Alcohol-related liver diseases

The wine culture of "knowing yourself with a thousand drinks" has a long history in China. Wine is inseparable from daily life and has a profound influence on politics, culture and the economy. The lofty rhetoric over drinks may be behind a huge health threat: Alcohol-related liver disease (ALD). ALD is a type of liver disease caused by alcohol dependence addiction and long-term excessive drinking. ALD includes alcoholic fatty liver (AFL), alcoholic steatohepatitis (ASH) and cirrhosis and its complications. AFL is characterized by simple hepatocyte steatosis (accumulation of triglycerides), while ASH is accompanied by hepatocyte steatosis with hepatocyte injury and inflammatory cells infiltration. With the improvement in living standards, the prevalence of metabolic liver diseases in China, including ALD, is increasing, which eventually leads to an increase in the number of cases of end-stage liver diseases (liver failure, liver cirrhosis, and liver cancer). There is a relationship between the amount of alcohol consumed and the risk of ALD. The vast majority (90%-100%) of chronic heavy drinkers will develop AFL. However, only 10%-20% of chronic heavy drinkers develop advanced ALD. Therefore, other factors may alter the course of the disease, such as genetics, environment, gender, etc. Based on the natural history of human liver progression from simple steatodegeneration to inflammation/fibrosis, it is estimated that the incidence of alcoholic steatohepatitis and liver fibrosis/cirrhosis will peak in China in the next 10 to 20 years. The pathogenesis of ALD has not been fully elucidated. Although alcohol-induced hepatotoxicity, oxidative stress and lipid metabolism disorder are key factors in its pathogenesis, a large number of studies have confirmed that immune response also promotes the development of ALD to a large extent. Emerging evidence from preclinical and clinical studies suggests that all stages of ALD involve novel immune mechanisms, including stages of immune response initiation, inflammatory response, and tissue repair. The new focus of clinical trials for ALD treatment includes probiotics, antioxidants, growth factors, empirical use of monoclonal antibodies against key inflammatory mediators, and enhanced behavioral interventions. However, up to now, there is still a lack of effective and specific ALD treatment drugs in clinic. Over the past 30 years, some countries have provided strong incentives for basic/clinical research, immunization, and drug discovery and development in the field of hepatology. To discard the reputation of "liver diseases in large countries", China has also made many efforts to launch liver disease prevention measures nationwide, establish global partnerships, and provide guidance programs for young liver doctors. This progress has been facilitated by the continued support of the National Natural Science Foundation of China (NSFC), which has helped almost all research areas in hepatology in China to flourish. This article summarizes the incidence rate of ALD and the related research funding situation in recent years in China and worldwide. In addition, this article also reviews the research progress of pathogenesis and treatment of ALD.