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Molecular Biology and Immunology in Hepatology. Advances in the Treatment of Intractable Liver Diseases
  1. J A Eksteen,
  2. D H Adams

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Dysregulated immune responses underlie the pathogenesis of many liver disorders including not only autoimmune diseases but also viral hepatitis and the chronic inflammatory responses stimulated by alcohol. Thus understanding liver immunology and the molecular signals involved in its regulation are critical if we are to gain insights into the pathogenesis of these diseases and develop novel therapies. Recent advances in immunology have been phenomenal and it is not surprising that many clinicians find it difficult to integrate and understand the importance of emerging immunology research. The editors of this book are to be commended for providing a summary of our knowledge of immunology of the liver and how this informs liver diseases, especially viral hepatitis and autoimmune diseases. They have made a creditable attempt to demystify the molecular and immune complexities involved and to distil the field into one concise volume.

Chronic hepatitis C infection is one of the greatest challenges facing hepatologists and gastroenterologists alike in the 21st century and it is now clear that both viral and host immune factors determine the outcome of infection. It is thus not surprising that viral hepatitis accounts for a substantial part of the book, which covers issues from viral genetics and host responses to gene therapy of viral hepatitis and transgenic mouse models of viral progression and hepatocellular carcinogenesis. Potential mechanisms of autoimmune liver diseases and the clinical features of the various overlap syndromes are also extensively reviewed. This section of the book demonstrates particularly well how an immunological understanding can provide direct insights into clinical disease.

The book includes chapters dedicated to the clinical management of liver disease, including viral hepatitis, hepatocellular carcinoma, acute liver failure, and living related liver transplantation. There is no doubt that the authors’ extensive experience in the field of living related liver transplantation will appeal to physicians and surgeons alike but the insights brought to these areas by immunology are less clearly stated.

The book is aimed at both clinicians and scientists, and provides much needed background reading in the rapidly evolving field of hepatology. However, it would be hard going for anyone without a background understanding of basic immunology/molecular biology given the complexity of the science involved. One problem with such a book is assessing the target audience. The rapid evolution of the immunology field means that parts of this book will be out of date by the time it is published and therefore of less relevance to people working directly in the field. It is perhaps most useful for clinicians or scientists working predominantly in other areas who need an introduction to liver immunology. In this context it would have been helpful to include more explanatory diagrams and a rather more “user friendly” style. However, overall this is a useful book and a good introduction to liver immunology.