Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Semin Liver Dis. 2021 Jan;41(1):67-78. doi: 10.1055/s-0040-1719177. Epub 2021 Feb 9.
Alcohol use disorder is the predominant cause of chronic liver disease globally. The standard of care for the treatment of alcoholic hepatitis, corticosteroids, has been shown to provide a therapeutic response in ∼60% of carefully selected patients with a short-term survival benefit. The patients who do not respond to steroids, or are ineligible due to infections or very severe disease, have little options other than liver transplantation. There is, thus, a large unmet need for new therapeutic strategies for this large and sick group of patients. Granulocyte colony stimulating factor (G-CSF) has been shown to favorably modulate the intrahepatic immune milieu and stimulate the regenerative potential of the liver. Initial studies have shown encouraging results with G-CSF in patients with severe alcoholic hepatitis. It has also been found to help steroid nonresponsive patients. There is, however, a need for careful selection of patients, regular dose monitoring and close observation for adverse events of G-CSF. In this review, we analyze the basis of the potential benefits, clinical studies, cautions and challenges in the use of G-CSF in alcoholic hepatitis.
酒精使用障碍是全球慢性肝病的主要原因。皮质类固醇是治疗酒精性肝炎的标准治疗方法，已被证明在经过精心选择的约 60%的患者中具有治疗反应，短期生存获益。对于那些对类固醇没有反应或因感染或非常严重的疾病而没有资格使用类固醇的患者，除了肝移植之外，几乎没有其他选择。因此，对于这群庞大且患病的患者，存在着大量未满足的新治疗策略需求。粒细胞集落刺激因子 (G-CSF) 已被证明可有利地调节肝内免疫环境并刺激肝脏的再生潜力。初步研究表明，G-CSF 在严重酒精性肝炎患者中具有令人鼓舞的结果。它也被发现有助于治疗对类固醇无反应的患者。然而，需要仔细选择患者，定期监测剂量并密切观察 G-CSF 的不良反应。在这篇综述中，我们分析了 G-CSF 在酒精性肝炎中的潜在益处、临床研究、注意事项和挑战的基础。
