Figure 2. Contribution of chronic inflammation, metabolic imbalances, and hypoxia in reshaping the immune landscape in NASH-related HCC.

The transition from NASH to HCC is a complex process involving multiple factors such as lipotoxicity, oxidative stress, gut dysbiosis metabolic imbalances, chronic injury, and hypoxia that, in turn, stimulate chronic inflammation causing tissue scarring, and HCC development. Chronic inflammation, hypoxia and metabolic imbalances also induce a profound reprogramming of the immune system that results in the loss of its antitumour action, thus leading to a cancer-prone microenvironment in which malignant cells can proliferate undisturbed.