Figure 4.

Conclusion and hypothesized working mechanism of cathepsins in NASH-induced hepatocellular carcinoma (HCC). Cathepsins are involved in NASH through actions in (1) apoptosis, (2) energy metabolism, and (3) immune stimulation, and they are involved in HCC through actions in (1) proliferation, (2) apoptosis, (3) angiogenesis, (4) invasion and metastasis, (5) deregulation of energy metabolism, and (6) evasion of the immune system. Cathepsins help to stimulate the immune system in NASH whereas they suppress the immune system in HCC.