Reversal of liver cirrhosis: current evidence and expectations

Abstract

In the past, liver cirrhosis was considered an irreversible phenomenon. However, many experimental data have provided evidence of the reversibility of liver fibrosis. Moreover, multiple clinical studies have also shown regression of fibrosis and reversal of cirrhosis on repeated biopsy samples. As various etiologies are associated with liver fibrosis via integrated signaling pathways, a comprehensive understanding of the pathobiology of hepatic fibrogenesis is critical for improving clinical outcomes. Hepatic stellate cells play a central role in hepatic fibrogenesis upon their activation from a quiescent state. Collagen and other extracellular material components from activated hepatic stellate cells are deposited on, and damage, the liver parenchyma and vascular structures. Hence, inactivation of hepatic stellate cells can lead to enhancement of fibrolytic activity and could be a potential target of antifibrotic therapy. In this regard, continued efforts have been made to develop better treatments for underlying liver diseases and antifibrotic agents in multiple clinical and therapeutic trials; the best results may be expected with the integration of such evidence. In this article, we present the underlying mechanisms of fibrosis, current experimental and clinical evidence of the reversibility of liver fibrosis/cirrhosis, and new agents with therapeutic potential for liver fibrosis.

Comparative evaluation of GPR versus APRI and FIB‐4 in predicting different levels of liver fibrosis of chronic hepatitis B

“…The evidence available so far demonstrated that, regardless of HBeAg‐positive or HBeAg‐negative status, antiviral‐induced and natural remission of liver inflammation can lead to regression of fibrosis, but the reversibility of cirrhosis accompanied by architectural alteration of liver remains controversial . Therefore, the identification of significant fibrosis prior to cirrhosis is a key factor for effective management of CHB.…”

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

“…Cirrhosis is the advanced stage of chronic hepatitis, being the result of imbalanced production (decrease) and destruction (increase) of the hepatocellular matrix [32][33][34]. Identifying patients with advanced fibrosis or beginning cirrhosis is clinically relevant, as it serves as a crucial determinant in the evaluation of disease progression, therapy response, and longterm outcome [5-8, 35, 36].…”

MRI as an alternative to serum ferritin for diagnosis of iron overload in children in the context of immune response after stem cell transplantation

“…5,18,19 Restitution of LP or a potentially reversible process of iron overload has been recently discussed and may play a role. 20 But, a complete recovery was not observed in any patient within the study period. In patients with thalassemia, cellular iron uptake is downregulated through hepcidin after many transfusions.…”

“…The probable causes are iron loss or regeneration of LP and the well‐described downregulation of iron transporting proteins . Restitution of LP or a potentially reversible process of iron overload has been recently discussed and may play a role . But, a complete recovery was not observed in any patient within the study period.…”