Albillos A, Martin-Mateos R, Van der Merwe S, Wiest R, Jalan R, Álvarez-Mon M. Cirrhosis-associated immune dysfunction
Nat Rev Gastroenterol Hepatol. 2021
"Systemic inflammation and immune deficiency are the key components of cirrhosis- associated immune dysfunction (CAID) and their intensity varies according to the stage of cirrhosis and the presence of incidental events." - Dr. Rosa Martín-Mateos and Dr. Agustín Albillos.
The term cirrhosis-associated immune dysfunction (CAID) comprises the distinctive spectrum of immune alterations associated with the course of end-stage liver disease. Systemic inflammation and immune deficiency are the key components of CAID. Their severity is highly dynamic and progressive, paralleling cirrhosis stage. CAID involves two different immune phenotypes: the low-grade systemic inflammatory phenotype and the high-grade systemic inflammatory phenotype. The low-grade systemic inflammatory phenotype can be found in patients with compensated disease or clinical decompensation with no organ failure. In this phenotype, there is an exaggerated immune activation but the effector response is not markedly compromised. The high-grade systemic inflammatory phenotype is present in patients with acute-on-chronic liver failure, a clinical situation characterized by decompensation, organ failure and high short-term mortality. Along with high-grade inflammation, this CAID phenotype includes intense immune paralysis that critically increases the risk of infections and worsens prognosis. The intensity of CAID has important consequences on cirrhosis progression and correlates with the severity of liver insufficiency, bacterial translocation and organ failure. Therapies targeting the modulation of the dysfunctional immune response are currently being evaluated in preclinical and clinical studies.
Why do you highlight this publication?
This review updates and summarizes the most recent knowledge on the immune alterations associated with cirrhosis at its different stages, and also describes the contribution of the liver to the immune response.
Publication commented by:
Dr. Rosa Martín-Mateos and Dr. Agustín Albillos
Digestive Service. Hospital Universitario Ramón y Cajal