Evan D Elias1, Julia Uhanova1, Gerald Y Minuk1,2. 1. Section of Hepatology, Department of Medicine, and. 2. Department of Pharmacology and Therapeutics, Rady College of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
Background: Recent data suggest intestinal immunity including immunoglobulin A (IgA) may contribute to the pathogenesis of alcohol-induced liver disease (ALD). Methods: We documented serum IgA levels in ALD patients and determined whether those with elevated levels of IgA (E-IgA) had similar, more, or less advanced disease and different rates of progression than those with normal levels of IgA (N-IgA). Standard liver function tests (bilirubin, international normalized ratio [INR], and albumin), model for end-stage liver disease (MELD), and Fibrosis-4 (FIB-4) scores were used as indicators of disease severity. Results: From the study centre's clinical database, we identified 175 adult patients with ALD, 107 (61%) with E-IgA and 68 (39%) with N-IgA. Gender distribution and mean age of the two cohorts were similar. E-IgA patients had biochemical evidence of more advanced liver disease (higher serum bilirubin and INR and lower albumin levels) than N-IgA patients (ps < .05). E-IgA patients also had significantly higher median MELD and FIB-4 scores (ps < .01). A higher percentage of E-IgA patients had FIB-4 values in keeping with advanced fibrosis or cirrhosis (55% versus 28%, p = .02). After mean follow-up periods of approximately 4 years, liver biochemistry and MELD and FIB-4 scores changed to similar extents in the two cohorts. Conclusions: Serum IgA levels were increased in approximately 70% of ALD patients. Although these patients had biochemical and non-invasive indicators of more advanced disease, elevations in serum IgA levels do not predict disease progression; therefore, IgA is unlikely to be of importance in the pathogenesis of ALD.
Background: Recent data suggest intestinal immunity including immunoglobulin A (IgA) may contribute to the pathogenesis of alcohol-induced liver disease (ALD). Methods: We documented serum IgA levels in ALD patients and determined whether those with elevated levels of IgA (E-IgA) had similar, more, or less advanced disease and different rates of progression than those with normal levels of IgA (N-IgA). Standard liver function tests (bilirubin, international normalized ratio [INR], and albumin), model for end-stage liver disease (MELD), and Fibrosis-4 (FIB-4) scores were used as indicators of disease severity. Results: From the study centre's clinical database, we identified 175 adult patients with ALD, 107 (61%) with E-IgA and 68 (39%) with N-IgA. Gender distribution and mean age of the two cohorts were similar. E-IgA patients had biochemical evidence of more advanced liver disease (higher serum bilirubin and INR and lower albumin levels) than N-IgA patients (ps < .05). E-IgA patients also had significantly higher median MELD and FIB-4 scores (ps < .01). A higher percentage of E-IgA patients had FIB-4 values in keeping with advanced fibrosis or cirrhosis (55% versus 28%, p = .02). After mean follow-up periods of approximately 4 years, liver biochemistry and MELD and FIB-4 scores changed to similar extents in the two cohorts. Conclusions: Serum IgA levels were increased in approximately 70% of ALD patients. Although these patients had biochemical and non-invasive indicators of more advanced disease, elevations in serum IgA levels do not predict disease progression; therefore, IgA is unlikely to be of importance in the pathogenesis of ALD.
Authors: M Fujimoto; M Uemura; Y Nakatani; S Tsujita; K Hoppo; T Tamagawa; H Kitano; M Kikukawa; T Ann; Y Ishii; H Kojima; S Sakurai; R Tanaka; T Namisaki; R Noguchi; T Higashino; E Kikuchi; K Nishimura; A Takaya; H Fukui Journal: Alcohol Clin Exp Res Date: 2000-04 Impact factor: 3.455
Authors: Julie Thompson; Natasha Jones; Ali Al-Khafaji; Shahid Malik; David Reich; Santiago Munoz; Ross MacNicholas; Tarek Hassanein; Lewis Teperman; Lance Stein; Andrés Duarte-Rojo; Raza Malik; Talal Adhami; Sumeet Asrani; Nikunj Shah; Paul Gaglio; Anupama Duddempudi; Brian Borg; Rajiv Jalan; Robert Brown; Heather Patton; Rohit Satoskar; Simona Rossi; Amay Parikh; Ahmed ElSharkawy; Parvez Mantry; Linda Sher; David Wolf; Marquis Hart; Charles Landis; Alan Wigg; Shahid Habib; Geoffrey McCaughan; Steven Colquhoun; Alyssa Henry; Patricia Bedard; Lee Landeen; Michael Millis; Robert Ashley; William Frank; Andrew Henry; Jan Stange; Ram Subramanian Journal: Liver Transpl Date: 2018-03 Impact factor: 5.799