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2014 ; 61
(4
): 912-24
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Vascular pathobiology in chronic liver disease and cirrhosis - current status and
future directions
#MMPMID24911462
Iwakiri Y
; Shah V
; Rockey DC
J Hepatol
2014[Oct]; 61
(4
): 912-24
PMID24911462
show ga
Chronic liver disease is associated with remarkable alterations in the intra- and
extrahepatic vasculature. Because of these changes, the fields of liver
vasculature and portal hypertension have recently become closely integrated
within the broader vascular biology discipline. As developments in vascular
biology have evolved, a deeper understanding of vascular processes has led to a
better understanding of the mechanisms of the dynamic vascular changes associated
with portal hypertension and chronic liver disease. In this context, hepatic
vascular cells, such as sinusoidal endothelial cells and pericyte-like hepatic
stellate cells, are closely associated with one another, where they have
paracrine and autocrine effects on each other and themselves. These cells play
important roles in the pathogenesis of liver fibrosis/cirrhosis and portal
hypertension. Further, a variety of signaling pathways have recently come to
light. These include growth factor pathways involving cytokines such as
transforming growth factor ?, platelet derived growth factor, and others as well
as a variety of vasoactive peptides and other molecules. An early and consistent
feature of liver injury is the development of an increase in intra-hepatic
resistance; this is associated with changes in hepatic vascular cells and their
signaling pathway that cause portal hypertension. A critical concept is that this
process aggregates signals to the extrahepatic circulation, causing derangement
in this system's cells and signaling pathways, which ultimately leads to the
collateral vessel formation and arterial vasodilation in the splanchnic and
systemic circulation, which by virtue of the hydraulic derivation of Ohm's law
(pressure = resistance × flow), worsens portal hypertension. This review provides
a detailed review of the current status and future direction of the basic biology
of portal hypertension with a focus on the physiology, pathophysiology, and
signaling of cells within the liver, as well as those in the mesenteric vascular
circulation. Translational implications of recent research and the future
directions that it points to are also highlighted.