TY - JOUR
T1 - Host response to translocated microbial products predicts outcomes of patients with HBV or HCV infection
AU - Sandler, Netanya G.
AU - Koh, Christopher
AU - Roque, Annelys
AU - Eccleston, Jason L.
AU - Siegel, Rebecca B.
AU - Demino, Mary
AU - Kleiner, David E.
AU - Deeks, Steven G.
AU - Liang, T. Jake
AU - Heller, Theo
AU - Douek, Daniel C.
N1 - Funding Information:
Funding Grant support received from the intramural programs of National Institute of Allergy and Infectious Diseases , National Institute of Diabetes and Digestive and Kidney Diseases , and National Cancer Institute (National Institutes of Health) and National Institutes of Health grant AI-76174 .
PY - 2011/10
Y1 - 2011/10
N2 - 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.
AB - 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.
KW - Hepatitis
KW - Intestinal Fatty Acid Binding Protein
KW - Microbial Translocation
KW - Soluble CD14
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U2 - 10.1053/j.gastro.2011.06.063
DO - 10.1053/j.gastro.2011.06.063
M3 - Article
C2 - 21726511
AN - SCOPUS:80053606297
SN - 0016-5085
VL - 141
SP - 1220-1230.e3
JO - Gastroenterology
JF - Gastroenterology
IS - 4
ER -