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Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy
Portal hypertension, defined as increased pressure in the portal vein, develops as a consequence of increased intrahepatic vascular resistance due to the dysregulation of liver sinusoidal endothelial cells (LSECs) and hepatic stellate cells (HSCs), frequently arising from chronic liver diseases. Ext...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318926/ https://www.ncbi.nlm.nih.gov/pubmed/34337369 http://dx.doi.org/10.1016/j.jhepr.2021.100316 |
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author | Iwakiri, Yasuko Trebicka, Jonel |
author_facet | Iwakiri, Yasuko Trebicka, Jonel |
author_sort | Iwakiri, Yasuko |
collection | PubMed |
description | Portal hypertension, defined as increased pressure in the portal vein, develops as a consequence of increased intrahepatic vascular resistance due to the dysregulation of liver sinusoidal endothelial cells (LSECs) and hepatic stellate cells (HSCs), frequently arising from chronic liver diseases. Extrahepatic haemodynamic changes contribute to the aggravation of portal hypertension. The pathogenic complexity of portal hypertension and the unsuccessful translation of preclinical studies have impeded the development of effective therapeutics for patients with cirrhosis, while counteracting hepatic and extrahepatic mechanisms also pose a major obstacle to effective treatment. In this review article, we will discuss the following topics: i) cellular and molecular mechanisms of portal hypertension, focusing on dysregulation of LSECs, HSCs and hepatic microvascular thrombosis, as well as changes in the extrahepatic vasculature, since these are the major contributors to portal hypertension; ii) translational/clinical advances in our knowledge of portal hypertension; and iii) future directions. |
format | Online Article Text |
id | pubmed-8318926 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-83189262021-07-31 Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy Iwakiri, Yasuko Trebicka, Jonel JHEP Rep Review Portal hypertension, defined as increased pressure in the portal vein, develops as a consequence of increased intrahepatic vascular resistance due to the dysregulation of liver sinusoidal endothelial cells (LSECs) and hepatic stellate cells (HSCs), frequently arising from chronic liver diseases. Extrahepatic haemodynamic changes contribute to the aggravation of portal hypertension. The pathogenic complexity of portal hypertension and the unsuccessful translation of preclinical studies have impeded the development of effective therapeutics for patients with cirrhosis, while counteracting hepatic and extrahepatic mechanisms also pose a major obstacle to effective treatment. In this review article, we will discuss the following topics: i) cellular and molecular mechanisms of portal hypertension, focusing on dysregulation of LSECs, HSCs and hepatic microvascular thrombosis, as well as changes in the extrahepatic vasculature, since these are the major contributors to portal hypertension; ii) translational/clinical advances in our knowledge of portal hypertension; and iii) future directions. Elsevier 2021-06-04 /pmc/articles/PMC8318926/ /pubmed/34337369 http://dx.doi.org/10.1016/j.jhepr.2021.100316 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Review Iwakiri, Yasuko Trebicka, Jonel Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title | Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title_full | Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title_fullStr | Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title_full_unstemmed | Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title_short | Portal hypertension in cirrhosis: Pathophysiological mechanisms and therapy |
title_sort | portal hypertension in cirrhosis: pathophysiological mechanisms and therapy |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318926/ https://www.ncbi.nlm.nih.gov/pubmed/34337369 http://dx.doi.org/10.1016/j.jhepr.2021.100316 |
work_keys_str_mv | AT iwakiriyasuko portalhypertensionincirrhosispathophysiologicalmechanismsandtherapy AT trebickajonel portalhypertensionincirrhosispathophysiologicalmechanismsandtherapy |