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Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage...

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Autores principales: Sauerbruch, Tilman, Hennenberg, Martin, Trebicka, Jonel, Schierwagen, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891090/
https://www.ncbi.nlm.nih.gov/pubmed/36743678
http://dx.doi.org/10.3389/fmed.2022.1100966
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author Sauerbruch, Tilman
Hennenberg, Martin
Trebicka, Jonel
Schierwagen, Robert
author_facet Sauerbruch, Tilman
Hennenberg, Martin
Trebicka, Jonel
Schierwagen, Robert
author_sort Sauerbruch, Tilman
collection PubMed
description With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients.
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spelling pubmed-98910902023-02-02 Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection? Sauerbruch, Tilman Hennenberg, Martin Trebicka, Jonel Schierwagen, Robert Front Med (Lausanne) Medicine With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to “biased-signaling” via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients. Frontiers Media S.A. 2023-01-09 /pmc/articles/PMC9891090/ /pubmed/36743678 http://dx.doi.org/10.3389/fmed.2022.1100966 Text en Copyright © 2023 Sauerbruch, Hennenberg, Trebicka and Schierwagen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Sauerbruch, Tilman
Hennenberg, Martin
Trebicka, Jonel
Schierwagen, Robert
Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title_full Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title_fullStr Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title_full_unstemmed Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title_short Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?
title_sort beta-blockers in patients with liver cirrhosis: pragmatism or perfection?
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9891090/
https://www.ncbi.nlm.nih.gov/pubmed/36743678
http://dx.doi.org/10.3389/fmed.2022.1100966
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