Macrophage-mediated modulation of hepatic function in multiple-system failure.

Hepatic insufficiency associated with the multiple-system organ-failure (MSOF) syndrome is a frequent sequellae of sepsis and severe trauma. Although its etiology is poorly understood, there is a growing literature suggesting that it may be mediated in part by secretory products of cells of monocyte/macrophage lineage including Kupffer cells. Several investigators have reported in vitro macrophage/Kupffer cell-mediated cytotoxicity toward target cells following appropriate stimulation. In addition, in vivo hepatocyte toxicity has been documented following activation of the reticuloendothelial system. The role of several secretory products including active oxygen intermediates, neutral proteases, and interleukin 1 in this cell-mediated model of hepatocellular modulation is reviewed.