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. 2020 Oct 5;5:49. doi: 10.21037/tgh.2019.12.05

Figure 1.

Figure 1

Increased gut permeability: alcohol damages tight junction integrity in the distal epithelium leading to increased gut permeability (1). Increased LPS in hepatic circulation: increased gut permeability leads to increased levels of bacterial lipopolysaccharide in intestinal venous circulation. This blood eventually enters hepatic circulation through the portal vein (2). Stellate cell activation: lipopolysaccharide binds to LPS-binding protein on liver macrophages known as hepatic stellate cells, leading to downstream proinflammatory cytokine and neutrophil recruiting chemokine activation. Activated hepatic stellate cells proliferate and take on a pro-fibrotic role (3). Fibrogenesis & cirrhosis: activated hepatic stellate cells lay down a fibrotic extracellular matrix composed of collagens type I and III, glycoproteins, and proteoglycans (4). LPS, lipopolysaccharide.