold D et al.. Expression patterns of matrix metalloproteinases and their inhibitors in parenchymal and non-parenchymal cells of rat liver: regulation by TNF-alpha and TGF-beta1.  J Hepatol. 1999;  30 48-60
  • 70 Matsutani T, Kang S C, Miyashita M et al.. Liver cytokine production and ICAM-1 expression following bone fracture, tissue trauma, and hemorrhage in middle-aged mice.  Am J Physiol Gastrointest Liver Physiol. 2007;  292 G268-G274
  • 71 Finotto S, Siebler J, Hausding M et al.. Severe hepatic injury in interleukin 18 (IL-18) transgenic mice: a key role for IL-18 in regulating hepatocyte apoptosis in vivo.  Gut. 2004;  53 392-400
  • 72 Breitkopf K, Haas S, Wiercinska E, Singer M V, Dooley S. Anti-TGF-beta strategies for the treatment of chronic liver disease.  Alcohol Clin Exp Res. 2005;  29 121S-131S
  • 73 Sweet M J, Hume D A. Endotoxin signal transduction in macrophages.  J Leukoc Biol. 1996;  60 8-26
  • 74 Guha M, Mackman N. LPS induction of gene expression in human monocytes.  Cell Signal. 2001;  13 85-94
  • 75 Guha M, O'Connell M A, Pawlinski R et al.. Lipopolysaccharide activation of the MEK-ERK1/2 pathway in human monocytic cells mediates tissue factor and tumor necrosis factor alpha expression by inducing Elk-1 phosphorylation and Egr-1 expression.  Blood. 2001;  98 1429-1439
  • 76 Shi L, Kishore R, McMullen M R, Nagy L E. Lipopolysaccharide stimulation of ERK1/2 increases TNF-alpha production via Egr-1.  Am J Physiol Cell Physiol. 2002;  282 C1205-C1211
  • 77 Kishore R, McMullen M R, Nagy L E. Stabilization of tumor necrosis factor alpha mRNA by chronic ethanol: role of A + U-rich elements and p38 mitogen-activated protein kinase signaling pathway.  J Biol Chem. 2001;  276 41930-41937
  • 78 Aroor A R, Shukla S D. MAP kinase signaling in diverse effects of ethanol.  Life Sci. 2004;  74 2339-2364
  • 79 Oak S, Mandrekar P, Catalano D, Kodys K, Szabo G. TLR2- and TLR4-mediated signals determine attenuation or augmentation of inflammation by acute alcohol in monocytes.  J Immunol. 2006;  176 7628-7635
  • 80 Ghosh S. Regulation of inducible gene expression by the transcription factor NF-kappaB.  Immunol Res. 1999;  19 183-189
  • 81 Zima T, Kalousova M. Oxidative stress and signal transduction pathways in alcoholic liver disease.  Alcohol Clin Exp Res. 2005;  29 110S-115S
  • 82 Dela Pena A, Leclercq I, Field J et al.. NF-kappaB activation, rather than TNF, mediates hepatic inflammation in a murine dietary model of steatohepatitis.  Gastroenterology. 2005;  129 1663-1674
  • 83 Schwabe R F, Brenner D A. Mechanisms of liver injury. I. TNF-alpha-induced liver injury: role of IKK, JNK, and ROS pathways.  Am J Physiol Gastrointest Liver Physiol. 2006;  290 G583-G589
  • 84 De Minicis S, Bataller R, Brenner D A. NADPH oxidase in the liver: defensive, offensive, or fibrogenic?.  Gastroenterology. 2006;  131 272-275
  • 85 Matsuda N, Hattori Y. Systemic inflammatory response syndrome (SIRS): molecular pathophysiology and gene therapy.  J Pharmacol Sci. 2006;  101 189-198
  • 86 Hoesel L M, Gao H, Ward P A. New insights into cellular mechanisms during sepsis.  Immunol Res. 2006;  34 133-141
  • 87 Prince J M, Levy R M, Yang R et al.. Toll-like receptor-4 signaling mediates hepatic injury and systemic inflammation in hemorrhagic shock.  J Am Coll Surg. 2006;  202 407-417
  • 88 Tsoulfas G, Takahashi Y, Ganster R W et al.. Activation of the lipopolysaccharide signaling pathway in hepatic transplantation preservation injury.  Transplantation. 2002;  74 7-13
  • 89 Oyama J, Blais Jr C, Liu X et al.. Reduced myocardial ischemia-reperfusion injury in toll-like receptor 4-deficient mice.  Circulation. 2004;  109 784-789
  • 90 Tsung A, Hoffman R A, Izuishi K et al.. Hepatic ischemia/reperfusion injury involves functional TLR4 signaling in nonparenchymal cells.  J Immunol. 2005;  175 7661-7668
  • 91 Zhai Y, Shen X D, O'Connell R et al.. Cutting edge: TLR4 activation mediates liver ischemia/reperfusion inflammatory response via IFN regulatory factor 3-dependent MyD88-independent pathway.  J Immunol. 2004;  173 7115-7119
  • 92 Tsung A, Zheng N, Jeyabalan G et al.. Increasing numbers of hepatic dendritic cells promote HMGB1-mediated ischemia-reperfusion injury.  J Leukoc Biol. 2007;  81 119-128
  • 93 Izuishi K, Tsung A, Jeyabalan G et al.. Cutting edge: high-mobility group box 1 preconditioning protects against liver ischemia-reperfusion injury.  J Immunol. 2006;  176 7154-7158
  • 94 Yu M, Wang H, Ding A et al.. HMGB1 signals through toll-like receptor (TLR) 4 and TLR2.  Shock. 2006;  26 174-179
  • 95 Park J S, Gamboni-Robertson F, He Q et al.. High mobility group box 1 protein interacts with multiple Toll-like receptors.  Am J Physiol Cell Physiol. 2006;  290 C917-C924
  • 96 Liu Z X, Han D, Gunawan B, Kaplowitz N. Neutrophil depletion protects against murine acetaminophen hepatotoxicity.  Hepatology. 2006;  43 1220-1230
  • 97 Liu Z X, Govindarajan S, Kaplowitz N. Innate immune system plays a critical role in determining the progression and severity of acetaminophen hepatotoxicity.  Gastroenterology. 2004;  127 1760-1774
  • 98 Boelsterli U A. Diclofenac-induced liver injury: a paradigm of idiosyncratic drug toxicity.  Toxicol Appl Pharmacol. 2003;  192 307-322
  • 99 Deng X, Stachlewitz R F, Liguori M J et al.. Modest inflammation enhances diclofenac hepatotoxicity in rats: role of neutrophils and bacterial translocation.  J Pharmacol Exp Ther. 2006;  319 1191-1199
  • 100 You Q, Cheng L, Reilly T P, Wegmann D, Ju C. Role of neutrophils in a mouse model of halothane-induced liver injury.  Hepatology. 2006;  44 1421-1431
  • 101 Seki E, Tsutsui H, Iimuro Y et al.. Contribution of Toll-like receptor/myeloid differentiation factor 88 signaling to murine liver regeneration.  Hepatology. 2005;  41 443-450
  • 102 Yang L, Magness S T, Bataller R, Rippe R A, Brenner D A. NF-kappaB activation in Kupffer cells after partial hepatectomy.  Am J Physiol Gastrointest Liver Physiol. 2005;  289 G530-G538
  • 103 Campbell J S, Riehle K J, Brooling J T et al.. Proinflammatory cytokine production in liver regeneration is Myd88-dependent, but independent of Cd14, Tlr2, and Tlr4.  J Immunol. 2006;  176 2522-2528
  • 104 Stepniak E, Ricci R, Eferl R et al.. c-Jun/AP-1 controls liver regeneration by repressing p53/p21 and p38 MAPK activity.  Genes Dev. 2006;  20 2306-2314
  • 105 Terui K, Ozaki M. The role of STAT3 in liver regeneration.  Drugs Today (Barc). 2005;  41 461-469
  • 106 Skarpen E, Oksvold M P, Grosvik H, Widnes C, Huitfeldt H S. Altered regulation of EGF receptor signaling following a partial hepatectomy.  J Cell Physiol. 2005;  202 707-716
  • 107 Sun R, Gao B. Negative regulation of liver regeneration by innate immunity (natural killer cells/interferon-gamma).  Gastroenterology. 2004;  127 1525-1539
  • 108 Uesugi T, Froh M, Arteel G E, Bradford B U, Thurman R G. Toll-like receptor 4 is involved in the mechanism of early alcohol-induced liver injury in mice.  Hepatology. 2001;  34 101-108
  • 109 Gonzalez-Reimers E, Garcia-Valdecasas-Campelo E, Santolaria-Fernandez F et al.. Pro-inflammatory cytokines in stable chronic alcoholics: Relationship with fat and lean mass.  Food Chem Toxicol. 2006 Nov 26 (Epub ahead of print); 
  • 110 Nanji A A, French S W. Animal models of alcoholic liver disease-focus on the intragastric feeding model.  Alcohol Res Health. 2003;  27 325-330
  • 111 Enomoto N, Ikejima K, Yamashina S et al.. Kupffer cell sensitization by alcohol involves increased permeability to gut-derived endotoxin.  Alcohol Clin Exp Res. 2001;  25 51S-54S
  • 112 Bode C, Bode J C. Activation of the innate immune system and alcoholic liver disease: effects of ethanol per se or enhanced intestinal translocation of bacterial toxins induced by ethanol?.  Alcohol Clin Exp Res. 2005;  29 166S-171S
  • 113 Rasaratnam B, Kaye D, Jennings G, Dudley F, Chin-Dusting J. The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis. A randomized trial.  Ann Intern Med. 2003;  139 186-193
  • 114 Gustot T, Lemmers A, Moreno C et al.. Differential liver sensitization to toll-like receptor pathways in mice with alcoholic fatty liver.  Hepatology. 2006;  43 989-1000
  • 115 Okubo K, Yoshizawa K, Okiyama W et al.. Severe alcoholic hepatitis with extremely high neutrophil count successfully treated by granulocytapheresis.  Intern Med. 2006;  45(3) 155-158
  • 116 Chitturi S, Farrell G C. Etiopathogenesis of nonalcoholic steatohepatitis.  Semin Liver Dis. 2001;  21 27-41
  • 117 Ikejima K, Okumura K, Lang T et al.. The role of leptin in progression of non-alcoholic fatty liver disease.  Hepatol Res. 2005;  33 151-154
  • 118 Szabo G, Velayudham A, Romics Jr L, Mandrekar P. Modulation of non-alcoholic steatohepatitis by pattern recognition receptors in mice: the role of toll-like receptors 2 and 4.  Alcohol Clin Exp Res. 2005;  29 140S-145S
  • 119 Ikura Y, Ohsawa M, Suekane T et al.. Localization of oxidized phosphatidylcholine in nonalcoholic fatty liver disease: impact on disease progression.  Hepatology. 2006;  43 506-514
  • 120 Li Z, Yang S, Lin H et al.. Probiotics and antibodies to TNF inhibit inflammatory activity and improve nonalcoholic fatty liver disease.  Hepatology. 2003;  37 343-350
  • 121 Dolganiuc A, Chang S, Kodys K et al.. Hepatitis C virus (HCV) core protein-induced, monocyte-mediated mechanisms of reduced IFN-alpha and plasmacytoid dendritic cell loss in chronic HCV infection.  J Immunol. 2006;  177 6758-6768
  • 122 Wertheimer A M, Bakke A, Rosen H R. Direct enumeration and functional assessment of circulating dendritic cells in patients with liver disease.  Hepatology. 2004;  40 335-345
  • 123 Murakami H, Akbar S M, Matsui H, Horiike N, Onji M. Decreased interferon-alpha production and impaired T helper 1 polarization by dendritic cells from patients with chronic hepatitis C.  Clin Exp Immunol. 2004;  137 559-565
  • 124 Yu H, Babiuk L A, van Drunen Littel-van den Hurk S. Priming with CpG-enriched plasmid and boosting with protein formulated with CpG oligodeoxynucleotides and Quil A induces strong cellular and humoral immune responses to hepatitis C virus NS3.  J Gen Virol. 2004;  85 1533-1543
  • 125 Jacobson A, Ghalib R, Lawitz E et al.. Early viral response and on treatment response to CPG 10101 (Actilon), in combination with pegylated interferon and/or ribavirin, in chronic HCV genotype 1 infected patients with prior relapse response.  Hepatology. 2006;  44 224A
  • 126 Dolganiuc A, Oak S, Kodys K et al.. Hepatitis C core and nonstructural 3 proteins trigger toll-like receptor 2-mediated pathways and inflammatory activation.  Gastroenterology. 2004;  127 1513-1524
  • 127 Polyak S J. Hepatitis C virus-cell interactions and their role in pathogenesis.  Clin Liver Dis. 2003;  7 67-88
  • 128 Brady M T, MacDonald A J, Rowan A G, Mills K H. Hepatitis C virus non-structural protein 4 suppresses Th1 responses by stimulating IL-10 production from monocytes.  Eur J Immunol. 2003;  33 3448-3457
  • 129 Düesberg U, von dem Bussche A, Kirschning C et al.. Cell activation by synthetic lipopeptides of the hepatitis C virus (HCV): core protein is mediated by toll like receptors (TLRs) 2 and 4.  Immunol Lett. 2002;  84 89-95
  • 130 Isogawa M, Robek M D, Furuichi Y, Chisari F V. Toll-like receptor signaling inhibits hepatitis B virus replication in vivo.  J Virol. 2005;  79 7269-7272
  • 131 Cooper C L, Davis H L, Morris M L et al.. CPG 7909, an immunostimulatory TLR9 agonist oligodeoxynucleotide, as adjuvant to Engerix-B HBV vaccine in healthy adults: a double-blind phase I/II study.  J Clin Immunol. 2004;  24 693-701
  • 132 Visvanathan K, Skinner N A, Thompson A J et al.. Regulation of Toll-like receptor-2 expression in chronic hepatitis B by the precore protein.  Hepatology. 2007;  45 102-110
  • 133 Huang Y H, Chou M H, Du Y Y et al.. Expression of toll-like receptors and type 1 interferon specific protein MxA in biliary atresia.  Lab Invest. 2007;  87 66-74
  • 134 Mao T K, Lian Z X, Selmi C et al.. Altered monocyte responses to defined TLR ligands in patients with primary biliary cirrhosis.  Hepatology. 2005;  42 802-808
  • 135 Takii Y, Nakamura M, Ito M et al.. Enhanced expression of type I interferon and toll-like receptor-3 in primary biliary cirrhosis.  Lab Invest. 2005;  85 908-920
  • 136 Schreiber H, Rowley D A. Inflammation and cancer. In: Gallin JI, Snyderman R Inflammation: basic principles and clinical correlates, 3rd ed. Philadelphia; Lippincott Williams & Wilkins 1999: 1117-1129
  • 137 Coussens L M, Werb Z. Inflammation and cancer.  Nature. 2002;  420 860-867
  • 138 Kew M C. Hepatocellular cancer. A century of progress.  Clin Liver Dis. 2000;  4 257-268
  • 139 Karin M, Lawrence T, Nizet V. Innate immunity gone awry: linking microbial infections to chronic inflammation and cancer.  Cell. 2006;  124 823-835
  • 140 Maeda S, Kamata H, Luo J L, Leffert H, Karin M. IKKbeta couples hepatocyte death to cytokine-driven compensatory proliferation that promotes chemical hepatocarcinogenesis.  Cell. 2005;  121 977-990
  • 141 Arkan M C, Hevener A L, Greten F R et al.. IKK-beta links inflammation to obesity-induced insulin resistance.  Nat Med. 2005;  11 191-198
  • 142 Ribeiro P S, Cortez-Pinto H, Sola S et al.. 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

Gyongyi SzaboM.D. Ph.D. 

Department of Medicine, University of Massachusetts Medical School

LRB 215, 364 Plantation Street, Worcester, MA 01605

Email: gyongyi.szabo@umassmed.edu