Liver Regeneration and Fibrosis
Stuart J. Forbes
MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
Search for more papers by this authorMalcolm R. Alison
Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, London, UK
Search for more papers by this authorStuart J. Forbes
MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
Search for more papers by this authorMalcolm R. Alison
Centre for Tumour Biology, Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, London, UK
Search for more papers by this authorHoward C. Thomas BSc, PhD, FRCP, FRCPath, FMedSci
Emeritus Professor of Hepatology, Department of Medicine, Imperial College London, London, UK
Search for more papers by this authorAnna S.F. Lok MD
Alice Lohrman Andrews Research Professor in Hepatology, Director of Clinical Hepatology, Professor of Internal Medicine, Associate Chair for Clinical Research, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
Search for more papers by this authorStephen A. Locarnini MBBS, BSc(Hons), PhD, FRCPath
Head, Research & Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
Search for more papers by this authorArie J. Zuckerman MD, DSc, FRCP, FRCPath, FMedSci
Emeritus Professor of Medical Microbiology, Formerly Principal and Dean, Royal Free Hospital School of Medicine
Search for more papers by this authorSummary
In a healthy adult liver, the rate of cell turnover is very low. Following acute liver injury, restoration of parenchymal mass is achieved by proliferation of normally mitotically quiescent hepatocytes. However, chronic liver injury results in the loss of this proliferative capacity of the hepatocytes, as increasing numbers of cells become senescent. In this situation, there is activation of hepatic progenitor cells from within the intrahepatic biliary tree. These bipotential cells are capable of supplying biliary cells and hepatocytes. In animal models, there is some controversy regarding the relative contribution to parenchymal regeneration from these two compartments, but human studies are compatible with the suggestion that as the severity and chronicity of the liver injury increase, the balance of contribution to regeneration switches from the mature hepatocytes to the immature progenitor cells. We are now beginning to understand the molecular signals and niche requirements that govern their cell fate. Alongside the parenchymal regeneration in chronic liver injury, there is a stereotypical wound-healing response with activation of hepatic stellate cells into scar-forming myofibroblasts and deposition of collagen. This change in the extracellular matrix affects the regenerative capacity of the liver, and excess scar tissue can impair liver regeneration from either hepatocytes or hepatic progenitor cells.
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