[Research advances on the role of eosinophils in acute liver injury]

The role of eosinophils (Eos) has attracted considerable attention in acute liver injury. Animal studies have validated that eosinophils recruited to the liver through the positive feedback loop of interleukin (IL)-4/chemokine (C-C motif) ligand 24 alleviate inflammation by inhibiting interferon-γ production via IL-4/IL-13 signaling and promotes hepatocyte proliferation through heparin-binding epidermal growth factor-like growth factor/epidermal growth factor receptor. Clinical study results suggest that drug-induced liver injury and drug-induced hypersensitivity syndrome often accompany elevated Eos levels, whereas the absence of Eos elevation predicts poor prognosis. The hypotheses of "conditional transition" and "exhaustion" have been proposed based on cases where liver failure reversed after the depletion of Eos with benralizumab monoclonal antibody, suggesting that Eos may exert a protective role in the early stages of disease but become overactivated in later stages, shifting to a pathogenic role and eventually leading to functional exhaustion.