Lipid-mediated immune reprogramming in cirrhosis-associated immune dysfunction: Mechanisms and therapeutic opportunities

This narrative review critically evaluates the evidence linking lipid dysregulation to cirrhosis-associated immune dysfunction.PubMed, Web of Science and Scopus were searched from database inception through February 2026, with priority given to human studies of compensated and decompensated cirrhosis, acute decompensation and acuteon-chronic liver failure.Evidence from acute liver failure and non-cirrhotic settings was considered indirect.Human observational studies associate several lipid alterations with disease stage and clinical outcomes, while direct lipid-immune functional evidence remains strongest for selected prostaglandin E2-dependent pathways.Direct functional evidence is strongest for prostaglandin E2-E prostanoid receptor 2/E prostanoid receptor 4-mediated monocyte dysfunction in decompensated cirrhosis, whereas evidence for other pathways remains limited or indirect.Interpretation is restricted by heterogeneous disease stages and study methods, potential clinical confounding and the scarcity of longitudinal studies integrating lipidomic and functional immune analyses.Overall, lipid dysregulation may contribute to cirrhosis-associated immune dysfunction, but causal roles for most pathways remain unconfirmed and require cirrhosis-specific functional validation.