Mechanisms of Fibrosis Development in Nonalcoholic Steatohepatitis
Open accessAbstract
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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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 .”
From Amphiregulin from regulatory T cells promotes liver fibrosis and insulin resistance in non-alcoholic steatohepatitis (2024) · cites this paper as [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”
From Understanding the cellular interactome of non-alcoholic fatty liver disease (2022) · cites this paper as [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”
From An integrated view of anti-inflammatory and antifibrotic targets for the treatment of NASH (2023) · cites this paper as [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”
From An integrated view of anti-inflammatory and antifibrotic targets for the treatment of NASH (2023) · cites this paper as [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]
Absence of Lyve1hiMHCIIlo interstitial macrophages exacerbates experimental lung fibrosis, showing that two independent populations of interstitial macrophages coexist across tissues with conserved niche-dependent functional programs.
“demonstrated that the absence of Lyve1hiMHCIIlo IMs exacerbates experimental lung fibrosis, thereby showing that two independent populations of IMs coexist across tissues with conserved niche-dependent functional programs61.”
From Fibrosis: from mechanisms to medicines (2020) · cites this paper as [61]
Two independent interstitial macrophage subpopulations conserved across lung, fat, heart, and dermis were identified: Lyve1loMHCIIhiCX3CR1hi and Lyve1hiMHCIIloCX3CR1lo monocyte-derived interstitial macrophages.
“Two independent IM subpopulations that are conserved across lung, fat, heart, and dermis were identified: (Lyve1loMHCIIhiCX3CR1hi (Lyve1loMHCIIhi) and Lyve1hiMHCIIloCX3CR1lo (Lyve1hiMHCIIlo) monocyte-derived IMs.”
From Fibrosis: from mechanisms to medicines (2020) · cites this paper as [61]
Several recent studies have identified subpopulations of monocytes and macrophages that can regulate fibrosis and tissue remodelling.
“Several recent studies have identified subpopulations of monocytes and macrophages which have the capacity to regulate fibrosis and tissue remodelling18,61,68–71.”
From Fibrosis: from mechanisms to medicines (2020) · cites this paper as [61]
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Thyroid hormones as a disease modifier and therapeutic target in nonalcoholic steatohepatitis
Wirth, E. K., Puengel, T., Spranger, J., & Tacke, F. (2022) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2022.2110864 · Cited by 42 · see citing works
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US Quantification of Liver Fat: Past, Present, and Future
Fetzer, D. T., Pierce, T. T., Robbin, M. L., Cloutier, G., Mufti, A., Hall, T. J., Chauhan, A., Kubale, R., & Tang, A. (2023) · Radiographics · doi:10.1148/rg.220178 · Cited by 41 · see citing works
- 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)
- PMC
- PMC7682538
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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