{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:16:20Z","timestamp":1788419780275,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI21\/00510, PI24\/01146"],"award-info":[{"award-number":["PI21\/00510, PI24\/01146"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Severe obesity is linked to metabolic dysfunction-associated steatotic liver disease (MASLD), which can progress to metabolic dysfunction-associated steatohepatitis (MASH) and advanced fibrosis. Currently, there are no accurate tissue biomarkers for measuring immune-mediated liver injury or remission post-bariatric surgery. This study utilized digital pathology and immunohistochemistry to analyze liver biopsies from three patient groups: those with severe obesity and liver damage before bariatric surgery, their paired re-do biopsies post-surgery, and patients with severe obesity and without evaluable liver injury per NASH CRN criteria. Quantitative metrics assessed immune cell proportions and staining areas from whole-slide images. Following bariatric surgery, patients experienced a significant reduction in body mass index (BMI) and improvements in liver histology, although lobular inflammation persisted at a median follow-up of six years. Analysis of the innate immune response showed a notable increase in CD15\n                    <jats:sup>+<\/jats:sup>\n                    neutrophils postoperatively, along with a progressive accumulation of CD56\n                    <jats:sup>+<\/jats:sup>\n                    natural killer cells across healthy and pre- and post-surgical cohorts. Additionally, long-term post-surgical samples exhibited higher densities of CD68\n                    <jats:sup>+<\/jats:sup>\n                    and CD163\n                    <jats:sup>+<\/jats:sup>\n                    macrophages. Within the adaptive immune compartment, the number of CD4\n                    <jats:sup>+<\/jats:sup>\n                    T cells significantly increased after surgery, while the abundance of CD8\n                    <jats:sup>+<\/jats:sup>\n                    T cells remained stable across all groups. Overall, the livers of postsurgical patients displayed the highest burden of immune cells and a restructured hierarchy of immune populations. This indicates the presence of a unique immune microenvironment associated with surgery rather than a return to a \u201chealthy liver\u201d profile. Despite metabolic and histological improvements post-surgery, persistent immune activation suggests a unique immunological state where immune cells may play dual roles in both liver damage and repair, emphasizing the need for comprehensive immune profiling and targeted therapeutic strategies.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1816648","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:30Z","timestamp":1788417750000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hepatic immune microenvironment dynamics in severe obesity and post-bariatric surgery: insights from immunohistochemical analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Alina-Iuliana","family":"Onoiu","sequence":"first","affiliation":[{"name":"Unitat de Recerca Biom\u00e8dica, Hospital Universitari Sant Joan","place":["Reus, Spain"]},{"name":"Department of Medicine and 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