抗肝纤维化的适应患者与治疗时机

1．肝纤维化治疗对象包括大多数慢性肝病患者，病因治疗与抗纤维化治疗同样重要：肝纤维化是存在于许多慢性肝病的共同病理特征，因此大多数慢性肝炎与肝硬化患者都有进行肝纤维化治疗的必要。肝纤维化治疗策略包含去除病因、抗炎症与免疫调节、抑制肝星状细胞（HSC）活化及其胶原代谢、刺激肝细胞再生等多方面，实际是一种广义的抗肝纤维化综合疗法，几乎适合于有慢性肝病，包括慢性病毒性乙型或丙型肝炎、慢性酒精性肝炎、非酒精性脂肪肝与肝硬化等，     

转化生长因子β与肝纤维化的研究

肝纤维化是慢性肝病的共同病理基础,可进一步发展为肝硬化、肝衰竭和门脉高压,其本质为肝星状细胞（HSC）的活化和细胞外基质（ECM）的过度沉积。目前认为肝纤维化的形成是由于多种损肝因子,启动炎性细胞,导致HSC激活,活化的HSC事实上是ECM的重要组成成分,     

抗肝纤维化治疗研究进展

肝纤维化是各种慢性肝病发展至肝硬化的必经阶段,是由于各种致病因子（常见病因为病毒性肝炎、慢性酒精中毒、遗传和代谢疾病、化学毒物或药物、肝脏淤血、寄生虫、脂肪肝等）引起肝脏损伤和炎症,导致细胞外基质（ECM）在肝脏过度沉积。其中肝星状细胞（HSC）的活化是纤维化的中心事件。随着肝纤维化发生机制进一步阐明,防治策略也进行了相应调整,抑制HSC活化和抑制ECM合成,促进降解,成为当今抗肝纤维化的关键措施。     

肝星状细胞的移行机制及药物干预研究

肝纤维化是各种慢性肝病向肝硬化发展的必经阶段。其关键环节是肝星状细胞（hepatic stellate cell,HSC）的激活。HSC的活化是导致细胞外基质（extracellular matrix,ECM）过度沉积,最终形成肝纤维化的主要原因。经典干预手段通过抑制HSC活化和促进HSC凋亡来逆转肝纤维化的进程,但也有部分学者认为HSC移行也是肝纤维化形成的重要机制之一。     

肝纤维化的基因治疗研究进展

肝纤维化是各种慢性肝病发展至肝硬化的必经阶段,以纤维组织大量增生和肝小叶结构无序化为特征.近年来随着分子生物学的发展,肝纤维化的分子机制逐渐得以阐明,从而使肝纤维化的基因治疗成为可能,肝纤维化的基因治疗主要起到阻止纤维化发展、刺激肝细胞再生和肝组织结构重建三方面的作用.目前,常用的方法一般是通过抑制肝星状细胞(HSC)的活化,抑制HSC的增殖,及对HSC的靶向治疗等,达到延缓和治愈肝纤维化的目的.     

RhoA特异性RNA干扰对肝星状细胞T6细胞外基质表达的影响

肝纤维化是多种慢性肝病向肝硬化发展的组织学基础。肝星状细胞（HSC）活化是肝纤维化的共同途径，活化的HSC产生大量细胞外基质（extracellular matrix，ECM）。如ECM生成过量大于降解并沉积，则引起肝纤维化。胶原蛋白（C01）Ⅰ、前胶原（PC）Ⅲ、透明质酸（HA）及层粘连蛋白（LN）是ECM的主要来源。RhoA是Rho家族蛋白中重要的促纤维化因子。     

肝损伤修复过程中p75神经营养因子受体的作用

p75神经营养因子受体(p75NTR)是肝星状细胞(HSC)表面表达的与神经生长因子(NGF)特异结合的受体,在肝脏损伤修复过程中发挥重要作用。在肝脏损伤修复过程中,p75NTR能提高肝组织肝细胞生长因子的表达,促进受损肝细胞的再生和肝组织结构的恢复;对于静息状态的HSC,p75NTR能促进HSC活化;在肝损伤晚期,随着再生肝细胞和活化HSC的增多,NGF分泌明显增加,NGF与p75NTR结合能促进活化的HSC凋亡和肝纤维化逆转。     

肝纤维化中医药治疗进展

肝纤维化（hepatic fibrosis，HF）是许多慢性肝病晚期共有的、渐进性的病理改变，是发展到肝硬化的必经阶段，其主要病理特征为以胶原为主的细胞外间质（extra cellular matrix，ECM）在肝脏的过量沉积。发病机制在于各种损肝因子引起肝细胞损伤，激活肝星状细胞（hepatic stellate cell，HSC）使其转变成为肌纤维母细胞。损伤及再生的肝细胞、Kupffer细胞、窦内皮细胞、     

肝星状细胞与肝纤维化

肝纤维化是各种慢性肝病共有的病理改变,逆转肝纤维化可阻止大多数慢性肝病进展。肝星状细胞(HSC)是肝内一种具有多功能、变化不定的非实质细胞,HSC活化是肝纤维化发生的中心环节。阐明其关系,有助于以HSC为靶点的肝纤维化方面的研究。     

生长抑素与肝星状细胞的研究进展

肝纤维化是肝硬化的病理组织学基础,主要表现为ECM分泌增加、降解减少,ECM在肝组织中沉积。肝星状细胞（HSC）是慢性肝病中ECM蛋白的主要来源。对HSC的干预无疑将成为防治肝纤维化的核心措施之一。近年研究发现生长抑素及其类似物可直接抑制活化HSC收缩,且可特异性抑制活化HSC增殖,促进其凋亡。本文就神经肽类激素生长抑素及其类似物与HSC相互作用做一综述。[第一段]     

Hepatic fibrosis: It is time to go with hepatic stellate cell-specific therapeutic targets

Hepatic fibrosis is a pathological lesion, characterized by the progressive accumulation of extracellular matrix (ECM) in the perisinusoidal space and it is a major problem in chronic liver diseases. Phenotypic activation of hepatic stellate cells (HSC) plays a central role in the progression of hepatic fibrosis. Retardation of proliferation and clearance of activated HSCs from the injured liver is an appropriate therapeutic strategy for the resolution and treatment of hepatic fibrosis. Clearance of activated HSCs from the injured liver by autophagy inhibitors, proapoptotic agents and senescence inducers with the high affinity toward the activated HSCs may be the novel therapeutic strategy for the treatment of hepatic fibrosis in the near future.     

Hepatic fibrogenesis in response to chronic liver injury: novel insights on the role of cell‐to‐cell interaction and transition

Hepatic fibrosis represents the wound‐healing response process of the liver to chronic injury, independently from aetiology. Advanced liver fibrosis results in cirrhosis that can lead to liver failure, portal hypertension and hepatocellular carcinoma. Currently, no effective therapies are available for hepatic fibrosis. After the definition of hepatic stellate cells (HSCs) as the main liver extracellular matrix‐producing cells in the 1980s, the subsequent decade was dedicated to determine the role of specific cytokines and growth factors. Fibrotic progression of chronic liver diseases can be nowadays considered as a dynamic and highly integrated process of cellular response to chronic liver injury. The present review is dedicated to the novel mechanisms of cellular response to chronic liver injury leading to hepatic myofibroblasts' activation. The understanding of the cellular and molecular pathways regulating their function is crucial to counteract therapeutically the organ dysfunction caused by myofibroblasts' activation.     

Mitochondria: A critical hub for hepatic stellate cells activation during chronic liver diseases

Background: Upon liver injury, quiescent hepatic stellate cells(q HSCs), reside in the perisinusoidal space, phenotypically transdifferentiate into myofibroblast-like cells(MFBs). The q HSCs in the normal liver are less fibrogenic, migratory, and also have less proliferative potential. However, activated HSCs(a HSCs) are more fibrogenic and have a high migratory and proliferative MFBs phenotype. HSCs activation is a highly energetic process that needs abundant intracellular energy in the form of adenosine triphosphate(ATP) for the synthesis of extracellular matrix(ECM) in the injured liver to substantiate the injury. Data sources: The articles were collected through Pub Med and EMBASE using search terms "mitochondria and hepatic stellate cells", "mitochondria and HSCs", "mitochondria and hepatic fibrosis", "mitochondria and liver diseases", and "mitochondria and chronic liver disease", and relevant publications published before September 31, 2020 were included in this review. Results: Mitochondria homeostasis is affected during HSCs activation. Mitochondria in a HSCs are highly energetic and are in a high metabolically active state exhibiting increased activity such as glycolysis and respiration. a HSCs have high glycolytic enzymes expression and glycolytic activity induced by Hedgehog(Hh) signaling from injured hepatocytes. Increased glycolysis and aerobic glycolysis(Warburg effect) endproducts in a HSCs consequently activate the ECM-related gene expressions. Increased Hh signaling from injured hepatocytes downregulates peroxisome proliferator-activated receptor-γ expression and decreases lipogenesis in a HSCs. Glutaminolysis and tricarboxylic acid cycle liberate ATPs that fuel HSCs to proliferate and produce ECM during their activation. Conclusions: Available studies suggest that mitochondria functions can increase in parallel with HSCs activation. Therefore, mitochondrial modulators should be tested in an elaborate manner to control or prevent the HSCs activation during liver injury to subsequently regress hepatic fibrosis.     

Hepatic stellate cells as a target for the treatment of liver fibrosis

Following chronic liver injury of any etiology, there is progressive fibrosis. To date, removing the causative agent is the only effective therapy to stop or even reverse liver fibrosis. Therefore, the development of effective antifibrotic therapies represents a challenge for modern hepatology. In the past decade, dramatic advances have been made in the understanding of the cellular and molecular mechanisms underlying liver fibrogenesis. The identification of activated hepatic stellate cells (HSCs) as the major fibrogenic cell type in the injured liver, as well as the recognition of key cytokines involved in this process, have facilitated the design of promising new antifibrotic therapies. These therapies are aimed at inhibiting the accumulation of activated HSCs at the sites of liver injury and preventing the deposition of extracellular matrix. Although many of these approaches are effective in experimental models of liver fibrosis, their efficacy and safety in humans are still unknown. This review describes the current therapeutic approaches for liver fibrosis and discusses different features of activated HSCs as a target to design new treatments to inhibit scar formation in chronic liver diseases.     

HBV介导的肝星状细胞和天然免疫细胞的相互作用

肝脏非实质细胞在HBV相关的肝脏疾病中发挥着至关重要的作用,而肝星状细胞(HSC)的激活以及与肝内细胞之间的相互作用是导致肝纤维化的主要原因。主要介绍了HBV诱导的肝脏炎症以及天然免疫细胞与HSC的相互作用,简述了HBV作用下单核/巨噬细胞和自然杀伤细胞(NK细胞)对HSC的激活和杀伤作用以及HSC的肝脏免疫调节作用。     

Lhx2-/- mice develop liver fibrosis

Liver fibrosis is a wound-healing response to chronic injury of any type and is characterized by a progressive increase in deposition of extracellular matrix (ECM) proteins, the major source of which are activated hepatic stellate cells (HSCs). Because the LIM homeobox gene Lhx2 is expressed in HSCs and liver development in Lhx2(-/-) mice is disrupted, we analyzed liver development in Lhx2(-/-) embryos in detail. Lhx2(-/-) embryos contain numerous activated HSCs and display a progressively increased deposition of the ECM proteins associated with liver fibrosis, suggesting that Lhx2 inhibits HSC activation. Transfection of Lhx2 cDNA into a human HSC line down-regulates expression of genes characteristic of activated HSCs. Moreover, the Lhx2(-/-) liver display a disrupted cellular organization and an altered gene expression pattern of the intrahepatic endodermal cells, and the increased deposition of ECM proteins precedes these abnormalities. Collectively these results show that Lhx2 negatively regulates HSC activation, and its inactivation in developing HSCs appears therefore to mimic the signals that are triggered by the wound-healing response to chronic liver injury. This study establishes a spontaneous and reproducible animal model for hepatic fibrosis and reveals that Lhx2 expression in HSCs is important for proper cellular organization and differentiation of the liver.     

Protease-activated receptor 2 promotes experimental liver fibrosis in mice and activates human hepatic stellate cells

Protease-activated receptor (PAR) 2 is a G-protein-coupled receptor that is activated after proteolytic cleavage by serine proteases, including mast cell tryptase and activated coagulation factors. PAR-2 activation augments inflammatory and profibrotic pathways through the induction of genes encoding proinflammatory cytokines and extracellular matrix proteins. Thus, PAR-2 represents an important interface linking coagulation and inflammation. PAR-2 is widely expressed in cells of the gastrointestinal tract, including hepatic stellate cells (HSCs), endothelial cells, and hepatic macrophages; however, its role in liver fibrosis has not been previously examined. We studied the development of CCl(4) -induced liver fibrosis in PAR-2 knockout mice, and showed that PAR-2 deficiency reduced the progression of liver fibrosis, hepatic collagen gene expression, and hydroxyproline content. Reduced fibrosis was associated with decreased transforming growth factor beta (TGFβ) gene and protein expression and decreased matrix metalloproteinase 2 and tissue inhibitor of matrix metalloproteinase 1 gene expression. In addition, PAR-2 stimulated activation, proliferation, collagen production, and TGFβ protein production by human stellate cells, indicating that hepatic PAR-2 activation increases profibrogenic cytokines and collagen production both in vivo and in vitro. CONCLUSION: Our findings demonstrate the capacity of PAR-2 activation to augment TGFβ production and promote hepatic fibrosis in mice and to induce a profibrogenic phenotype in human HSCs. PAR-2 antagonists have recently been developed and may represent a novel therapeutic approach in preventing fibrosis in patients with chronic liver disease.