Ductular reaction in non-alcoholic fatty liver disease: When Macbeth is perverted

World J Hepatol. 2023 Jun 27;15(6):725-740. doi: 10.4254/wjh.v15.i6.725.

Abstract

Non-alcoholic fatty liver disease (NAFLD) or metabolic (dysfunction)-associated fatty liver disease is the leading cause of chronic liver diseases defined as a disease spectrum comprising hepatic steatosis, non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and hepatic carcinoma. NASH, characterized by hepatocyte injury, steatosis, inflammation, and fibrosis, is associated with NAFLD prognosis. Ductular reaction (DR) is a common compensatory reaction associated with liver injury, which involves the hepatic progenitor cells (HPCs), hepatic stellate cells, myofibroblasts, inflammatory cells (such as macrophages), and their secreted substances. Recently, several studies have shown that the extent of DR parallels the stage of NASH and fibrosis. This review summarizes previous research on the correlation between DR and NASH, the potential interplay mechanism driving HPC differentiation, and NASH progression.

Keywords: Cell differentiation; Ductular reaction; Hepatic progenitor cells; Inflammatory cells; Liver fibrosis; Non-alcoholic steatohepatitis.

Publication types

  • Review