Cytoprotection with ursodeoxycholic acid: effect in chronic non-cholestatic and chronic cholestatic liver disease

Studies in vitro and in vivo show that hydrophobic bile acids tend to accumulate in the liver tissue in chronic liver disease, thus damaging hepatocyte membranes. Ursodeoxycholic acid (UDCA) is a hydrophilic bile acid which counteracts hepatotoxicity of more hydrophobic bile acids by partially replacing the pool of bile acids in the liver and/or by inhibiting the intestinal absorption of toxic bile acids. UDCA seems safe and effective in the early stages of primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and possibly in other severe cholestatic syndromes of infancy. Moreover, there is increasing evidence that UDCA improves the common indices of liver function in chronic non-cholestatic hepatic disorders including active cirrhosis, though maintaining the residual functional liver mass. This article reviews the cytoprotective effect of UDCA in chronic cholestatic and non-cholestatic liver disease based on the results of major clinical trials on this topic.