Immunologic abnormalities in alcoholic hepatitis

There are many unanswered questions in the possible autoimmune pathogenesis of alcoholic liver disease. Why do only 15-20% of chronic alcoholic patients develop alcoholic hepatitis and cirrhosis? What factors make a patient susceptible to immune events in alcoholism? What initiates immune reactivity in susceptible patients? What permits accumulation of alcoholic hyalin in patients with alcoholic hepatitis? Is alcoholic hyalin central to the pathogenesis of alcoholic hepatitis? If adducts play a role, why don't more alcoholics develop liver disease, as adducts probably form in all patients? Unfortunately, the lack of an appropriate animal model will probably allow these questions to remain unanswered for some time. However, further research into the role of adducts in alcoholic liver disease may be helpful. Isolation of adducts from hepatocytes of patients with alcoholic hepatitis may permit study of their intracellular location, formation and perhaps of their timing in the sequence of liver disease. These studies should provide additional clues to the pathogenesis of alcoholic liver disease.