Elizabeth Phillips

The liver is continuously exposed to a large number of substances, including pathogens, xenobiotics, tumor cells and harmless dietary antigens. Infectious agents from systemic circulation need to be efficiently removed, whereas tolerance needs to be developed against the large number of antigens derived from the gastrointestinal tract. To respond to these challenges, the adaptive immune responses in the liver favor tolerance rather than immunity. However, when regulation of the immune system goes awry, the delicate balance of immunity and tolerance in the liver is compromised, which can result in immune-mediated liver injury. In this article, we review the current literature in which the pathogenesis of liver injury is advanced by adaptive immunity, specifically in cases of primary biliary cirrhosis, viral hepatitis, alcoholic liver disease, and nonalcoholic fatty liver disease.