Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management

Acute-on-chronic liver failure (ACLF) is a multifaceted condition with poor treatment options and high short-term mortality. ACLF can develop in patients with or without liver cirrhosis, where patients with decompensated cirrhosis display a higher risk of short-term mortality. Pathophysiological mec...

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Autores principales:	Arshi Khanam, Shyam Kottilil
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	acute-on-chronic liver failure cirrhosis immunopathology liver transplantation stem cell therapy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/38a2a598a17f4d6e86fb2c4f229f21e3
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spelling	oai:doaj.org-article:38a2a598a17f4d6e86fb2c4f229f21e32021-11-08T05:00:39ZAcute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management2296-858X10.3389/fmed.2021.752875https://doaj.org/article/38a2a598a17f4d6e86fb2c4f229f21e32021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.752875/fullhttps://doaj.org/toc/2296-858XAcute-on-chronic liver failure (ACLF) is a multifaceted condition with poor treatment options and high short-term mortality. ACLF can develop in patients with or without liver cirrhosis, where patients with decompensated cirrhosis display a higher risk of short-term mortality. Pathophysiological mechanisms include systemic inflammation due to bacterial and fungal infections and acute hepatic insult with drug, alcohol, and viral hepatitis. Cryptogenic factors also contribute to the development of ACLF. The clinical outcome of patients with ACLF gets further complicated by the occurrence of variceal hemorrhage, hepatorenal syndrome, hepatic encephalopathy, and systemic immune dysfunction. Regardless of the better understanding of pathophysiological mechanisms, no specific and definitive treatment is available except for liver transplantation. The recent approach of regenerative medicine using mesenchymal stem cells (MSCs) could be advantageous for the treatment of ACLF as these cells can downregulate inflammatory response by inducing antiinflammatory events and prevent hepatic damage and fibrosis by inhibiting hepatic stellate cell activation and collagen synthesis. Moreover, MSCs are involved in tissue repair by the process of liver regeneration. Considering the broad therapeutic potential of MSCs, it can serve as an alternative treatment to liver transplant in the near future, if promising results are achieved.Arshi KhanamShyam KottililFrontiers Media S.A.articleacute-on-chronic liver failurecirrhosisimmunopathologyliver transplantationstem cell therapyMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute-on-chronic liver failure cirrhosis immunopathology liver transplantation stem cell therapy Medicine (General) R5-920
spellingShingle	acute-on-chronic liver failure cirrhosis immunopathology liver transplantation stem cell therapy Medicine (General) R5-920 Arshi Khanam Shyam Kottilil Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
description	Acute-on-chronic liver failure (ACLF) is a multifaceted condition with poor treatment options and high short-term mortality. ACLF can develop in patients with or without liver cirrhosis, where patients with decompensated cirrhosis display a higher risk of short-term mortality. Pathophysiological mechanisms include systemic inflammation due to bacterial and fungal infections and acute hepatic insult with drug, alcohol, and viral hepatitis. Cryptogenic factors also contribute to the development of ACLF. The clinical outcome of patients with ACLF gets further complicated by the occurrence of variceal hemorrhage, hepatorenal syndrome, hepatic encephalopathy, and systemic immune dysfunction. Regardless of the better understanding of pathophysiological mechanisms, no specific and definitive treatment is available except for liver transplantation. The recent approach of regenerative medicine using mesenchymal stem cells (MSCs) could be advantageous for the treatment of ACLF as these cells can downregulate inflammatory response by inducing antiinflammatory events and prevent hepatic damage and fibrosis by inhibiting hepatic stellate cell activation and collagen synthesis. Moreover, MSCs are involved in tissue repair by the process of liver regeneration. Considering the broad therapeutic potential of MSCs, it can serve as an alternative treatment to liver transplant in the near future, if promising results are achieved.
format	article
author	Arshi Khanam Shyam Kottilil
author_facet	Arshi Khanam Shyam Kottilil
author_sort	Arshi Khanam
title	Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
title_short	Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
title_full	Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
title_fullStr	Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
title_full_unstemmed	Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management
title_sort	acute-on-chronic liver failure: pathophysiological mechanisms and management
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/38a2a598a17f4d6e86fb2c4f229f21e3
work_keys_str_mv	AT arshikhanam acuteonchronicliverfailurepathophysiologicalmechanismsandmanagement AT shyamkottilil acuteonchronicliverfailurepathophysiologicalmechanismsandmanagement
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Acute-on-Chronic Liver Failure: Pathophysiological Mechanisms and Management

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