Danger-Associated Molecular Patterns (DAMPs): Molecular Triggers for Sterile Inflammation in the Liver
Open accessAbstract
Inflammatory liver diseases in the absence of pathogens such as intoxication by xenobiotics, cholestatic liver injury, hepatic ischemia-reperfusion injury (I/R), non-alcoholic steatohepatitis (NASH), or alcoholic liver disease (ALD) remain threatening conditions demanding specific therapeutic options. Caused by various different noxae, all these conditions have been recognized to be triggered by danger- or death-associated molecular patterns (DAMPs), discompartmentalized self-structures released by dying cells. These endogenous, ectopic molecules comprise proteins, nucleic acids, adenosine triphosphate (ATP), or mitochondrial compounds, among others. This review resumes the respective modes of their release—passively by necrotic hepatocytes or actively by viable or apoptotic parenchymal cells—and their particular roles in sterile liver pathology. It addresses their sensors and the initial inflammatory responses they provoke. It further addresses a resulting second wave of parenchymal death that might be of different mode, boosting the release of additional, second-line DAMPs. Thus, triggering a more complex and pronounced response. Initial and secondary inflammatory responses comprise the activation of Kupffer cells (KCs), the attraction and activation of monocytes and neutrophil granulocytes, and the induction of type I interferons (IFNs) and their effectors. A thorough understanding of pathophysiology is a prerequisite for identifying rational therapeutic targets.
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DAMPs like HMGB1 bind TLR4/MyD88 in Kupffer cells, leading to NF-κB and generation of pro-inflammatory and pro-fibrotic mediators TGF-β1 and IL-1β.
“Damage-associated molecular patterns (DAMPs), like high-mobility group box 1 (HMGB1) or fragmented DNA, are released from hepatocytes. Endogenous danger stimuli bind to Toll-like receptor 4(TRL4) with the MyD88 adaptor protein in Kupffer cells. TLR4/MyD88, prompts the protein NF-κB to lead to the generation of pro-inflammatory and pro-fibrotic mediators associated with the disease—such as TGF-β1”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [33]
Section 2 (page not supplied) says HMGB1 interacts with TLR4, and section 5.3 describes hepatocyte HMGB1 release and a Kupffer-cell response to TLR4 activation. The copy does not establish the claimed MyD88–NF-κB pathway or its production of TGF-β1 and IL-1β; section 5 instead links IL-1β release to mitochondrial DNA and NLRP3 inflammasomes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTNF-α and IL-1β activate NF-κB in HSCs, inducing pro-fibrotic gene expression and inhibiting HSC apoptosis.
“Pro-inflammatory cytokines TNF-α and IL-1β (secreted by M1 macrophages) activate NF-κB within HSCs, inducing pro-fibrotic gene expression and inhibiting HSC apoptosis.”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [33]
Section 5 (Mitochondrial DAMPs; page unavailable) describes TNF-α release by macrophages, and Section 4 (ATP; page unavailable) describes IL-1β activation and secretion. Neither passage addresses whether these cytokines activate NF-κB in hepatic stellate cells, induce pro-fibrotic genes, or inhibit stellate-cell apoptosis. Searches for stellate cells, NF-κB, and the cytokines found no passage establishing that mechanism. (LLM, conf=0.75)
Experimental — accuracy not yet measuredTGF-β1 binds TβRII on HSCs, phosphorylates Smad2/3; the complex translocates to the nucleus, activating α-SMA, collagen I/III, and TIMP-1 while suppressing MMPs.
“TGF-β1 (released by Kupffer cells, platelets, and injured hepatocytes) binds to TβRII receptors on HSCs, leading to phosphorylation of Smad2/3. The phospho-Smad2/3-Smad4 complex translocates to the nucleus, activating genes encoding α-smooth muscle actin (α-SMA), collagen I and III, and tissue inhibitor of metalloproteinase-1 (TIMP-1) while suppressing matrix metalloproteinases (MMPs).”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [33]
The supplied passages from section 2 (HMGB1) and section 5 (Mitochondrial DAMPs) discuss danger signals and inflammatory signaling, not TGF-β1 signaling in hepatic stellate cells. Searches for Smad, TβRII, α-SMA, collagen, TIMP-1, and MMPs found no passage in our copy addressing the claimed pathway. (LLM, conf=0.76)
Experimental — accuracy not yet measuredChemokines CCL2 and CXCL8 recruit monocytes, perpetuating the inflammatory response and fibrosis.
“Chemokines such as CCL2 and CXCL8 recruit monocytes, perpetuating the inflammatory response and fibrosis [33, 34].”
From From signaling pathways to clinical trials: mesenchymal stem cells as multimodal regenerative architects in liver cirrhosis therapy (2025) · cites this paper as [33]
Section 2.2 discusses chemokine induction and likely neutrophil recruitment, but does not link CCL2 or CXCL8 to monocyte recruitment or fibrosis. Searches for CCL2, CXCL8, and monocyte recruitment with fibrosis found no passage in our copy establishing the claimed pathway. (LLM, conf=0.76)
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- Authors
- Mihm, S.
- Affiliations
- Universitätsmedizin Göttingen (DE)
- Corresponding author
- Mihm, Sabine
- ORCID
- Mihm, Sabine
- Venue
- International Journal of Molecular Sciences
- Publisher
- MDPI AG
- Published
- 2018-10-10
- Volume
- 19
- Issue
- 10
- Pages
- 3104
- ISSN
- 1422-0067 (ISSN-L)
- PMC
- PMC6213769
- OpenAlex
- W2896394478
- Cited by
- 232
- References
- 123
- Citations by year
- 2026: 27 · 2025: 30 · 2024: 32 · 2023: 35 · 2022: 34 · 2021: 25 · 2020: 32 · 2019: 16 · 2018: 1
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- International Journal of Molecular Sciences (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cell death mechanisms and regulation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
- Keywords
- damage-associated molecular patterns, sterile inflammation, liver inflammation, liver necrosis, apoptosis, Kupffer cells, monocytes, neutrophils, type I interferon, nonalcoholic steatohepatitis, alcoholic liver disease, cholestatic liver injury, hepatic ischemia-reperfusion injury, innate immune recognition
- MeSH terms
- Alarmins, Pathogen-Associated Molecular Pattern Molecules, Adenosine Triphosphate, Animals, Hepatitis, Humans, Keratins, Mitochondria, Liver, Biomarkers, HMGB1 Protein
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