Abstract
Background: Liver fibrosis arises from chronic hepatic injury and involves the accumulation of extracellular matrix proteins. Fibrosis progression ultimately leads to cirrhosis, characterized by architectural distortion and complications. Molecular profiling has identified prognostic transcriptomic subtypes, but management remains limited for advanced disease. Methods: We conducted a systematic review of the literature to identify recent advances in characterizing liver cirrhosis subtypes and emerging therapies. Electronic databases were searched using relevant terms, and studies published between 2020-2023 involving human subjects were included. Results: We identified three transcriptomic subtypes (inflammatory, proliferative, cholangiocyte-associated) associated with varying prognoses. Genetic variants like PNPLA3 and HLA alleles influence disease risk. Novel antifibrotic agents targeting hepatic stellate cells and molecular drivers showed promising preclinical efficacy. Observational studies reported association of agents like Obet cholic acid and vitamin E with histologic benefits in early fibrosis. Conclusion: While addressing etiologies remains key, limitations persist for established cirrhosis without approved antifibrotics. Priorities include developing noninvasive diagnostics, studying early interventions, and validating antifibrotic pipelines informed by molecular subclassification. Precision therapies may help curb advancing cirrhosis worldwide.
Published Version
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