Title: Bacterial translocation occurs early in cirrhosis and triggers a selective
infammatory response |
Authors: Simbrunner, Benedikt ![](/image/ORCID.jpg) Caparrós, Esther ![](/image/ORCID.jpg) Neuwirth, Teresa Schwabl, Philipp ![](/image/ORCID.jpg) Königshofer, Philipp ![](/image/ORCID.jpg) Bauer, David Marculescu, Rodrig ![](/image/ORCID.jpg) Trauner, Michael ![](/image/ORCID.jpg) Scheiner, Bernhard ![](/image/ORCID.jpg) Stary, Georg Mandorfer, Mattias ![](/image/ORCID.jpg) Reiberger, Thomas ![](/image/ORCID.jpg) Francés, Rubén ![](/image/ORCID.jpg) |
Editor: Springer |
Department: Departamentos de la UMH::Medicina Clínica |
Issue Date: 2023-08 |
URI: https://hdl.handle.net/11000/31334 |
Abstract:
Background: Experimental data suggest that bacterial translocation (BT) promotes systemic inflammation, portal hypertension, and circulatory dysfunction in advanced chronic liver disease (ACLD).
Methods: Patients with ACLD undergoing hepatic venous pressure gradient (HVPG) measurement and absence of acute decompensation or infections were included (n = 249). Serum biomarkers of BT (lipopolysaccharide [LPS], lipoteichoic acid [LTA], bacterial DNA [bactDNA]), systemic inflammation and markers of circulatory dysfunction were assessed. T-cell subsets in intestinal biopsies (n = 7 ACLD, n = 4 controls) were analyzed by flow cytometry.
Results: Patients had a median HVPG of 18 (12-21) mmHg and 56% had decompensated ACLD. LPS (0.04 [0.02-0.06] vs. 0.64 [0.30-1.06] EU/mL), LTA (4.53 [3.58-5.97] vs. 43.2 [23.2-109] pg/mL), and detection of bactDNA (≥ 5 pg/mL; 5% vs. 41%) were markedly higher in patients with ACLD than healthy controls (n = 40; p < 0.001) but were similar between different clinical stages of compensated and decompensated ACLD and displayed no meaningful correlation with HVPG and systemic hemodynamics. TNF-α and IL-10 correlated with LPS (Spearman's rs = 0.523, p < 0.001/rs = 0.143, p = 0.024) but not with LTA. Presence of bactDNA was associated with higher LPS (0.54 [0.28-0.95] vs. 0.88 [0.32-1.31] EU/mL, p = 0.001) and TNF-α (15.3 [6.31-28.1] vs. 20.9 [13.8-32.9] pg/mL). Patients with ACLD exhibited a decreased CD4:CD8-ratio and increased TH1-cells in the intestinal mucosa as compared to controls. During a median FU of 14.7 (8.20-26.5) months, bacterial antigens did not predict decompensation or liver-related death (in contrast to HVPG, IL-6, and MAP) as well as infections at 24 months.
Conclusion: BT occurs already in early ACLD stages and triggers a systemic inflammatory response via TNF-α and IL-10. Interestingly, BT markers showed no clear correlation with portal hypertension and circulatory dysfunction in patients with stable ACLD.
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Keywords/Subjects: Bacterial translocation Circulatory dysfunction Cirrhosis Cytokine Endotoxin Gut–liver axis Immunity Inflammation PAMPs Portal hypertension |
Type of document: application/pdf |
Access rights: info:eu-repo/semantics/openAccess Attribution-NonCommercial-NoDerivatives 4.0 Internacional |
DOI: https://doi.org/10.1007/s12072-023-10496-y |
Appears in Collections: Artículos Medicina Clínica
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