The medicinal effect of ulinastatin in various liver diseases

Ulinastatin (UTI) is an endogenous broad-spectrum serine protease inhibitor naturally present in human plasma and urine. It exerts therapeutic effects through multiple mechanisms, including inhibition of cytokines and inflammatory mediators, attenuation of apoptosis and oxidative stress, and modulation of immune responses. Additionally, UTI regulates enzymatic activities involved in the coagulation-fibrinolysis system. These protective actions underpin its potential in mitigating organ dysfunction, particularly in the context of inflammatory and ischemic insults. The liver plays a pivotal role in homeostasis, being central to the metabolism of carbohydrates, proteins, lipids, and vitamins. It is also crucial for detoxification, bile production, coagulation factor synthesis, immune modulation, and hormone regulation. Given its extensive metabolic and regulatory functions, the liver is highly susceptible to damage from sepsis, toxins, ischemia, and chronic diseases. Accumulating evidence indicates that UTI confers significant protection in various liver diseases, including sepsis-induced liver injury, hepatic ischemia-reperfusion injury, liver failure, hepatitis, liver fibrosis, hepatocellular carcinoma, and hepatic encephalopathy. This review systematically summarizes the pharmacological effects of ulinastatin and current advances in UTI research for liver diseases, highlighting its potential as a supportive treatment.