Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

Tilman Sauerbruch; Martin Hennenberg; Jonel Trebicka; Robert Schierwagen

doi:10.3389/fmed.2022.1100966

Beta-blockers in patients with liver cirrhosis: Pragmatism or perfection?

Front Med (Lausanne). 2023 Jan 9:9:1100966. doi: 10.3389/fmed.2022.1100966. eCollection 2022.

Authors

Tilman Sauerbruch¹, Martin Hennenberg², Jonel Trebicka^{3

4}, Robert Schierwagen³

Affiliations

¹ Department of Internal Medicine I, University of Bonn, Bonn, Germany.
² Department of Urology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
³ Department of Internal Medicine B, University of Münster, Münster, Germany.
⁴ European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.

Abstract

With increasing decompensation, hyperdynamic circulatory disturbance occurs in liver cirrhosis despite activation of vasoconstrictors. Here, the concept of a therapy with non-selective beta-blockers was established decades ago. They lower elevated portal pressure, protect against variceal hemorrhage, and may also have pleiotropic immunomodulatory effects. Recently, the beneficial effect of carvedilol, which blocks alpha and beta receptors, has been highlighted. Carvedilol leads to "biased-signaling" via recruitment of beta-arrestin. This effect and its consequences have not been sufficiently investigated in patients with liver cirrhosis. Also, a number of questions remain open regarding the expression of beta-receptors and its intracellular signaling and the respective consequences in the intra- and extrahepatic tissue compartments. Despite the undisputed role of non-selective beta-blockers in the treatment of liver cirrhosis, we still can improve the knowledge as to when and how beta-blockers should be used in which patients.

Keywords: adherence; beta-blockers; carvedilol; liver cirrhosis; portal hypertension; signaling.

Publication types

Review

Grants and funding

JT and RS received funding by the German Research Foundation (DFG) project ID 403224013–SFB 1382 (A09), by the German Federal Ministry of Education and Research (BMBF) for the DEEP-HCC project and by the Hessian Ministry of Higher Education, Research and the Arts (HMWK) for the ACLF-I cluster project. The MICROB-PREDICT (project ID 825694), DECISION (project ID 847949), GALAXY (project ID 668031), LIVERHOPE (project ID 731875), and IHMCSA (project ID 964590) projects have received funding from the European Union’s Horizon 2020 research and innovation program. The manuscript reflects only the authors’ views, and the European Commission is not responsible for any use that may be made of the information it contains. The funders had no influence on the decision to publish, or preparation of the manuscript.