Pathomechanism of Liver Fibrosis and Mesenchymal Stem Cells in its Resolution Process

Abstract

Liver fibrosis is a disease process that, without adequate treatment, can lead to liver failure and can be life-threatening. This disease is reversible and appropriate therapy can prevent further liver damage. Liver transplant therapy is the only treatment for an end-stage liver disease that works, but it has various obstacles and limitations in its implementation. Therefore, nowadays, mesenchymal stem cells (MSCs) have become a hope of therapy for liver fibrosis. Our literature review describes the pathomechanism of liver fibrosis and the steps of its resolution, accompanied by the possible role of MSCs in supporting the process. The activation of several complex pathways regulates liver fibrosis, and its resolution, involving Transforming Growth Factor (TGF)-β, signal transducer and activator of transcription-3, and Wnt/β-catenin signaling is involved in Hepatic Stellate Cells (HSCs) activation, which are precursors of myofibroblasts (MFs) and causes fibrosis. The presence of the High-mobility group box-1 pathway, which also induces the production of proinflammatory cytokines and the role of matrix metalloproteinases (MMPs)/tissue Inhibitors of MMPs s and Syndecan-1, is incorporated into the extracellular matrix (ECM). In repairing liver damage, four steps of liver fibrosis resolution are required, such as preventing further damage, restoring the intrahepatic balance of inflammation, removing and inactivating MFs, and ECM degradation associated with arresting the eight pathways of the fibrosis mechanism. MSCs can help resolve liver fibrosis and speed up wound healing, increase hepatocyte survival, and suppress HSCs activation by blocking fibrosis mechanism pathways such as TGF-β and pro-inflammatory factors such as tumor necrosis factor-alpha, interferon-gamma, IL-6, IL-17, and IL-23, in addition to an elevated level of an anti-inflammatory factor like IL-10.