Intestinal endotoxins as co-factors in liver injury

The interaction between sinusoidal cells of the liver and endotoxins absorbed from the gut may be critical in causing liver cell injury due to a variety of toxins. Both fixed liver macrophages, and those recruited during injury may be important to this process either by their inability to detoxify increased amounts of LPS presented from the intestinal track, or because of the release of potent effectors under its influence. Evidence that intestinal endotoxins are an important co-factor in both experimental and clinical liver injury is discussed. Mechanisms responsible for macrophage mediation of endotoxin injury are proposed, and preliminary evidence that tumor necrosis factor levels are elevated in human liver disease is presented.