The DOI matches its Crossref record; 135 of the 137 references it cites were found in a registry or an index.
Adaptive immunity: an emerging player in the progression of NAFLD
Open accessAbstract
In the past decade, nonalcoholic fatty liver disease (NAFLD) has become a leading cause of chronic liver disease and cirrhosis, as well as an important risk factor for hepatocellular carcinoma (HCC). NAFLD encompasses a spectrum of liver lesions, including simple steatosis, steatohepatitis and fibrosis. Although steatosis is often harmless, the lobular inflammation that characterizes nonalcoholic steatohepatitis (NASH) is considered a driving force in the progression of NAFLD. The current view is that innate immune mechanisms represent a key element in supporting hepatic inflammation in NASH. However, increasing evidence points to the role of adaptive immunity as an additional factor promoting liver inflammation. This Review discusses data regarding the role of B cells and T cells in sustaining the progression of NASH to fibrosis and HCC, along with the findings that antigens originating from oxidative stress act as a trigger for immune responses. We also highlight the mechanisms affecting liver immune tolerance in the setting of steatohepatitis that favour lymphocyte activation. Finally, we analyse emerging evidence concerning the possible application of immune modulating treatments in NASH therapy.
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“In MASLD, this finely tuned immunological equilibrium is perturbed, resulting in chronic low-grade inflammation and inappropriate activation of both innate and adaptive immune responses (Shrestha et al. 2025; Sutti and Albano 2020).”
From The double-edged sword of regulatory T cells in MASLD: from inflammation control to fibrosis promotion (2026) · cites this paper as Sutti and Albano 2020
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Tregs consistently exhibit an increased susceptibility to apoptosis in MASH (Sutti and Albano 2020).”
From The double-edged sword of regulatory T cells in MASLD: from inflammation control to fibrosis promotion (2026) · cites this paper as Sutti and Albano 2020
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“growing evidence has highlighted the critical contribution of immune dysregulation to its pathogenesis.”
From The double-edged sword of regulatory T cells in MASLD: from inflammation control to fibrosis promotion (2026) · cites this paper as Sutti and Albano 2020
In the citing paper
“However, recent evidence indicates that adaptive immunity plays an essential role in the progression of NASH, fibrosis, and HCC.( 6 )”
From The Emerging Role of B Cells in the Pathogenesis of NAFLD (2021) · cites this paper as [6]
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Citations
Cites
Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention
Younossi, Z., Anstee, Q. M., Marietti, M., Hardy, T., Henry, L., Eslam, M., George, J., & Bugianesi, E. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2017.109 · Cited by 5,249
Mechanisms of NAFLD development and therapeutic strategies
Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018) · Nature Medicine · doi:10.1038/s41591-018-0104-9 · Cited by 4,354
Evolution of inflammation in nonalcoholic fatty liver disease: The multiple parallel hits hypothesis
Tilg, H., & Moschen, A. R. (2010) · Hepatology · doi:10.1002/hep.24001 · Cited by 2,548
Inflammasome-mediated dysbiosis regulates progression of NAFLD and obesity
Henao-Mejia, J., Elinav, E., Jin, C., Hao, L., Mehal, W. Z., Strowig, T., Thaiss, C. A., Kau, A. L., Eisenbarth, S. C., Jurczak, M. J., et al. (2012) · Nature · doi:10.1038/nature10809 · Cited by 2,435
Nonalcoholic Fatty Liver Disease
Rinella, M. E. (2015) · JAMA · doi:10.1001/jama.2015.5370 · Cited by 2,320
Estes, C., Anstee, Q. M., Arias, M., Bantel, H., Bellentani, S., Caballería, J., Colombo, M., Craxì, A., Crespo, J., Day, C. P., et al. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2018.05.036 · Cited by 2,046
Park, E. J., Lee, J. H., Yu, G.-Y., He, G., Ali, S. R., Holzer, R. G., Österreicher, C. H., Takahashi, H., & Karin, M. (2010) · Cell · doi:10.1016/j.cell.2009.12.052 · Cited by 1,764
Immunology in the liver — from homeostasis to disease
Heymann, F., & Tacke, F. (2016) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2015.200 · Cited by 1,180
Neuschwander‐Tetri, B. A. (2010) · Hepatology · doi:10.1002/hep.23719 · Cited by 1,077
The immunology of hepatocellular carcinoma
Ringelhan, M., Pfister, D., O’Connor, T., Pikarsky, E., & Heikenwalder, M. (2018) · Nature Immunology · doi:10.1038/s41590-018-0044-z · Cited by 1,076
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Llovet, J. M., Kelley, R. K., Villanueva, A., Singal, A. G., Pikarsky, E., Roayaie, S., Lencioni, R., Koike, K., Zucman-Rossi, J., & Finn, R. S. (2021) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-00240-3 · Cited by 7,055
Hepatic inflammatory responses in liver fibrosis
Hammerich, L., & Tacke, F. (2023) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-023-00807-x · Cited by 803
The immunological and metabolic landscape in primary and metastatic liver cancer
Li, X., Ramadori, P., Pfister, D. R., Seehawer, M., Zender, L., & Heikenwälder, M. F. (2021) · Nature reviews. Cancer · doi:10.1038/s41568-021-00383-9 · Cited by 639
Peiseler, M., Schwabe, R., Hampe, J., Kubes, P., Heikenwälder, M., & Tacke, F. (2022) · Journal of Hepatology · doi:10.1016/j.jhep.2022.06.012 · Cited by 564
Non-alcoholic fatty liver disease: the interplay between metabolism, microbes and immunity
Tilg, H., Adolph, T. E., Dudek, M., & Knolle, P. A. (2021) · Nature Metabolism · doi:10.1038/s42255-021-00501-9 · Cited by 539
Metadata
- Authors
- Sutti, S., & Albano, E.
- Affiliations
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Corresponding author
- Albano, Emanuele
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2019-10-11
- Volume
- 17
- Issue
- 2
- Pages
- 81-92
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- PMC
- PMC7222953
- OpenAlex
- W2979371456
- Cited by
- 374
- References
- 137
- Citations by year
- 2026: 35 · 2025: 42 · 2024: 67 · 2023: 70 · 2022: 75 · 2021: 55 · 2020: 27 · 2019: 1
- FWCI
- 5.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Nature Reviews Gastroenterology & Hepatology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fondazione Cariplo (2011-0470)
- Ministero dell’Istruzione, dell’Università e della Ricerca (FAR 2015)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, nonalcoholic steatohepatitis, adaptive immunity, B cells, T cells, liver inflammation, liver fibrosis, hepatocellular carcinoma, immune tolerance, immunomodulatory therapy, disease progression
- MeSH terms
- B-Lymphocytes, Carcinoma, Hepatocellular, Humans, Immune Tolerance, Immunity, Innate, Liver Cirrhosis, Liver Neoplasms, T-Lymphocytes, Oxidative Stress, Disease Progression, Natural Killer T-Cells, Adaptive Immunity, Non-alcoholic Fatty Liver Disease
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