Inflammatory mechanisms in the progression of fatty liver disease as innovative molecular targets

Multiple injurious stimuli in the course of nonalcoholic fatty liver diseases (NAFLD) and the resulting changes in the liver such as hepatic lipid deposits, accumulation of toxic metabolites, oxidative stress or apoptosis and necrosis of hepatocytes lead to an activation of the immune system. This in turn leads to an inflammatory reaction that favors the progression from the prognostically more favorable nonalcoholic fatty liver (NAFL) to the progressive phenotype of nonalcoholic steatohepatitis (NASH). Chronic inflammation leads to fibrosis, which is the major risk factor for overall and liver-related morbidity and mortality in NAFLD. There are currently no approved drug treatments, but numerous substances are in clinical trials. A better understanding of the inflammatory processes in the liver provides new innovative therapeutic targets for the treatment of NAFLD and its complications. The immunological mechanisms and the resulting therapeutic approaches are presented in this review.