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Mechanisms of Liver Injury

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Diseases of the Liver in Children

Abstract

A diverse range of pathophysiologic processes lead to liver injury in the pediatric population. This chapter discusses mechanisms of hepatocyte or other liver cellular injury, beginning with a brief discussion of liver functions and general mechanisms of cell death. Particular attention is paid to the role of apoptotic pathways and mitochondrial damage in liver diseases, including metabolic disorders, infections, toxin ingestions, and diseases that primarily affect the biliary tree.

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References

  1. Kmiec Z. Cooperation of liver cells in health and disease. Adv Anat Embryol Cell Biol. 2001;161:III–XIII, 1–151.

    PubMed  CAS  Google Scholar 

  2. Fausto N, Campbell JS, Riehle KJ. Liver regeneration. Hepatology. 2006;43(2 Suppl 1):S45–53.

    Article  PubMed  CAS  Google Scholar 

  3. Fausto N, Campbell JS, Riehle KJ. Liver regeneration. J Hepatol. 2012;57(3):692–4.

    Article  PubMed  Google Scholar 

  4. Friedman SL. Mechanisms of hepatic fibrogenesis. Gastroenterology. 2008;134(6):1655–69.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Alisi A, et al. Liver fibrosis in paediatric liver diseases. Best Pract Res Clin Gastroenterol. 2011;25(2):259–68.

    Article  PubMed  CAS  Google Scholar 

  6. Goldschmidt I, Baumann U. Hepatic fibrosis in paediatric liver disease. Clin Res Hepatol Gastroenterol. 2012;36(3):268–70.

    Article  PubMed  Google Scholar 

  7. Riehle KJ, et al. New concepts in liver regeneration. J Gastroenterol Hepatol. 2011;26 Suppl 1:203–12.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tanner MS. Mechanisms of liver injury relevant to pediatric hepatology. Crit Rev Clin Lab Sci. 2002;39(1):1–61.

    Article  PubMed  CAS  Google Scholar 

  9. Guicciardi ME, Gores GJ. Apoptosis as a mechanism for liver disease progression. Semin Liver Dis. 2010;30(4):402–10.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. Malhi H, Kaufman RJ. Endoplasmic reticulum stress in liver disease. J Hepatol. 2011;54(4):795–809.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  11. Sokol RJ, Treem WR. Mitochondria and childhood liver diseases. J Pediatr Gastroenterol Nutr. 1999;28(1):4.16.

    PubMed  Google Scholar 

  12. Ibrahim SH, Kohli R, Gores GJ. Mechanisms of lipotoxicity in NAFLD and clinical implications. J Pediatr Gastroenterol Nutr. 2011;53(2):131–40.

    PubMed  CAS  PubMed Central  Google Scholar 

  13. Sokol RJ, et al. “Let there be bile”–understanding hepatic injury in cholestasis. J Pediatr Gastroenterol Nutr. 2006;43 Suppl 1:S4.9.

    PubMed  Google Scholar 

  14. Murray KF, et al. Drug-related hepatotoxicity and acute liver failure. J Pediatr Gastroenterol Nutr. 2008;47(4):395–405.

    Article  PubMed  CAS  Google Scholar 

  15. Jaeschke H. Reactive oxygen and mechanisms of inflammatory liver injury: Present concepts. J Gastroenterol Hepatol. 2011;26 Suppl 1:173–9.

    Article  PubMed  CAS  Google Scholar 

  16. Fellman V, Kotarsky H. Mitochondrial hepatopathies in the newborn period. Semin Fetal Neonatal Med. 2011;16(4):222–8.

    Article  PubMed  Google Scholar 

  17. Dimmock D, et al. Citrin deficiency, a perplexing global disorder. Mol Genet Metab. 2009;96(1):44.9.

    PubMed  Google Scholar 

  18. Couce ML, et al. Tyrosinemia type 1 in Spain: mutational analysis, treatment and long-term outcome. Pediatr Int. 2011;53(6):985–9.

    Article  PubMed  CAS  Google Scholar 

  19. Leslie ND. Insights into the pathogenesis of galactosemia. Annu Rev Nutr. 2003;23:59–80.

    Article  PubMed  CAS  Google Scholar 

  20. Devictor D, et al. Acute liver failure in neonates, infants and children. Expert Rev Gastroenterol Hepatol. 2011;5(6):717–29.

    Article  PubMed  Google Scholar 

  21. Bouteldja N, Timson DJ. The biochemical basis of hereditary fructose intolerance. J Inherit Metab Dis. 2010;33(2):105–12.

    Article  PubMed  CAS  Google Scholar 

  22. Kim SY, et al. Necrotic foci, elevated chemokines and infiltrating neutrophils in the liver of glycogen storage disease type Ia. J Hepatol. 2008;48(3):479–85.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Magoulas PL, et al. Diffuse reticuloendothelial system involvement in type IV glycogen storage disease with a novel GBE1 mutation: a case report and review. Hum Pathol. 2012;43(6):943–51.

    Article  PubMed  CAS  Google Scholar 

  24. Koscielak J. Carbohydrate-deficient glycoprotein syndromes. Acta Biochim Pol. 1999;46(3):727–38.

    PubMed  CAS  Google Scholar 

  25. Grunewald S, Matthijs G, Jaeken J. Congenital disorders of glycosylation: a review. Pediatr Res. 2002;52(5):618–24.

    PubMed  Google Scholar 

  26. vom Dahl S, Mengel E. Lysosomal storage diseases as differential diagnosis of hepatosplenomegaly. Best Pract Res Clin Gastroenterol. 2010;24(5):619–28.

    Article  Google Scholar 

  27. Ayto RM, et al. Long-term outcomes of liver transplantation in type 1 Gaucher disease. Am J Transplant. 2010;10(8):1934.9.

    PubMed  Google Scholar 

  28. Rutledge JC. Progressive neonatal liver failure due to type C Niemann-Pick disease. Pediatr Pathol. 1989;9(6):779–84.

    Article  PubMed  CAS  Google Scholar 

  29. Takahashi T, et al. Heterogeneity of liver disorder in type B Niemann-Pick disease. Hum Pathol. 1997;28(3):385–8.

    Article  PubMed  CAS  Google Scholar 

  30. Bowden KL, et al. Lysosomal acid lipase deficiency impairs regulation of ABCA1 gene and formation of high density lipoproteins in cholesteryl ester storage disease. J Biol Chem. 2011;286(35):30624.35.

    PubMed  Google Scholar 

  31. Alisi A, et al. Pediatric nonalcoholic fatty liver disease: a multidisciplinary approach. Nat Rev Gastroenterol Hepatol. 2012;9(3):152–61.

    Article  PubMed  CAS  Google Scholar 

  32. de Meijer VE, et al. Parenteral fish oil monotherapy in the management of patients with parenteral nutrition-associated liver disease. Arch Surg. 2010;145(6):547–51.

    Article  PubMed  Google Scholar 

  33. Nehra D, Fallon EM, Puder M. The prevention and treatment of intestinal failure-associated liver disease in neonates and children. Surg Clin North Am. 2011;91(3):543–63.

    Article  PubMed  Google Scholar 

  34. Debray FG, et al. Neonatal liver cirrhosis without iron overload caused by gestational alloimmune liver disease. Pediatrics. 2012;129(4):e1076–9.

    Article  PubMed  Google Scholar 

  35. Bacon BR, et al. Diagnosis and management of hemochromatosis: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54(1):328–43.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Nelson DR, et al. Diagnosis and management of patients with alpha1-antitrypsin (A1AT) deficiency. Clin Gastroenterol Hepatol. 2012;10(6):575–80.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hidvegi T, et al. An autophagy-enhancing drug promotes degradation of mutant alpha1-antitrypsin Z and reduces hepatic fibrosis. Science. 2010;329(5988):229–32.

    Article  PubMed  CAS  Google Scholar 

  38. Petrukhin K, et al. Mapping, cloning and genetic characterization of the region containing the Wilson disease gene. Nat Genet. 1993;5(4):338–43.

    Article  PubMed  CAS  Google Scholar 

  39. Bull PC, et al. The Wilson disease gene is a putative copper transporting P-type ATPase similar to the Menkes gene. Nat Genet. 1993;5(4):327–37.

    Article  PubMed  CAS  Google Scholar 

  40. Vulpe CD, Packman S. Cellular copper transport. Annu Rev Nutr. 1995;15:293–322.

    Article  PubMed  CAS  Google Scholar 

  41. Pfeiffer RF. Wilson’s disease. Semin Neurol. 2007;27(2):123–32.

    Article  PubMed  Google Scholar 

  42. Dandri M, Locarnini S. New insight in the pathobiology of hepatitis B virus infection. Gut. 2012;61 Suppl 1:i6–17.

    Article  PubMed  CAS  Google Scholar 

  43. Jhaveri R. Diagnosis and management of hepatitis C virus-infected children. Pediatr Infect Dis J. 2011;30(11):983–5.

    Article  PubMed  Google Scholar 

  44. Khalil S, et al. Prevalence and outcome of hepatobiliary dysfunction in neonatal septicaemia. J Pediatr Gastroenterol Nutr. 2012;54(2):218–22.

    Article  PubMed  Google Scholar 

  45. Epps RE, Pittelkow MR, Su WP. TORCH syndrome. Semin Dermatol. 1995;14(2):179–86.

    Article  PubMed  CAS  Google Scholar 

  46. Fellman V, et al. Iron-overload disease in infants involving fetal growth retardation, lactic acidosis, liver haemosiderosis, and aminoaciduria. Lancet. 1998;351(9101):490–3.

    Article  PubMed  CAS  Google Scholar 

  47. Vanden Eijnden S, et al. Iron overload in gestational alloimmune liver disease: still more questions than answers. Prenat Diagn. 2012;32(8):810–2.

    Article  PubMed  Google Scholar 

  48. Roberts EA. Autoimmune hepatitis from the paediatric perspective. Liver Int. 2011;31(10):1424.31.

    PubMed  Google Scholar 

  49. Gupta A, Bowlus CL. Primary sclerosing cholangitis: etiopathogenesis and clinical management. Front Biosci (Elite Ed). 2012;4:1683–705.

    Google Scholar 

  50. Sorrentino P, et al. Oxidative stress and steatosis are cofactors of liver injury in primary biliary cirrhosis. J Gastroenterol. 2010;45(10):1053–62.

    Article  PubMed  CAS  Google Scholar 

  51. Shneider BL. Diagnostic and therapeutic challenges in pediatric primary sclerosing cholangitis. Liver Transpl. 2012;18(3):277–81.

    Article  PubMed  Google Scholar 

  52. Rivera-Penera T, et al. Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity. J Pediatr. 1997;130(2):300–4.

    Article  PubMed  CAS  Google Scholar 

  53. Chawla A, et al. Rapidly progressive cholestasis: an unusual reaction to amoxicillin/clavulanic acid therapy in a child. J Pediatr. 2000;136(1):121–3.

    Article  PubMed  CAS  Google Scholar 

  54. Eliasson E, Kenna JG. Cytochrome P450 2E1 is a cell surface autoantigen in halothane hepatitis. Mol Pharmacol. 1996;50(3):573–82.

    PubMed  CAS  Google Scholar 

  55. Kosters A, Karpen SJ. The role of inflammation in cholestasis: clinical and basic aspects. Semin Liver Dis. 2010;30(2):186–94.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  56. Sundaram SS, et al. Mechanisms of disease: Inborn errors of bile acid synthesis. Nat Clin Pract Gastroenterol Hepatol. 2008;5(8):456–68.

    Article  PubMed  CAS  Google Scholar 

  57. Bull LN, et al. A gene encoding a P-type ATPase mutated in two forms of hereditary cholestasis. Nat Genet. 1998;18(3):219–24.

    Article  PubMed  CAS  Google Scholar 

  58. Strautnieks SS, et al. A gene encoding a liver-specific ABC transporter is mutated in progressive familial intrahepatic cholestasis. Nat Genet. 1998;20(3):233–8.

    Article  PubMed  CAS  Google Scholar 

  59. Suchy FJ, Ananthanarayanan M. Bile salt excretory pump: biology and pathobiology. J Pediatr Gastroenterol Nutr. 2006;43 Suppl 1:S10–6.

    Article  PubMed  CAS  Google Scholar 

  60. de Vree JM, et al. Mutations in the MDR3 gene cause progressive familial intrahepatic cholestasis. Proc Natl Acad Sci U S A. 1998;95(1):282–7.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Rowland M, Bourke B. Liver disease in cystic fibrosis. Curr Opin Pulm Med. 2011;17(6):461–6.

    PubMed  Google Scholar 

  62. Bartlett JR, et al. Genetic modifiers of liver disease in cystic fibrosis. JAMA. 2009;302(10):1076–83.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  63. Alagille D, et al. Syndromic paucity of interlobular bile ducts (Alagille syndrome or arteriohepatic dysplasia): review of 80 cases. J Pediatr. 1987;110(2):195–200.

    Article  PubMed  CAS  Google Scholar 

  64. Subramaniam P, et al. Diagnosis of Alagille syndrome-25 years of experience at King’s College Hospital. J Pediatr Gastroenterol Nutr. 2011;52(1):84.9.

    PubMed  Google Scholar 

  65. Phillips MJ, et al. Abnormalities in villin gene expression and canalicular microvillus structure in progressive cholestatic liver disease of childhood. Lancet. 2003;362(9390):1112–9.

    Article  PubMed  CAS  Google Scholar 

  66. Bates MD, et al. Biliary atresia: pathogenesis and treatment. Semin Liver Dis. 1998;18(3):281–93.

    Article  PubMed  CAS  Google Scholar 

  67. Harper P, Plant JW, Unger DB. Congenital biliary atresia and jaundice in lambs and calves. Aust Vet J. 1990;67(1):18–22.

    Article  PubMed  CAS  Google Scholar 

  68. Srinath A, Shneider BL. Congenital hepatic fibrosis and autosomal recessive polycystic kidney disease. J Pediatr Gastroenterol Nutr. 2012;54(5):580–7.

    Article  PubMed  Google Scholar 

  69. Nakanuma Y, et al. Recent progress in the etiopathogenesis of pediatric biliary disease, particularly Caroli’s disease with congenital hepatic fibrosis and biliary atresia. Histol Histopathol. 2010;25(2):223–35.

    PubMed  CAS  Google Scholar 

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Correspondence to Kimberly J. Riehle MD .

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Riehle, K.J., Fausto, N. (2014). Mechanisms of Liver Injury. In: Murray, K., Horslen, S. (eds) Diseases of the Liver in Children. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9005-0_4

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  • DOI: https://doi.org/10.1007/978-1-4614-9005-0_4

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