Immunotherapy for acute-on-chronic liver failure

Inflammatory response and immune dysfunction play important roles in the progression of acute-on-chronic liver failure ( ACLF) and may lead to systemic inflammatory response syndrome. Excessive inflammatory and immune response may result in increased susceptibility to infection and finally lead to multiple organ dysfunction syndrome ( MODS) . Elimination of liver injury and correction of immune dysfunction can prevent sepsis and/or MODS and improve patients'survival. Up to now, immunotherapy for ACLF has not been recommended in related guidelines. However, as an important pathophysiological change of ACLF and a key event closely associated with incidence rate and mortality rate, persistent activation of hepatic and systemic inflammatory response and immune cell dysfunction urges us to consider immunoregulatory treatment, in order to block and reverse disease progression. This article introduces potential immunoregulatory drugs for the treatment of ACLF, including albumin, glucocorticoids, granulocyte colony-stimulating factor, artificial liver support system, and mesenchymal stem cell transplantation, and discusses some promising targets for immunotherapy.