ICVS researcher Dalila Costa authored a review in Nature Reviews Gastroenterology & Hepatology, “Interaction of inflammation and portal hypertension in cirrhosis progression” proposing a new concept for explaining the mechanisms of decompensated cirrhosis, a serious, but still uncurable disease that affects thousands of people worldwide.
Decompensated cirrhosis is the most severe stage of chronic liver disease and is characterized by the development of complications such as ascites, variceal hemorrhage, or hepatic encephalopathy, all with high mortality. Research on this condition over the years has been aimed primarily at portal hypertension: an increase in blood pressure in the liver vessels, a major determining factor for disease severity. Nevertheless, the current review emphasizes that systemic inflammation, a body system response, is equally crucial, particularly in the subsequent phases, when it leads to organ failure and clinical deterioration.
Through the interaction analysis between the two processes, Dalila Costa and her co-authors unveil an integrative model of cirrhosis development, with portal hypertension and systemic inflammation existing alongside and dynamically interacting with each other. The review proposes that various patients might have a predominance of one mechanism over the other, or even a mixed profile, which would be responsible for differences in disease evolution and response to treatment. This theoretical framework provides an opportunity to build more tailor-made therapeutic strategies based on each patient’s prevailing pathophysiological mechanism.
The paper also maps out a range of biomarkers and clinical markers which may be able to help clinicians identify such differences and, in the future, alter treatment strategies in response. It also distills new therapeutic avenues aimed at systemic inflammation and portal hypertension, two areas showing great promise in recent translational and clinical studies. A better understanding of how these processes interact more comprehensively is key toward mechanism-directed therapy development as well as toward an improved prognosis in decompensated cirrhotic patients.
Hospital de Braga gastroenterologist and ICVS researcher since 2014, Dalila Costa has dedicated her career to the study of chronic liver disease. Her additional training in Hepatology at Medical University of Vienna saw her involved in an innovative project of systemic inflammation in cirrhosis. She is currently a PhD candidate in Medicine at the University of Minho’s School of Medicine, focusing on establishing prognostic biomarkers of progression and regression of cirrhosis.
