GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Am J Pathol. 2023 Oct;193(10):1427-1439. doi: 10.1016/j.ajpath.2022.08.010. Epub 2022 Oct 25.
Alcohol-associated liver disease (ALD) is a common chronic liver disease with increasing incidence worldwide. Alcoholic liver steatosis/steatohepatitis can progress to liver fibrosis/cirrhosis, which can cause predisposition to hepatocellular carcinoma. ALD diagnosis and management are confounded by several challenges. Iron loading is a feature of ALD which can exacerbate alcohol-induced liver injury and promote ALD pathologic progression. Knowledge of the mechanisms that mediate liver iron loading can help identify cellular/molecular targets and thereby aid in designing adjunct diagnostic, prognostic, and therapeutic approaches for ALD. Herein, the cellular mechanisms underlying alcohol-induced liver iron loading are reviewed and how excess iron in patients with ALD can promote liver fibrosis and aggravate disease pathology is discussed. Alcohol-induced increase in hepatic transferrin receptor-1 expression and up-regulation of high iron protein in Kupffer cells (proposed) facilitate iron deposition and retention in the liver. Iron is loaded in both parenchymal and nonparenchymal liver cells. Iron-loaded liver can promote ferroptosis and thereby contribute to ALD pathology. Iron and alcohol can independently elevate oxidative stress. Therefore, a combination of excess iron and alcohol amplifies oxidative stress and accelerates liver injury. Excess iron-stimulated hepatocytes directly or indirectly (through Kupffer cell activation) activate the hepatic stellate cells via secretion of proinflammatory and profibrotic factors. Persistently activated hepatic stellate cells promote liver fibrosis, and thereby facilitate ALD progression.
酒精相关性肝病(ALD)是一种常见的慢性肝病,全球发病率不断上升。酒精性肝脂肪变性/肝炎可进展为肝纤维化/肝硬化,从而导致肝癌易感性增加。ALD 的诊断和管理受到多种挑战的困扰。铁过载是 ALD 的一个特征,可加重酒精引起的肝损伤并促进 ALD 病理进展。了解介导肝铁过载的机制有助于确定细胞/分子靶标,从而有助于设计 ALD 的辅助诊断、预后和治疗方法。本文综述了酒精引起的肝铁过载的细胞机制,以及 ALD 患者过量铁如何促进肝纤维化和加重疾病病理。酒精诱导的肝转铁蛋白受体 1 表达增加和库普弗细胞中铁蛋白的上调(拟议)促进了铁在肝脏中的沉积和保留。铁在实质和非实质肝细胞中被加载。含铁的肝脏可以促进铁死亡,从而有助于 ALD 病理。铁和酒精可以独立地增加氧化应激。因此,过量的铁和酒精会放大氧化应激并加速肝损伤。过量铁刺激的肝细胞通过分泌促炎和促纤维化因子直接或间接(通过库普弗细胞激活)激活肝星状细胞。持续激活的肝星状细胞促进肝纤维化,从而促进 ALD 进展。
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