Viral infections, malignant transformation, and xenobiotics may elicit immune responses capable of mediating tissue injury. Accumulating evidence indicates that immune responses against viral antigens expressed by infected hepatocytes may mediate hepatocellular necrosis during hepatitis B or C viral infections. Recent studies have clarified the role of T cells, cytokines, and both major histocompatibility complex and adhesion molecules during hepatitis B and C infections. Additional studies have assessed the impact of hepatitis B virus mutants on the immune response and the ability of the hepatitis B virus to alter the phenotype of infected hepatocytes. Emerging data also indicate that hepatitis C infection may play a role in autoimmune reactions. New observations have further defined a relationship between the development of hepatocellular carcinoma and the immune response. In addition, continuing investigations have emphasized the importance of the immune response in the pathogenesis of alcoholic hepatitis. Further understanding of these immune mechanisms may lead to innovative therapeutic strategies.
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