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KCs are specialised macrophages that maintain liver homeostasis by clearing pathogens and cellular debris under normal conditions.30 However, during liver injury, such as chronic ethanol exposure, the livers inflammatory environment triggers the recruitment of circulating monocytes.31 These monocytes differentiate into infiltrating macrophages, which play a crucial role in tissue homeostasis, particularly in response to the heightened demands of pathogen clearance, tissue repair and immune modulation.30 In mouse models, infiltrating macrophages arise from two major subsets of circulating monocytes: classical Ly-6C hi and non-classical Ly-6C low cells.32 These are analogous to the human monocyte subsets CD14 hi CD16 and CD14 dim CD16 + monocytes, respectively.32 Ly-6C low macrophages are characterised by their anti-inflammatory and tissue-protective properties.30 They promote tissue repair and help resolve inflammation, thus contributing to liver recovery following injury.30 In contrast, Ly-6C hi macrophages adopt a pro-inflammatory phenotype, releasing cytokines that exacerbate liver damage and inflammation.30 Interestingly, Ly-6C hi macrophages can transition to a Ly-6C low phenotype after phagocytosing apoptotic hepatocytes, indicating a possible regulatory mechanism that aids in resolving inflammation and promoting tissue repair.30 In ALD, both infiltrating macrophages and neutrophils are key players in the immune response.33 These cells collaborate to clear necrotic cellular debris, which is essential for maintaining tissue integrity.33 However, macrophage activation plays a central role in modulating the inflammatory response, as inhibiting macrophage activation reduces neutrophil recruitment to the liver, potentially decreasing inflammation and injury.34 This suggests that macrophages are involved in direct pathogen clearance and regulate neutrophil-mediated responses, further illustrating their complex role in ALD pathogenesis
assigned to Nihon Zoki Seiyaku Kabushikikaisha (Japan) A
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