Chronic liver disease and oxidative stress – a narrative review

ABSTRACT

Introduction: Oxidative stress underlies the pathophysiology of various etiologies of chronic liver disease and contributes to the development of hepatocarcinogenesis.

Areas covered: This review focuses on the impact of oxidative stress in various etiologies of chronic liver disease such as alcoholic liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis B virus (HBV), and hepatitis C virus (HCV) infection. The efficacy of antioxidants in laboratory, animal, and clinical studies in chronic liver disease is also reviewed.

Expert opinion: Currently, there are limited targeted pharmacotherapeutics for NASH and no pharmacotherapeutics for ALD and antioxidant supplementation may be useful in these conditions to improve liver function and reverse fibrosis. Antioxidants may also be used in patients with HBV or HCV infection to supplement antiviral therapies. Specific genotypes of antioxidant and prooxidant genes render patients more susceptible to liver cirrhosis and hepatocellular carcinoma while other individual characteristics like age, genotype, and metabolomic profiling can influence the efficacy of antioxidants on CLD. More research needs to be done to establish the safety, efficacy, and dosage of antioxidants and to establish the ideal patient profile that will benefit the most from antioxidant treatment.

KEYWORDS:

• Alcoholic liver disease
• cirrhosis
• hepatitis B
• hepatitis C
• hepatocellular carcinoma
• nonalcoholic steatohepatitis

Article highlights

• Oxidative stress occurs when the antioxidant defenses are overwhelmed by the generation of reactive oxygen species. The various etiologies of chronic liver disease cause oxidative stress by diminishing antioxidant defenses while increasing the generation of reactive oxygen species.

• Antioxidants have proven to be effective in improving hepatic function and reducing fibrosis in laboratory and animal studies. Clinical studies have been limited but results have been mixed.

• More clinical studies should be done to establish the efficacy of antioxidants in patients given the promising results in animal studies.

• The different genotypes of antioxidant and prooxidant genes in patients influence their clinical outcomes and may help with prognostication.

• Other individual characteristics such as age, genotype, and metabolomic profiling influence the efficacy of antioxidant therapy in CLD patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.