The three main broad categories of autoimmune liver disease are autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). The etiologies of these diseases are still incompletely understood, but seem to involve a combination of immune, genetic and environmental factors. Although each of these diseases has relatively distinct clinical, serologic and histological profiles, all of them share common pathways of immune-mediated liver injury. The development of autoimmune liver diseases is thought to be due to an imbalance of proinflammatory and anti-inflammatory immune responses within the liver, with proinflammatory immune responses being upregulated and anti-inflammatory ones downregulated. The available evidence, suggest that during autoimmune responses within the liver, "self" antigens are presented by antigen presenting cells (APCs) which then activate, directly and/or indirectly, NKT cells and other innate immune cells within the liver. Importantly, the hepatic innate immune system plays an increasingly recognized role in the development and propagation of autoimmune liver injury. NKT cells predominantly reside in the liver sinusoids, and through their ability to rapidly produce a wide variety of cytokines (e.g. Th1, TH2, Th17 cytokine patterns), are a critical checkpoint that bridges innate and adaptive immune responses. Specifically, activated NKT cells are capable of transactivating other innate and adaptive immune cells within the liver to amplify and regulate subsequent immune responses within the liver. It has been hypothesized that NKT cells in the setting of autoimmune liver disease can play diverse roles, including driving both anti-inflammatory and proinflammatory responses, as well as regulating the hepatic recruitment of other types of immunoregulatory cells, including regulatory T cells.
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