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Störungen des angeborenen Immunsystems bei akuten und chronischen Lebererkrankungen

Innate immune dysfunction in acute and chronic liver disease

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Summary

Liver cirrhosis is a common disease causing great public-health concern because of the frequent complications requiring hospital care. Acute liver failure is also prone to several complications but is rare. One of the main complications for both acute and chronic liver diseases is infection, which regularly causes decompensation of cirrhosis, possibly leading to organ failure and death. This review focuses on innate immune function in cirrhosis, acute-on-chronic liver failure and acute liver failure. The known defects of Kupffer cells, neutrophils and monocytes are discussed, together with the pathophysiological importance of gut permeability, portal hypertension and intrinsic cellular defects, and the role of endotoxin, albumin, lipoproteins and toll-like receptors. Based on these different pathomechanisms, the available information on therapeutic strategies is presented. Antibiotic and probiotic treatment, nutritional support, artificial liver support, and experimental strategies such as inhibition of toll-like receptors and use of albumin and colony-stimulating factors are highlighted.

Zusammenfassung

Die Leberzirrhose ist eine häufige Erkrankung, die aufgrund zahlreicher Komplikationen, die Spitalsaufnahmen nach sich ziehen, ein Problem für das Gesundheitssystem darstellt. Das akute Leberversagen hingegen ist selten, doch wenn es auftritt, sind zahlreiche schwerwiegende Komplikationen die Folge. Zu den wichtigsten Komplikationen, sowohl bei akuten als auch chronischen Lebererkrankungen, zählen Infektionen. In dieser Übersichtsarbeit werden Störungen des angeborenen Immunsystems bei Leberzirrhose, akut-auf-chronischem Leberversagen und akuten Leberversagen. Die bekannten Defekte der Kupffer-Zellen, neutrophilen Granulozyten und Monozyten werden besprochen. Weiters wird die pathophysiologische Relevanz der Darmpermeabilität, der portalen Hypertension sowie intrinsische zelluläre Defizite diskutiert und die Rolle von Endotoxin, Albumin, Lipoproteinen und Toll-like Rezeptoren herausgearbeitet. Basierend auf diesen pathophysiologischen Konzepten werden die verfügbaren therapeutischen Strategien präsentiert: Therapie mit Antibiotika, Probiotika, Ernährungstherapie und Leberunterstützungssysteme sowie experimentelle Strategien wie Toll-like Rezeptor Hemmung, Albumin oder Kolonie-stimulierende Faktoren.

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Authors and Affiliations

  1. Division of Surgery, Medical University of Graz, Graz, Austria

    Bettina Leber & Ursula Mayrhauser

  2. Division of Internal Medicine, Medical University of Graz, Graz, Austria

    Michael Rybczynski & Vanessa Stadlbauer

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  1. Bettina Leber
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  2. Ursula Mayrhauser
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  3. Michael Rybczynski
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  4. Vanessa Stadlbauer
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Correspondence to Vanessa Stadlbauer.

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Leber, B., Mayrhauser, U., Rybczynski, M. et al. Störungen des angeborenen Immunsystems bei akuten und chronischen Lebererkrankungen. Wien Klin Wochenschr 121, 732–744 (2009). https://doi.org/10.1007/s00508-009-1288-2

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