The remodeling index as a practical tool for predicting progression rate during early stages of chronic liver disease

Chronic liver disease (CLD) constitutes a major cause of morbidity and mortality worldwide. Follow-up studies have documented that the majority of patients with CLD never reach the cirrhotic stage, while others display a higher progression rate leading to liver failure at relatively short intervals. This phenomenon has never been adequately explained. Recent evidence suggests that the renin–angiotensin system (RAS) is a major coordinator of chronic liver inflammation and subsequent fibrosis development, a process often termed hepatic remodeling. Combining these data with the “natural neutralizing antibodies theory” led us to the assumption that there could be an intrinsic anti-remodeling mechanism consisted of natural antibodies against components of the RAS. Varying degrees of activation of this defense mechanism could account for the variability in disease progression rate among patients with CLD. Identifying the main components of this mechanism allowed us to develop a ratio, designated remodeling index, as a measure of an individual's predilection towards cirrhosis. We believe that this index could be used as a safe, non-invasive and cost effective tool for assessing progression rate in normotensive patients with early CLD, thus alleviating the need for repeated liver biopsies.