Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

Primary Screening for Breast Diseases among 17618 Women in Wufeng Area, a Region with High Incidence of Cervical Cancer in China

In this study, the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated. From March to August, 2009, 17618 women, from Wufeng area of Hubei province, China, were recruited to screen breast diseases by using breast infrared diagnostic apparatus. Other diagnostic methods, such as B-mode ultrasound, X-ray mammography, needle biopsy and pathological examination were, if necessary, used to further confirm the diagnosis. The screening showed that 5990 of 17618 cases (34.00%) had breast diseases, 5843 (33.16%) had mammary gland hyperplasia, 48 (0.27%) had breast fibroadenoma, 11 (0.06%) had breast carcinoma, and 88 (0.50%) had other breast diseases. The peak morbidity of breast cancer was found in the women aged 50–60 ages. The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8, 0.157%) in comparison with that in the subjects younger than 50 years old (n=3, 0.024%) (u=2.327, P<0.05). It was shown that the occurrence of breast diseases was concentrated in women aged 20–40 years, while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40. Compared with the patients elder than or equal to 40 years old (n=3289, 27.46%), the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases, 47.18%; P<0.001). However, there was no significant difference in the morbidity of breast diseases between the age group of 20–29 years and that of 30–39 years (P=0.453), and both of them were high. There was no significant association between the morbidity of breast diseases and cervical cancer. Since the morbidity of breast diseases was higher among young women, more attention should be paid to the screening of breast diseases among young women for early diagnosis.

Epidemiological Pattern of Breast Diseases among Females in the South-Western Region, Saudi Arabia

Background: Breast diseases cover several conditions. The majority of breast diseases are noncancerous. Some of these lesions are clinically unremarkable, which needed minimal intervention. However, some symptoms may be of clinical value and attract the attention of both the patient and the attending physician, especially when they become persistent. The study aimed to assess the prevalence, pattern, types, and clinical profile of breast diseases among females in the South-western region, during the period from 2018-2020. Methods: A retrospective record-based descriptive approach was used through reviewing medical records of all cases with breast disease attended King Khalid Hospital during the period from January 2018 to January 2020. Data extracted throng pre-structured questionnaire. Results: The study included 211 cases whose ages ranged from 18 to 58 years old with a mean age of 28.9 ± 12.8 years. Breast mass was the most recorded complaint (95.1%) followed with breast pain (32%), skin changes. Benign findings based on the final pathology report were recorded for more than two thirds of the cases, with the most common finding were fibroadenoma. Excisional biopsy and modified radical mastectomy were the most reported surgical interventions. Conclusions: In conclusion, the study revealed that the majority of the cases had benign breast disease (BBD), where fibroadenoma was the most frequent.

基于Th免疫应答、呼吸功能探讨多索茶碱联合辛伐他汀治疗COPD合并支气管哮喘的效果

目的:探讨多索茶碱联合辛伐他汀治疗慢性阻塞性肺疾病(COPD)合并支气管哮喘的效果,分析其对Th免疫应答、呼吸功能、肺功能的影响。方法:选取2021年2月至2023年2月我院收治的97例COPD合并支气管哮喘患者为研究对象,随机分为对照组(48例)和研究组(49例),分别接受多索茶碱治疗和多索茶碱联合辛伐他汀治疗。统计对比2组临床疗效、不良反应发生情况及治疗前后肺功能、呼吸功能、哮喘相关临床指标[外周血嗜酸性粒细胞(EOS)计数、EOS比例、血清总免疫球蛋白E (IgE)]及Th1/Th2细胞因子[白细胞介素-2 (IL-2)、干扰素-γ (IFN-γ)、白细胞介素-4 (IL-4)、白细胞介素-6 (IL-6)]水平。结果:研究组总有效率高于对照组(P<0.05);治疗后,研究组肺功能、呼吸功能改善幅度大于对照组(P<0.05);治疗后,研究组EOS计数、EOS比例、IgE水平低于对照组(P<0.05);治疗后,研究组血清IL-2、IFN-γ水平高于对照组,血清IL-4、IL-6水平低于对照组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论:多索茶碱联合辛伐他汀治疗COPD合并支气管哮喘的疗效确切且具有一定安全性,可改善肺功能、呼吸功能,降低气道高敏反应性,可能与调节Th免疫应答有关。

Can trastuzumab emtansine be replaced by additional chemotherapy plus targeted therapy for HER2-overexpressing breast cancer patients with residual disease after neoadjuvant chemotherapy?

Human epidermal growth factor receptor 2(HER2)-overexpressing breast cancer is an aggressive phenotype with a poor prognosis,and can easily metastasize and recur.Currently,chemotherapy plus HER2-targeted therapy is the standard systemic treatment for most of these patients.Given that neoadjuvant chemotherapy(NAC)has an efficacy equivalent to that of adjuvant chemotherapy and some additional benefits,many patients,especially those with more advanced tumors,prefer NAC and generally will not receive additional chemotherapy after surgery,irrespective of the pathological response.However,achieving pathological complete response to NAC is strongly correlated with prognosis,especially in triple-negative and HER2-overexpressing breast cancer.Therefore,postoperative treatment of these patients with residual diseases should be optimized to achieve favorable outcomes.The CREATE-X study has confirmed that additional chemotherapy can improve the outcomes of patients with HER2-negative residual disease after NAC.In addition,chemotherapy plays an indispensable role in the treatment of patients who receive surgery directly or who have recurrent lesions.Therefore,can additional chemotherapy improve prognosis of patients with HER2-overexpressing residual breast cancer?At present,no studies have compared the efficacy of additional chemotherapy plus trastuzumab with that of anti-HER2 therapy alone in residual cancer.The KATHERINE study revealed that trastuzumab emtansine(T-DM1)can reduce the risk of recurrence or death by 50%compared with trastuzumab in patients with HER2-positive residual invasive breast cancer after neoadjuvant therapy.T-DM1 is an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine,and thus,to an extent,T-DM1 is equivalent to simultaneous application of chemotherapy and targeted therapy.However,high cost and low accessibility limit its use especially in low-and middle-income countries and regions.Hence,we proposed this perspective that additional chemotherapy plus trastuzumab should be given to HER2-overexpressing breast cancer patients with residual disease after NAC to improve their prognosis by discussing that the efficacy of additional chemotherapy plus trastuzumab is superior to that of anti-HER2 therapy alone and not inferior to T-DM1.Additional chemotherapy plus trastuzumab-based HER2-targeted therapy can be used as an alternative regimen to T-DM1 when T-DM1 is unavailable.However,further clinical research on the selection of chemotherapeutic agents is warranted.

Inflammatory bowel diseases: From the mystical to the cellular and now the molecular

It is of interest in an era of increasing biomedical sophisticaton to recall that a relatively short time ago, early in the 20th century, ‘simple' ulcerative colitis was an obscure ‘medical curiosity' emerging slowly from an unknown past. Crohn's disease was yet unidentified as a separate entity although careful review of the IBD literature documented its early presence, masquerading as ‘intestinal tuberculosis'. Into the 1930s, the etiology and pathogenesis of ulcerative colitis and Crohn's disease were unknown, and investigative hypotheses were scarce. Therapeutic resources were limited and treatment was primitive. At a time of limited biomedical knowledge and minimal clinical awareness, unsubstantiated views prevailed, including ‘vague reactions to foods' (sugar,margarine, corn flakes), deficiency of a ‘protective factor'in pig intestine, and psychiatric disease.

Comparative Study of the Effect of Shugan Shuru Granule (疏肝舒乳颗粒) on Pathology and p53 Gene Expression in Patients with Hyperplastic Disease of Breast

Objective: To study the effect of Shugan Shuru Granule (疏肝舒乳颗粒,SSG) on the p53 gene expression in patients with hyperplastic disease of breast (HDB) to indirectly explore the mechanism of SSG’s effect on HDB on the molecular pathological level. Methods: Sixty-six patients with HDB were allocated in the treated group and the control group,with the former treated with SSG and the latter not. All patients underwent breast operation and their diseased mammary tissues were cut out, sectioned, and observed under microscopy with HE staining and immunohistochemical staining, with ABC method adopted to estimate the degree of hyperplasia and p53 gene expression. The severity of HDB was classified into normal, mild, moderate and severe grades (marked as 0 to Ⅲ), according to the degree of hyperplasia in the mammary gland. Results: Hyperplasia in the control group mostly belonged to grade Ⅰ-Ⅲ before treatment, showing overgrowth of gland and proliferation of glandular epithelial cells, which were high columnar shaped, more stratified, with papillary or substantive dysplasia. While in the treated group, most belonged to grade 0-Ⅰ after SSG treatment, with proliferated gland and dysplasia recovered to normal or disappeared. The positive rate of p53 gene expression in the treated group was 9.09%, and in the control group 39.39%, comparison between the two groups showing significant difference (P<0.01), the intensity in the former was significantly weaker than that in the latter.Conclusion: SSG could not only inhibit the proliferation of mammary duct epithelia and lobuli, but also inhibit the over-expression of P53. Therefore, it could be regarded as an effective remedy for treatment of HDB and prevention of mammary cancer genesis.

The significance of certain factors in the malignant degeneration of fibrocystic disease of breasts．

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A Novel Combined Approach for Metastatic Breast Cancer with Dural and Leptomeningeal Disease with an Impressive Clinical Outcome: A Case Study

Concurrent dural and leptomeningeal metastatic carcinomatosis are very rare and have a poor prognosis. Here we present a woman with advanced estrogen receptor (ER) positive and progesterone receptor (PR) positive breast cancer who presented with leptomeningeal disease. Patient underwent multi targeted epigenetic therapies applied in a protocol called MTET. She continued to respond to the interval treatment, which consisted only of the nutraceutical agents. Here we discuss her case in detail and we believe that such an example might be applied to other patients in this situation resulting clinical improvement and less toxicity.

舒肌汤对L-DOPA诱发的帕金森病肌僵直大鼠的作用及其脑组织TH、DA含量和FosB、p-ERK蛋白的影响

目的:观察舒肌汤对左旋多巴(Levodopa,L-DOPA)诱发的帕金森病(Parkinson’s disease,PD)肌僵直模型大鼠的影响,并探讨其作用机制。方法:L-DOPA诱导建立PD肌僵直大鼠模型,随机分为模型组(等体积生理盐水),舒肌汤低、中、高剂量组(10、20、40 g/kg),同时设假手术组(等体积生理盐水)作为对照,每组6只大鼠,每天灌胃给药1次,连续给药28 d。给药完成后通过旋转次数实验、翻正反射实验、肌电图检测行为学表现。免疫组化检测脑组织酪氨酸羟化酶(tyrosine hydroxylase,TH)表达水平。ELISA检测脑纹状体组织多巴胺(dopamine,DA)和TH的含量。Western blot检测脑纹状体组织FBJ鼠科骨肉瘤病毒癌基因同源物B(FBJ Murine Osteosarcoma Viral Oncogene Homolog B,FosB)、磷酸化细胞外信号调节激酶(phosphorylation-extracellular signal-regulated kinase,p-ERK)蛋白表达水平。结果:与假手术组相比,模型组大鼠旋转次数、翻正反射时间与评分、肌肉动作电位波幅和潜伏期显著升高或延长(P<0.01),MCV显著降低(P<0.01);与模型组相比,舒肌汤组大鼠旋转次数、翻正反射时间与评分、肌肉动作电位波幅和潜伏期显著降低或缩短(P<0.05),MCV显著升高(P<0.01)。免疫组化结果显示舒肌汤可上调脑组织TH表达水平;ELISA结果显示舒肌汤可上调DA和TH含量。Western blot结果显示舒肌汤可下调FosB、p-ERK蛋白表达水平。结论:舒肌汤对帕金森病模型大鼠肌僵直有显著疗效,其作用机制可能与上调DA和TH含量、下调FosB、p-ERK蛋白表达有关。

STUDIES ON THE HISTOLOGICAL CLASSIFICATION OF PROLIFERATIVE DISEASE OF BREAST AND ITS RELATION WITH BREAST CARCINOMA

Objective: Proliferative disease of breast (PDB)always exists compositely, it is difficult to be classifiedduring pathologic diagnosis. For probe into therelationship between PDB and breast carcinoma in thecyto-biologic level, a new classification method wasstudied.Matcrials and methods: Specimen slices of 439 PDBin females and 176 breast carcinomas were studied incontrast. The degree of fibroplastic proliferation wastaken as the classifying index of the consecutive progressof PDB. Then the PDB cases were divided into three types:the lobular hyperplastic type (LHT), the fibroadenosistype (FAT) and the fibrosclerosis type (FST). Each typewas once again separated into simple and compoundgroups- A part of these slices were stained withmonoclonal immunohistochemical stain to demonstratethe hyperplastic activities of PDB cells as well as theencirclement of periductal myoepithelial cells and basemembrane.Results: PCNA express level was increasedsuccessively along with the progress of pathologic changesin all the three types of PDB. And especially, it was almostparallel with the cancerous express in FST. ASMAstaining showed afrophy and rupture of periductalmyoepithelial cells and base membrane in FST andserious untypical hyperplastic PDB cases.Conclusions: In FST and serious untypicalhyperplastic PDB cases, the ductal epithelial cellsproliferated vigorously, it is closely related with thegrowth of carcinomas. The imcomplete encirclement ofperiductal myoepithelial cells and base membrane arealso a sort of dangerous factor.

Enhanced Wolf Pack Algorithm (EWPA) and Dense-kUNet Segmentation for Arterial Calcifications in Mammograms

Breast Arterial Calcification(BAC)is a mammographic decision dissimilar to cancer and commonly observed in elderly women.Thus identifying BAC could provide an expense,and be inaccurate.Recently Deep Learning(DL)methods have been introduced for automatic BAC detection and quantification with increased accuracy.Previously,classification with deep learning had reached higher efficiency,but designing the structure of DL proved to be an extremely challenging task due to overfitting models.It also is not able to capture the patterns and irregularities presented in the images.To solve the overfitting problem,an optimal feature set has been formed by Enhanced Wolf Pack Algorithm(EWPA),and their irregularities are identified by Dense-kUNet segmentation.In this paper,Dense-kUNet for segmentation and optimal feature has been introduced for classification(severe,mild,light)that integrates DenseUNet and kU-Net.Longer bound links exist among adjacent modules,allowing relatively rough data to be sent to the following component and assisting the system in finding higher qualities.The major contribution of the work is to design the best features selected by Enhanced Wolf Pack Algorithm(EWPA),and Modified Support Vector Machine(MSVM)based learning for classification.k-Dense-UNet is introduced which combines the procedure of Dense-UNet and kU-Net for image segmentation.Longer bound associations occur among nearby sections,allowing relatively granular data to be sent to the next subsystem and benefiting the system in recognizing smaller characteristics.The proposed techniques and the performance are tested using several types of analysis techniques 826 filled digitized mammography.The proposed method achieved the highest precision,recall,F-measure,and accuracy of 84.4333%,84.5333%,84.4833%,and 86.8667%when compared to other methods on the Digital Database for Screening Mammography(DDSM).

The Therapeutic Ways for Chronic Liver Diseases Accompanied by Diseases of the Endocrine and Mammary Glands

It is discovered by the authors of this article thatchronic hepatitis and hepatocirrhosis (hereinafterchronic hepatopathy for short) are often accompaniedby some diseases of endocrine and mammary glands.The authors have studied the pathogenesis andtreatment of the complications as presented in thefollowing.

The Influence of Progesterone Gel Therapy in the Treatment of Fibrocystic Breast Disease

The effect of progesterone therapy on E2/P ratio changes during the luteal phase, and its consequences are on mastalgia and cyst, within a fibrocystic breast disease (FBD). Fifty women with FBD were included. Information for mastalgia and mastodynia were checked with a questionnaire. All women had (E2) and (P) concentration checked before and during the therapy on the 21st and 24th day of a cycle, ultrasound measured size and number of cysts before and during the therapy. T-test, X2-test, McNemar test, Wilcoxon test and Friedman test were used for statistics. There was a decrease E2/P relation during the therapy vs. before the treatment p < 0.01, as well as the decrease of E2 level on the 24th day during the therapy vs. same day of E2 level, before the therapy (p = 0.164). There was an increase of p level on the 24th day vs. on 24th day before the therapy (p < 0.001). During the therapy, it was found decrease in pain and tension (p < 0.001), and the number and size of the cysts (p < 0.001). Mastalgia and mastodynia significantly decreased during the local p gel therapy, and there was a significantly lower number and size of the cysts in patients with FBD.

Therapeutic molecules for multiple human diseases identified from pigeon pea(Cajanus cajan L.Millsp.)through GC–MS and molecular docking

Molecular mechanism behind the therapeutic potential of pigeon pea over the human diseases such as rheumatoid arthritis,breast cancer,type II diabetes,malaria,measles and sickle cell disease were revealed through docking of GC–MS identified phyto-compound ligands with candidate disease proteins.Of the 242 ligands,three dimensional structures of 47 compounds had to be drawn using ChemSketch and the remaining structures were retrieved from PubChem and docked with the active sites of candidate proteins.The molecules identified through docking were further subjected to ADMET analysis and promising drug candidates were identified for each disease.This paper presents a precise account of the chemoprofile of pigeon pea leaves,stems and seeds,interaction of these molecules with target proteins and suggests 26 highly potential molecules which are drug candidates for multiple human diseases.Pigeon pea seeds are especially proven as invaluable source for therapeutic molecules.

Potential role of Th17 cells in the pathogenesis of inflammatory bowel disease

The etiopathology of inflammatory bowel disease （IBD） remains elusive. Accumulating evidence suggests that the abnormality of innate and adaptive immunity responses plays an important role in intestinal inflam- mation. IBD including Crohn＇s disease （CD） and ulcerative colitis （UC） is a chronic inflammatory disease of the gastrointestinal tract, which is implicated in an inappropriate and overactive mucosal immune response to luminal flora. Traditionally, CD is regarded as a Thl- mediated inflammatory disorder while UC is regarded as a Th2-1ike disease. Recently, Th17 cells were identified as a new subset of T helper cells unrelated to Thl or Th2 cells, and several cytokines [e.g. interleukin （IL）-21, IL-23] are involved in regulating their activation and differentiation. They not only play an important role in host defense against extracellular pathogens, but are also associated with the development of autoimmunity and inflammatory response such as IBD. The identification of Th17 cells helps us to explain some of the anomalies seen in the Thl/Th2 axis and has broadened our understanding of the immunopathological effects of Th17 cells in the development of IBD.

Decrease in the Ki67 index during neoadjuvant chemotherapy predicts favorable relapse-free survival in patients with locally advanced breast cancer

Objective: The purpose of this study was to explore the optimal cutoffs of the three parameters of Ki67 during NAC for predicting patient prognosis and investigate whether the optimal cutoffs of the Ki67 values were associated with relapse-free survival(RFS) or breast cancer-specific survival(BCSS).Methods: A total of 92 patients with locally advanced breast cancer(LABC), who had residual disease after NAC were retrospectively investigated.The optimal cutoff values of the Ki67 parameters were assessed by the online algorithm Cutoff Finder.Kaplan-Meier analysis, the log-rank test and Cox regression analysis were carried out to analyze survival.Results: The optimal cutoff values for the postsurgical Ki67 level and the decrease in the Ki67 level during NAC were defined as 25% and 12.5%, respectively.According to the univariate survival analysis, a higher Ki67 level in residual disease was associated with poor RFS(P = 0.004) and BCSS(P = 0.014).In addition, a Ki67 expression decrease > 12.5% during NAC was related to favorable RFS(P = 0.007), but was not related to BCSS(P = 0.452).Cox regression analysis showed that the Ki67 expression decrease(> 12.5% vs.≤ 12.5%) and histological grade(grade 3 vs.grade 1-2) were the independent factors associated with RFS(P =0.020 and P = 0.023, respectively), with HR values of 0.353(95% CI: 0.147-0.850) and 3.422(95% CI: 1.188-9.858), respectively.Conclusions: The Ki67 decrease was one of the independent factors associated with RFS in LABC patients with residual disease after receiving NAC.

Th lymphocyte subsets in patients with Vogt-KoyanagiHarada disease

AIM: To assess helper T(Th) lymphocyte subset balance in patients with Vogt-Koyanagi-Harada(VKH) disease. METHODS: Sixty-eight active VKH patients and seventytwo inactive VKH patients were included in this study. One hundred healthy individuals served as controls. Peripheral blood was obtained from VKH patients and healthy controls. Th lymphocyte subsets were analyzed by flow cytometry. Plasma concentration of interleukin(IL)-17, IL-10, transforming growth factor(TGF)-β, IL-23 and IL-6 was examined by enzyme-linked immunosorbent assay(ELISA). RESULTS: VKH patients with active uveitis had significantly higher percentages of both Th1 and Th17 cells and lower percentages of regulatory T(Treg) cells as compared with inactive VKH patients and healthy controls. Th1/Th2 and Th17/Treg ratios were also significantly elevated in active VKH patients. The percentages of Th1, Th17 and Treg cells and the Th1/Th2, Th17/Treg ratio did not differ between inactive VKH patients and healthy controls. There was no difference concerning the percentage of Th2 cells among all the groups. VKH patients with active uveitis showed an elevated level of peripheral Th17 related cytokines levels(TGF-β, IL-6, IL-23, and IL-17) and a decreased level of Treg related cytokines(IL-10) compared with inactive VKH patients and healthy controls. Inactive VKH patients showed no differences in peripheral Th17 related cytokines(TGF-β, IL-6, IL-23, and IL-17) and Treg related cytokines(IL-10) levels compared with healthy controls. CONCLUSION: Th1 and Th17 cells are significantly increased and Treg cells significantly decreased in active VKH compared with inactive VKH or healthy controls. Therefore, Th lymphocyte subset analysis may serve as a disease biomarker for VKH.

Expression and Clinical Significance of Vascular Endothelial Growth Factor in Benign and Malignant Tissues of Breast

Objective： To detect the expression of vascular endothelial growth factor （VEGF） and microvessel density （MVD） count in breast benign affection, breast atypical hyperplasia and breast carcinoma in situ, and to clarify the relationship between VEGF expression, MVD and the clinicopathological features of these diseases. Methods： The expression of VEGF and MVD count in 115 cases breast benign diseases （including 40 breast fibroid tumor, 40 breast cystic hyperplasia and 35 intraductal papilloma, 19 breast atypical hyperplasias and 32 breast carcinomas in situ were examined by immunohistochemistry staining （SP-method）. Results： The positive rate of VEGF in breast benign diseases, breast atypical hyperplasia and breast carcinoma in situ were 21.74%（25/115）, 31.58.% （6/19）and 53.13%（17/32） respectively. It was the lowest in breast benign affection group, and was the highest breast carcinoma in situ group. The expression of VEGF increased gradually in the three groups （P〈0.05）. The MVD count of the three groups were 14.41 ± 2.59, 18.89± 4.47 and 21.13 ± 4.12 respectively, It was the lowest in breast benign affection group, and was the highest breast carcinoma in situ group. The MVD count of the three groups increased gradually （P〈0.05）. In VEGF positive group, MVD count was 19.41 ±4.78; In VEGF negative group, MVD count was 14.91±3.15. The MVD count was higher in VEGF positive group than that in VEGF negative group （P〈0.05）. Conclusion： The results of this study suggested that VEGF could promote microvessel growth in breast tumors. The occurrence and progression of breast cancer might be related with the expression of VEGF.

Th17 involvement in nonalcoholic fatty liver disease progression to non-alcoholic steatohepatitis

The nonalcoholic fatty liver disease(NAFLD) is the hepatic manifestation of the metabolic syndrome. NAFLD encompasses a wide histological spectrum ranging from benign simple steatosis to non-alcoholic steatohepatitis(NASH). Sustained inflammation in the liver is critical in this process. Hepatic macrophages, including liver resident macropaghes(Kupffer cells), monocytes infiltrating the injured liver, as well as specific lymphocytes subsets play a pivotal role in the initiation and perpetuation of the inflammatory response, with a major deleterious impact on the progression of fatty liver to fibrosis. During the last years, Th17 cells have been involved in the development of inflammation not only in liver but also in other organs, such as adipose tissue or lung. Differentiation of a na?ve T cell into a Th17 cell leads to pro-inflammatory cytokine and chemokine production with subsequent myeloid cell recruitment to the inflamed tissue. Th17 response can be mitigated by T regulatory cells that secrete anti-inflammatory cytokines. Both T cell subsets need TGF-β for their differentiation and a characteristic plasticity in their phenotype may render them new therapeutic targets. In this review, we discuss the role of the Th17 pathway in NAFLD progression to NASH and to liver fibrosis analyzing different animal models of liver injury and human studies.