Cytokines, for better or worse?

Cytokines play an important role in the pathogenesis of many diseases including liver failure. Both newly described and 'classic' pro-inflammatory cytokines, such as tumour necrosis factor-alpha, have been implicated in both hepatic injury and liver regeneration. In addition, increased circulating concentrations of these cytokines suggest they may have a hormone-like endocrine effect on tissues distant to their production, leading to the hypotension, lung injury and cerebral oedema that occur in such patients. Increased understanding of the cytokine networks involved in acute liver failure may lead to the development of novel therapies, which may reduce the requirement for liver transplantation in this condition.