BACKGROUND & AIMS: Chronic infection with hepatitis B or C virus (HBV or HCV) is a leading cause of cirrhosis by unknown mechanisms of pathogenesis. Translocation of gut microbial products into the systemic circulation might increase because of increased intestinal permeability, bacterial overgrowth, or impaired clearance of microbial products by Kupffer cells. We investigated whether the extent and progression of liver disease in patients with chronic HBV or HCV infection are associated with microbial translocation and subsequent activation of monocytes. METHODS: In a retrospective study, we analyzed data from 16 patients with minimal fibrosis, 68 with cirrhosis, and 67 uninfected volunteers. We analyzed plasma levels of soluble CD14 (sCD14), intestinal fatty acid binding protein, and interleukin-6 by enzyme-linked immunosorbent assay, and lipopolysaccharide (LPS) by the limulus amebocyte lysate assay, at presentation and after antiviral treatment. RESULTS: Compared with uninfected individuals, HCV- and HBV-infected individuals had higher plasma levels of LPS, intestinal fatty acid binding protein (indicating enterocyte death), sCD14 (produced upon LPS activation of monocytes), and interleukin-6. Portal hypertension, indicated by low platelet counts, was associated with enterocyte death (P=.045 at presentation, P<.0001 after therapy). Levels of sCD14 correlated with markers of hepatic inflammation (P=.02 for aspartate aminotransferase, P=.002 for ferritin) and fibrosis (P<.0001 for γ-glutamyl transpeptidase, P=.01 for alkaline phosphatase, P<.0001 for α-fetoprotein). Compared to subjects with minimal fibrosis, subjects with severe fibrosis at presentation had higher plasma levels of sCD14 (P=.01) and more hepatic CD14+ cells (P=.0002); each increased risk for disease progression (P=.0009 and P=.005, respectively). CONCLUSIONS: LPS-induced local and systemic inflammation is associated with cirrhosis and predicts progression to end-stage liver disease in patients with HBV or HCV infection.
BACKGROUND & AIMS:Chronic infection with hepatitis B or C virus (HBV or HCV) is a leading cause of cirrhosis by unknown mechanisms of pathogenesis. Translocation of gut microbial products into the systemic circulation might increase because of increased intestinal permeability, bacterial overgrowth, or impaired clearance of microbial products by Kupffer cells. We investigated whether the extent and progression of liver disease in patients with chronic HBV or HCV infection are associated with microbial translocation and subsequent activation of monocytes. METHODS: In a retrospective study, we analyzed data from 16 patients with minimal fibrosis, 68 with cirrhosis, and 67 uninfected volunteers. We analyzed plasma levels of soluble CD14 (sCD14), intestinal fatty acid binding protein, and interleukin-6 by enzyme-linked immunosorbent assay, and lipopolysaccharide (LPS) by the limulus amebocyte lysate assay, at presentation and after antiviral treatment. RESULTS: Compared with uninfected individuals, HCV- and HBV-infected individuals had higher plasma levels of LPS, intestinal fatty acid binding protein (indicating enterocyte death), sCD14 (produced upon LPS activation of monocytes), and interleukin-6. Portal hypertension, indicated by low platelet counts, was associated with enterocyte death (P=.045 at presentation, P<.0001 after therapy). Levels of sCD14 correlated with markers of hepatic inflammation (P=.02 for aspartate aminotransferase, P=.002 for ferritin) and fibrosis (P<.0001 for γ-glutamyl transpeptidase, P=.01 for alkaline phosphatase, P<.0001 for α-fetoprotein). Compared to subjects with minimal fibrosis, subjects with severe fibrosis at presentation had higher plasma levels of sCD14 (P=.01) and more hepatic CD14+ cells (P=.0002); each increased risk for disease progression (P=.0009 and P=.005, respectively). CONCLUSIONS:LPS-induced local and systemic inflammation is associated with cirrhosis and predicts progression to end-stage liver disease in patients with HBV or HCV infection.
Authors: N Hiki; D Berger; C Prigl; E Boelke; H Wiedeck; M Seidelmann; L Staib; M Kaminishi; T Oohara; H G Beger Journal: Infect Immun Date: 1998-03 Impact factor: 3.441
Authors: C A Rivera; B U Bradford; K J Hunt; Y Adachi; L W Schrum; D R Koop; E R Burchardt; R A Rippe; R G Thurman Journal: Am J Physiol Gastrointest Liver Physiol Date: 2001-07 Impact factor: 4.052
Authors: Joseph Romagnuolo; Christopher N Andrews; Vincent G Bain; Maurizio Bonacini; Scott J Cotler; Mang Ma; Morris Sherman Journal: Scand J Gastroenterol Date: 2005-11 Impact factor: 2.423
Authors: Netanya G Sandler; Handan Wand; Annelys Roque; Matthew Law; Martha C Nason; Daniel E Nixon; Court Pedersen; Kiat Ruxrungtham; Sharon R Lewin; Sean Emery; James D Neaton; Jason M Brenchley; Steven G Deeks; Irini Sereti; Daniel C Douek Journal: J Infect Dis Date: 2011-01-20 Impact factor: 5.226
Authors: Ekihiro Seki; Samuele De Minicis; Christoph H Osterreicher; Johannes Kluwe; Yosuke Osawa; David A Brenner; Robert F Schwabe Journal: Nat Med Date: 2007-10-21 Impact factor: 53.440
Authors: Georgios I Tsiaoussis; Stelios F Assimakopoulos; Athanassios C Tsamandas; Christos K Triantos; Konstantinos C Thomopoulos Journal: World J Hepatol Date: 2015-08-18
Authors: Fabio C O F Cachem; Aleida S Dias; Clarice Monteiro; José Roberto Castro; Gabriel Fernandes; Letícia Delphim; Adilson J Almeida; Felipe Tavares; Alessandra M A Maciel; Marcia M Amendola-Pires; Carlos E Brandão-Mello; Cleonice A M Bento Journal: Immunology Date: 2017-03-13 Impact factor: 7.397
Authors: Julian J Weiss; Laura Sanchez; Jane Hubbard; Janet Lo; Steven K Grinspoon; Kathleen V Fitch Journal: J Nutr Date: 2019-01-01 Impact factor: 4.798
Authors: Joana Dias; Julia Hengst; Tiphaine Parrot; Edwin Leeansyah; Sebastian Lunemann; David F G Malone; Svenja Hardtke; Otto Strauss; Christine L Zimmer; Lena Berglin; Thomas Schirdewahn; Sandra Ciesek; Nicole Marquardt; Thomas von Hahn; Michael P Manns; Markus Cornberg; Hans-Gustaf Ljunggren; Heiner Wedemeyer; Johan K Sandberg; Niklas K Björkström Journal: J Hepatol Date: 2019-05-14 Impact factor: 25.083
Authors: Michael Reid; Yifei Ma; Rebecca Scherzer; Jennifer C Price; Audrey L French; Gregory D Huhn; Michael W Plankey; Marion Peters; Carl Grunfeld; Phyllis C Tien Journal: J Infect Dis Date: 2018-03-28 Impact factor: 5.226
Authors: Rosa Zampino; Aldo Marrone; Luciano Restivo; Barbara Guerrera; Ausilia Sellitto; Luca Rinaldi; Ciro Romano; Luigi E Adinolfi Journal: World J Hepatol Date: 2013-10-27