Fibrotic processes

Obviously the best treatment for cirrhosis is removal of the injurious event. In the case of viral hepatitis, viral load can at least be temporarily reduced with anti-viral agents such as lamivudine, ribavirin and/or IFNa [76]. Unfortunately, complete removal of the injurious event is frequently not possible. Moreover, by the time cirrhosis is diagnosed the fibrotic process has usually progressed beyond the point of no return and removal of the injurious event will have little effect. Successful pharmacological treatment to reverse the fibrotic... 

The bile add ursodeoxycholic acid has shown some promise in slowing down the fibrotic process in cholestatic patients, especially those suffering from PBC and PSC [77,78]. Its mechanism of action, however, is stiU a matter of debate. 

Several classes of drugs can be potentially used to reduce the release of pro-inflammatory mediators by SECs and KCs in the fibrotic process. 

Although the cellular and molecular mechanisms underlying fibrosis are not fully explained, it is assumed that an inflammatory reaction is the initiating factor in the early stage of fibrosis and that this inflammatory process continues during the fibrotic process [77, 105, 106], Kupffer and endothelial cells are considered to be the most important resident cells involved in the local production of inflammatory mediators [24, 28, 29, 76], Besides causing the activation of HSC, the inflammatory mediators induce the expression of adhesion molecules, such as ICAM-1 and VCAM on endothelial cells, that direct neutrophils and monocytes into the inflamed liver tissue [41-43], Expression of adhesion molecules is also shown for KC and stellate cells [42, 107], Furthermore, chemotactic compounds are released by endothelial and KC to attract immune competent cells... 

This patient s main symptom was progressive stiffness, due to contractures of the quadriceps muscles induced by chronic heroin injections. The findings made it very likely that heroin caused a primarily vascular lesion leading to non-specific inflammatory changes and subsequent fibrosis. Clinically, weakness was minimal and there was painless contracture. This presumably reflects the predominantly fibrotic process within muscle tissue. Combination therapy with prednisone and D-penicillamine led to significant improvement. The regenerating... 

Cavalleri A, Gobba F, Bacchella L, et al. 1991. Evaluation of serum aminoterminal propeptide of type 111 procollagen as an early marker of the active fibrotic process in asbestos-exposed workers. Scand J Work Environ Health 17 139-144. 

Sotaniemi EA, Niemela O, Risteli L, Stenback F, Pelkonen RO, Lahtela JT, Risteli J. Fibrotic process and drug metabolism in alcoholic liver disease. Clin Pharmacol Ther 1986 40 46-55. 

Interlobular and afferent arterioles showed thickening of their walls due to a swelling of the endothelial cells. These aspects suggest that the primary lesions could be located in the vessel walls leading to ischemia and interstitial fibrosis [34]. In one case, an extension of the fibrotic process to the pelvis and the ureter was observed [33], what may explain the unusual presentation of this case with a bilateral hydronephrosis [35]. 

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