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Innate immunity and steatohepatitis: a critical role of another toll (TLR-9).

Worldwide, chronic viral hepatitis, alcoholic steatohepatitis (ASH), and nonalcoholic steatohepatitis (NASH) are 3 major causes of chronic liver diseases, leading to cirrhosis and hepatocellular carcinoma. Although hepatitis viruses themselves are not cytopathogenic and do not kill hepatocytes, the adaptive immune responses (eg, cytotoxic T cells) to viral infection are considered key in causing hepatocellular damage,1 despite recent data suggesting that natural killer cells are responsible also for liver damage in viral hepatitis infection.2 By contrast, innate immunity seems to play a key role in the pathogenesis of ASH and NASH, with adaptive immunity playing a less important role.3–6