Unraveling the complexities of fibrosis and ductular reaction in liver disease: pathogenesis, mechanisms, and therapeutic insights

Abstract

Ductular reaction and fibrosis are hallmarks of many liver diseases including primary sclerosing cholangitis, primary biliary cholangitis, biliary atresia, and metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis. Liver fibrosis is the accumulation of extracellular matrix often caused by excessed collagen deposition by myofibroblasts. Ductular reaction is the proliferation of bile ducts (which are composed of cholangiocytes) during liver injury. Many other liver cells including hepatic stellate cells, hepatocytes, hepatic progenitor cells, and mesenchymal stem cells contribute to ductular reaction and fibrosis by either directly or indirectly interacting with myofibroblasts and cholangiocytes. This review summarizes the recent findings in cellular links between ductular reaction and fibrosis in numerous liver diseases.

Ductular Reactions in Liver Injury, Regeneration, and Disease Progression—An Overview

“…DRs develop in many chronic liver diseases with different etiologies, where they show a strong correlation with the disease severity [7]. Cholangiopathies such as biliary atresia (BA), primary sclerosing cholangitis (PSC), primary biliary cirrhosis (PBC), and other chronic conditions such as alcoholic hepatitis (AH), nonalcoholic steatohepatitis (NASH), and viral hepatitis are some of the liver diseases associated with DRs [7][8][9][10][11][12][13][14][15][16].…”