Cited by 679Liver Disease Diagnosis and TreatmentLiver physiology and pathologyLiver Diseases and Immunity

Mechanisms of Fibrosis Development in Nonalcoholic Steatohepatitis

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Schwabe, Robert F., Tabas, Ira, Pajvani, Utpal B.·2020·Gastroenterology

Abstract

Nonalcoholic fatty liver disease is the most prevalent liver disease worldwide, affecting 20%-25% of the adult population. In 25% of patients, nonalcoholic fatty liver disease progresses to nonalcoholic steatohepatitis (NASH), which increases the risk for the development of cirrhosis, liver failure, and hepatocellular carcinoma. In patients with NASH, liver fibrosis is the main determinant of mortality. Here, we review how interactions between different liver cells culminate in fibrosis development in NASH, focusing on triggers and consequences of hepatocyte-macrophage-hepatic stellate cell (HSC) crosstalk. We discuss pathways through which stressed and dead hepatocytes instigate the profibrogenic crosstalk with HSC and macrophages, including the reactivation of developmental pathways such as TAZ, Notch, and hedgehog; how clearance of dead cells in NASH via efferocytosis may affect inflammation and fibrogenesis; and insights into HSC and macrophage heterogeneity revealed by single-cell RNA sequencing. Finally, we summarize options to therapeutically interrupt this profibrogenic hepatocyte-macrophage-HSC network in NASH.

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Crossref · 10.1053/j.gastro.2019.11.311

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  • Progression to NASH involves hepatocyte damage and liver inflammation, and development of liver fibrosis is the key determinant of patient outcomes.

    “The progression to NASH involves hepatocyte damage and liver inflammation, with the development of liver fibrosis being the key determinant of patient outcomes 3-9 .”
  • The perisinusoidal fibrosis in early human NASH is thought to be produced by activated HSCs/myofibroblasts.

    “The perisinusoidal fibrosis in early human NASH is thought to be produced by activated HSCs/myofibroblasts.114”
  • The disease-driving pathways of NASH converge on fibrosis.

    “The disease-driving pathways of NASH converge in fibrosis (Fig. 3), an aberrant wound-healing process resulting not only in scarring (extracellular matrix deposition), but also in the loss of functional hepatocytes and chronic inflammation.104”
  • Fibrosis is an aberrant wound-healing process that causes scarring, loss of functional hepatocytes and chronic inflammation.

    “The disease-driving pathways of NASH converge in fibrosis (Fig. 3), an aberrant wound-healing process resulting not only in scarring (extracellular matrix deposition), but also in the loss of functional hepatocytes and chronic inflammation.104”
  • Monocytes and macrophages are capable of remarkable functional plasticity, displaying diverse phenotypes during wound healing dependent on multiple cues including the environmental niche and the temporal stage of tissue injury and repair.

    “Furthermore, monocytes and macrophages are capable of remarkable functional plasticity, displaying diverse phenotypes during wound healing dependent on multiple cues including the environmental niche61,62 and the temporal stage of tissue injury and repair63–66.”

    From Fibrosis: from mechanisms to medicines (2020) · cites this paper as [61]

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Authors
Schwabe, R. F., Tabas, I., & Pajvani, U. B.
Affiliations
  • Columbia University Irving Medical Center (US)
  • Columbia University (US)
Corresponding author
Schwabe, Robert F.
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2020-05
Volume
158
Issue
7
Pages
1913-1928
ISSN
0016-5085 (ISSN-L)
OpenAlex
W3005214954
Cited by
671
References
169
Citations by year
2026: 82 · 2025: 121 · 2024: 138 · 2023: 131 · 2022: 117 · 2021: 53 · 2020: 27 · 2012: 1
FWCI
12.15
Type
journal article
Language
en
Open access
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
  • Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
Keywords
nonalcoholic steatohepatitis, liver fibrosis, hepatic stellate cells, macrophages, hepatocyte death, efferocytosis, TAZ, Notch signaling, Hedgehog signaling, single-cell RNA sequencing, antifibrotic therapy, non-alcoholic fatty liver disease
MeSH terms
Animals, Cell Communication, Extracellular Matrix, Humans, Liver, Liver Cirrhosis, Macrophages, Signal Transduction, Cell Death, Hepatocytes, Hepatic Stellate Cells, Non-alcoholic Fatty Liver Disease

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