title: The liver in sepsis: patterns of response and injury.
abstract: OBJECTIVE
  Sepsis elicits profound changes in the concentrations of plasma proteins synthesized by liver parenchymal cells referred to as acute-phase proteins. Mechanisms controlling this orchestrated response include release of cytokines that induce acute-phase proteins, while other 'house-keeping' genes are downregulated.
  
  
  RESULTS
  Although some acute-phase proteins help to control damage, functions of many other acute-phase reactants remain obscure. Changes in acute-phase gene expression are primarily subject to transcriptional regulation and can be comprehensively monitored by array techniques. Emerging evidence from such strategies implies that in addition to a 'common host response' also highly specific pathways are induced in specific disease contexts. Applying a systems biology approach to the integrated response of the hepatocyte to infection would suggest that the reprogramming of metabolic functions occurs in parallel with a severity-dependent disruption of phase I and II biotransformation and canalicular transport, that is, excretory failure. Although traditionally bilirubin serves to monitor excretion, emerging evidence suggests that bile acids indicate liver dysfunction with higher sensitivity and specificity.
  
  
  CONCLUSIONS
  Sepsis induces reprogramming of the hepatic transcriptome. This includes induction of adaptive acute-phase proteins but also repression of phase I, II metabolism and transport with important implications for monitoring and pharmacotherapy.
authors: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. michael.bauer@med.uni-jena.de
authors: Michael
authors: M
authors: Bauer
authors: Adrian T
authors: AT
authors: Press
authors: Michael
authors: M
authors: Trauner
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism*; D003422:Critical Care; D058625:End Stage Liver Disease / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000378:metabolism*; D008099:Liver / Q000378:metabolism* / Q000473:pathology; D008107:Liver Diseases / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D011379:Prognosis; D018805:Sepsis / Q000276:immunology / Q000378:metabolism* / Q000503:physiopathology; D015398:Signal Transduction
chemical_list: D000209:Acute-Phase Proteins; D015850:Interleukin-6