Печеночно-клеточное повреждение и воспаление при разных формах алкогольной болезни печени
Печеночно-клеточное повреждение и воспаление при разных формах алкогольной болезни печени
Родина А.С., Шубина М.Э., Курбатова И.В. и др. Печеночно-клеточное повреждение и воспаление при разных формах алкогольной болезни печени. Терапевтический архив. 2021; 93 (1): 15–19. DOI: 10.26442/00403660.2021.01.200587
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Rodina A.S., Shubina M.E., Kurbatova I.V., et al. Hepatocellular damage and inflammation in various forms of alcoholic liver disease. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (1): 15–19. DOI: 10.26442/00403660.2021.01.200587
Печеночно-клеточное повреждение и воспаление при разных формах алкогольной болезни печени
Родина А.С., Шубина М.Э., Курбатова И.В. и др. Печеночно-клеточное повреждение и воспаление при разных формах алкогольной болезни печени. Терапевтический архив. 2021; 93 (1): 15–19. DOI: 10.26442/00403660.2021.01.200587
________________________________________________
Rodina A.S., Shubina M.E., Kurbatova I.V., et al. Hepatocellular damage and inflammation in various forms of alcoholic liver disease. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (1): 15–19. DOI: 10.26442/00403660.2021.01.200587
Цель. Оценка печеночно-клеточного повреждения и иммунного воспаления при разных формах алкогольной болезни печени (АБП). Материалы и методы. Обследованы 104 больных АБП: 15 (14,4%) стеатозом печени (СП), 19 (18,3%) стеатогепатитом и 70 (67,3%) циррозом печени (ЦП); мужчин 50 (48,1%), женщин 54 (51,9%); возраст – 45,7±8,4 года. Выполнялись традиционные клинико-лабораторные, инструментальные исследования, иммуноферментным анализом определялись уровни фрагментов цитокератина-18 (ФЦК-18), цитокинов – интерлейкина (ИЛ)-1β, фактора некроза опухоли α (TNF-α), ИЛ-4, ИЛ-6, ИЛ-8. Контрольную группу составили 39 здоровых лиц: мужчин – 20 (51,2%), женщин – 19 (48,7%), возраст – 48,5±8,3 года. Результаты. При СП отмечалось увеличение уровня ФЦК-18 при нормальной активности аминотрансфераз, увеличивалось содержание TNF-α, ИЛ-6, ИЛ-1β, ИЛ-8 и снижался уровень ИЛ-4 по сравнению с таковыми у здоровых лиц. При стеатогепатите отмечались трехкратный по сравнению со СП рост аминотрансфераз и ФЦК-18, а также увеличение уровня медиаторов воспаления, в большей степени – ИЛ-6, в меньшей степени – ИЛ-8, TNF-α, снижение ИЛ-4, ИЛ-1β сохранялся на том же уровне. При ЦП фиксировался дальнейший рост ФЦК-18, достоверно более выраженный, чем увеличение аспартатаминотрансферазы, и продолжалось увеличение цитокинов – в одинаковой степени уровня ИЛ-6 и ИЛ-8, в меньшей степени – ИЛ-1β и TNF-α, снижался уровень ИЛ-4. Заключение. При прогрессировании АБП от СП до стеатогепатита печеночно-клеточное повреждение осуществлялось в одинаковой степени выраженными процессами некроза и апоптоза гепатоцитов, при развитии ЦП повреждение паренхимы происходило преимущественно за счет апоптоза гепатоцитов. Иммуновоспалительный процесс прогрессивно нарастал от стадии СП до ЦП, наибольшую динамику при этом претерпевали ИЛ-6 и ИЛ-8. ФЦК-18 могут служить неинвазивным маркером печеночно-клеточного повреждения, а ИЛ-6 и ИЛ-8 – маркерами иммунного воспаления при АБП.
Aim. The aim of the study was to evaluate hepatocellular damage and immune inflammation in various forms of alcoholic liver disease (ALD). Materials and methods. 104 patients with ALD were examined: 15 (14.4%) with liver steatosis (LS), 19 (18.3%) with steatohepatitis and
70 (67.3%) with liver cirrhosis (LC); men 50 (48.1%), women 54 (51.9%); age – 45.7±8.4 years. Traditional clinical, laboratory, instrumental studies were performed, the levels of fragments of cytokeratin-18 (FCK-18), cytokines – IL-1β, TNF-α, IL-4, IL-6, IL-8 were determined by ELISA. The control group consisted of 39 healthy individuals: men – 20 (51.2%), women – 19 (48.7%), age – 48.5±8.3 years. Results. In LS, an increase in the level of FCK-18 was noted with normal aminotransferase activity, the content of TNF-α, IL-6, IL-1β, IL-8 increased and the level of IL-4 decreased compared to those in healthy individuals. In steatohepatitis, a triple increase in aminotransferases and FCK-18 was observed compared with LS, as well as an increase in the level of inflammatory mediators, to a greater extent – IL-6, to a lesser extent – IL-8, TNF-α, a decrease in IL-4, IL-1β remained at the same level. In LC, there was a further increase in FCK-18, significantly more pronounced than an increase in AST, and the increase in cytokines continued – to the same extent, the levels of IL-6 and IL-8, to a lesser extent – IL-1β and TNF-α, and the level of IL-4. Conclusion. With the progression of ALD from LS to steatohepatitis, hepatic cell damage was carried out by equally pronounced processes of hepatocyte necrosis and apoptosis, with the development of cirrhosis of the liver, parenchyma damage occurred mainly due to hepatocyte apoptosis. The immuno-inflammatory process progressively increased from the stage of LS to LC with IL-6 and IL-8 undergoing the greatest dynamics. FCK-18 can serve as a non-invasive marker of hepatic cell damage, and IL-6 and IL-8 – markers of immune inflammation in ALD.
1. Маев И.В., Абдурахманов Д.Т., Андреев Д.Н., Дичева Д.Т. Алкогольная болезнь печени: современное состояние проблемы. Терапевтический архив. 2014;86(4):108-16 [Maev IV, Abdurahmanov DT, Andreev DN, Dicheva DT. Alcoholic liver disease: current state of the problem. Therapeutic Archive. 2014;86(4):108-16 (In Russ.)]. https://ter-arkhiv.ru/0040-3660/article/view/31527
2. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации Российского общества по изучению печени по ведению взрослых пациентов с алкогольной болезнью печени. РЖГГК. 2017;27(6):20-40 [Ivashkin VT, Maevskaja MV, Pavlov ChS, et al. Clinical recommendations of the Russian Society for the Study of the Liver for the management of adult patients with alcoholic liver disease. RZhGGK. 2017;27(6):20-40 (In Russ.)]. doi: 10.22416/1382-4376-2017-27-6-20-40
3. Lavallard VJ, Bonnafous S, Patouraux S, et al. Serum Markers of Hepatocyte Death and Apoptosis Are Non Invasive Biomarkers of Severe Fibrosis in Patients with Alcoholic Liver Disease. PLoS ONE. 2011;6(3):e17599. doi: 10.1371/journal.pone.0017599
4. Kany Sh, Janicova A, Relja B. Innate Immunity and Alcohol. J Clin Med. 2019;8:1981. doi: 10.3390/jcm8111981
5. Wang HJ, Gao B, Zakhari S, Nagy LE. Inflammation in alcoholic liver disease. Ann Rev Nutr. 2012;32:343-68. doi: 10.1146/annurev-nutr-072610-145138
6. Tilg H, Moschen AR, Szabo G. Interleukin-1 and inflammasomes in alcoholic liver disease/acute alcoholic h1. Маев И.В., Абдурахманов Д.Т., Андреев Д.Н., Дичева Д.Т. Алкогольная болезнь печени: современное состояние проблемы. Терапевтический архив. 2014;86(4):108-16 [Maev IV, Abdurahmanov DT, Andreev DN, Dicheva DT. Alcoholic liver disease: current state of the problem. Terapevticheskii Arkhiv (Ter. Arkh.). 2014;86(4):108-16 (In Russ.)]. Available at: http://ter-arkhiv.ru/0040-3660/article/view/31527
2. Ивашкин В.Т., Маевская М.В., Павлов Ч.С., и др. Клинические рекомендации Российского общества по изучению печени по ведению взрослых пациентов с алкогольной болезнью печени. РЖГГК. 2017;27(6):20-40 [Ivashkin VT, Maevskaja MV, Pavlov ChS, et al. Clinical recommendations of the Russian Society for the Study of the Liver for the management of adult patients with alcoholic liver disease. RZhGGK. 2017;27(6):20-40 (In Russ.)]. doi: 10.22416/1382-4376-2017-27-6-20-40
3. Lavallard VJ, Bonnafous S, Patouraux S, et al. Serum Markers of Hepatocyte Death and Apoptosis Are Non Invasive Biomarkers of Severe Fibrosis in Patients with Alcoholic Liver Disease. PLoS ONE. 2011;6(3):e17599. doi: 10.1371/journal.pone.0017599
4. Kany Sh, Janicova A, Relja B. Innate Immunity and Alcohol. J Clin Med. 2019;8:1981. doi: 10.3390/jcm8111981
5. Wang HJ, Gao B, Zakhari S, Nagy LE. Inflammation in alcoholic liver disease. Ann Rev Nutr. 2012;32:343-68. doi: 10.1146/annurev-nutr-072610-145138
6. Tilg H, Moschen AR, Szabo G. Interleukin-1 and inflammasomes in alcoholic liver disease/acute alcoholic hepatitis and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Hepatology. 2016;64:955-65. doi: 10.1002/hep.28456
7. Patel OP, Noor MT, Kumar R, Thakur BS. Serum interleukin 8 and
12 levels predict severity and mortality in patients with alcoholic hepatitis. Indian J Gastroenterol. 2015;34(3):209-15. doi: 10.1007/s12664-015-0565-4
8. Nurmi K, Virkanen J, Rajamäki K, et al. Ethanol inhibits activation of NLRP3 and AIM2 inflammasomes in human macrophages – A novel anti-inflammatory action of alcohol. PLoS One. 2013;8(11):e78537. doi: 10.1371/journal.pone.0078537
9. Relja B, Menke J, Wagner N, et al. Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients. Injury. 2016;47(3):640-5. doi: 10.1016/j.injury.2016.01.016
10. Wagner N, Akbarpour A, Mors K, et al. Alcohol Intoxication Reduces Systemic Interleukin-6 Levels and Leukocyte Counts After Severe TBI Compared With Not Intoxicated TBI Patients. Shock. 2016;46(3):261-9. doi: 10.1097/SHK.0000000000000620
11. Hoyt LR, Ather JL, Randall MJ, et al. Ethanol and Other Short-Chain Alcohols Inhibit NLRP3 Inflammasome Activation through Protein Tyrosine Phosphatase Stimulation. J Immunol. 2016;197:1322-34. doi: 10.4049/jimmunol.1600406
12. Chen YF, Tseng ChY, Wang H-W, et al. Rapid Generation of Mature Hepatocyte-Like Cells from Human Induced Pluripotent Stem Cells by an Efficient Three-Step Protocol. Hepatology. 2012;55(4):1193-203. doi: 10.1002/hep.24790
13. Jeong J, Kim KN, Chung MS, Kim HJ. Functional comparison of human embryonic stem cells and induced pluripotent stem cells as sources of hepatocyte-like cells. Tissue Eng Regen Med. 2016;13(6):740-9. doi: 10.1007/s13770-016-0094-y
14. Lamkanfi M, Dixit VM. Mechanisms and functions of inflammasomes. Cell. 2014;157:1013-22. doi: 10.1016/j.cell.2014.04.007
15. Gehrke N, Hövelmeyer N, Waisman A, et al. Hepatocyte-specific deletion of IL1-RI attenuates liver injury by blocking IL-1 driven autoinflammation. J Hepatol. 2018;68(5):986-95. doi: 10.1016/j.jhep.2018.01.008
16. González-Reimers E, Sánchez-Pérez MJ, Santolaria-Fernández F, et al. Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis. Alcohol. 2012;46(5):433-40. doi: 10.1016/j.alcohol.2011.10.001
17. Gao B, Seki E, Brenner DA, et al. Innate immunity in alcoholic liver disease. Am J Physiol Gastrointest Liver Physiol. 2011;300(4):G516-25. doi: 10.1152/ajpgj.00537.2010
18. Schaper F, Rose-John S. Interleukin-6: Biology, signaling and strategies of blockade. Cytokine Growth Factor Rev. 2015;26(5):475-87.
19. Wan J, Benkdane M, Alons E, et al. M2 kupffer cells promote hepatocyte senescence: an IL-6-dependent protective mechanism against alcoholic liver disease. Am J Pathol. 2014;184(6):1763-72. doi: 10.1016/j.ajpath. 2014.02.014
20. Gudowska-Sawczuk M, Wrona A, Gruszewska E, et al. Serum level of interleukin-6 (IL-6) and N-terminal propeptide of procollagen type I (PINP) in patients with liver diseases. Scand J Clin Lab Invest. 2018;78(1-2):125-30. doi: 10.1080/00365513.2017.1420217
21. Li W, Amet T, Xing Y, et al. Alcohol abstinence ameliorates the dysregulated immune profiles in patients with alcoholic hepatitis: a prospective observational study. Hepatology. 2017;66(2):575-90. doi: 10.1002/hep.29242
22. Sasaki T, Suzuki Y, Kakisaka K, et al. IL-8 induces transdifferentiation of mature hepatocytes toward the cholangiocyte phenotype. FEBS Open Bio. 2019;9(12):2105-16. doi: 10.1002/2211-5463.12750
________________________________________________
1. Maev IV, Abdurahmanov DT, Andreev DN, Dicheva DT. Alcoholic liver disease: current state of the problem. Terapevticheskii Arkhiv (Ter. Arkh.). 2014;86(4):108-16 (In Russ.)
Available at: http://ter-arkhiv.ru/0040-3660/article/view/31527
2. Ivashkin VT, Maevskaja MV, Pavlov ChS, et al. Clinical recommendations of the Russian Society for the Study of the Liver for the management of adult patients with alcoholic liver disease. RZhGGK. 2017;27(6):20-40 (In Russ.) doi: 10.22416/1382-4376-2017-27-6-20-40
3. Lavallard VJ, Bonnafous S, Patouraux S, et al. Serum Markers of Hepatocyte Death and Apoptosis Are Non Invasive Biomarkers of Severe Fibrosis in Patients with Alcoholic Liver Disease. PLoS ONE. 2011;6(3):e17599. doi: 10.1371/journal.pone.0017599
4. Kany Sh, Janicova A, Relja B. Innate Immunity and Alcohol. J Clin Med. 2019;8:1981. doi: 10.3390/jcm8111981
5. Wang HJ, Gao B, Zakhari S, Nagy LE. Inflammation in alcoholic liver disease. Ann Rev Nutr. 2012;32:343-68. doi: 10.1146/annurev-nutr-072610-145138
6. Tilg H, Moschen AR, Szabo G. Interleukin-1 and inflammasomes in alcoholic liver disease/acute alcoholic hepatitis and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Hepatology. 2016;64:955-65. doi: 10.1002/hep.28456
7. Patel OP, Noor MT, Kumar R, Thakur BS. Serum interleukin 8 and
12 levels predict severity and mortality in patients with alcoholic hepatitis. Indian J Gastroenterol. 2015;34(3):209-15. doi: 10.1007/s12664-015-0565-4
8. Nurmi K, Virkanen J, Rajamäki K, et al. Ethanol inhibits activation of NLRP3 and AIM2 inflammasomes in human macrophages – A novel anti-inflammatory action of alcohol. PLoS One. 2013;8(11):e78537. doi: 10.1371/journal.pone.0078537
9. Relja B, Menke J, Wagner N, et al. Effects of positive blood alcohol concentration on outcome and systemic interleukin-6 in major trauma patients. Injury. 2016;47(3):640-5. doi: 10.1016/j.injury.2016.01.016
10. Wagner N, Akbarpour A, Mors K, et al. Alcohol Intoxication Reduces Systemic Interleukin-6 Levels and Leukocyte Counts After Severe TBI Compared With Not Intoxicated TBI Patients. Shock. 2016;46(3):261-9. doi: 10.1097/SHK.0000000000000620
11. Hoyt LR, Ather JL, Randall MJ, et al. Ethanol and Other Short-Chain Alcohols Inhibit NLRP3 Inflammasome Activation through Protein Tyrosine Phosphatase Stimulation. J Immunol. 2016;197:1322-34. doi: 10.4049/jimmunol.1600406
12. Chen YF, Tseng ChY, Wang H-W, et al. Rapid Generation of Mature Hepatocyte-Like Cells from Human Induced Pluripotent Stem Cells by an Efficient Three-Step Protocol. Hepatology. 2012;55(4):1193-203. doi: 10.1002/hep.24790
13. Jeong J, Kim KN, Chung MS, Kim HJ. Functional comparison of human embryonic stem cells and induced pluripotent stem cells as sources of hepatocyte-like cells. Tissue Eng Regen Med. 2016;13(6):740-9. doi: 10.1007/s13770-016-0094-y
14. Lamkanfi M, Dixit VM. Mechanisms and functions of inflammasomes. Cell. 2014;157:1013-22. doi: 10.1016/j.cell.2014.04.007
15. Gehrke N, Hövelmeyer N, Waisman A, et al. Hepatocyte-specific deletion of IL1-RI attenuates liver injury by blocking IL-1 driven autoinflammation. J Hepatol. 2018;68(5):986-95. doi: 10.1016/j.jhep.2018.01.008
16. González-Reimers E, Sánchez-Pérez MJ, Santolaria-Fernández F, et al. Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis. Alcohol. 2012;46(5):433-40. doi: 10.1016/j.alcohol.2011.10.001
17. Gao B, Seki E, Brenner DA, et al. Innate immunity in alcoholic liver disease. Am J Physiol Gastrointest Liver Physiol. 2011;300(4):G516-25. doi: 10.1152/ajpgj.00537.2010
18. Schaper F, Rose-John S. Interleukin-6: Biology, signaling and strategies of blockade. Cytokine Growth Factor Rev. 2015;26(5):475-87.
19. Wan J, Benkdane M, Alons E, et al. M2 kupffer cells promote hepatocyte senescence: an IL-6-dependent protective mechanism against alcoholic liver disease. Am J Pathol. 2014;184(6):1763-72. doi: 10.1016/j.ajpath. 2014.02.014
20. Gudowska-Sawczuk M, Wrona A, Gruszewska E, et al. Serum level of interleukin-6 (IL-6) and N-terminal propeptide of procollagen type I (PINP) in patients with liver diseases. Scand J Clin Lab Invest. 2018;78(1-2):125-30. doi: 10.1080/00365513.2017.1420217
21. Li W, Amet T, Xing Y, et al. Alcohol abstinence ameliorates the dysregulated immune profiles in patients with alcoholic hepatitis: a prospective observational study. Hepatology. 2017;66(2):575-90. doi: 10.1002/hep.29242
22. Sasaki T, Suzuki Y, Kakisaka K, et al. IL-8 induces transdifferentiation of mature hepatocytes toward the cholangiocyte phenotype. FEBS Open Bio. 2019;9(12):2105-16. doi: 10.1002/2211-5463.12750
1 ФГБОУ ВО «Петрозаводский государственный университет», Петрозаводск, Россия;
2 Институт биологии – обособленное подразделение ФГБУН «Федеральный исследовательский центр "Карельский научный центр"» Российской академии наук, Петрозаводск, Россия
1 Petrozavodsk State University, Petrozavodsk, Russia;
2 Institute of Biology of the Karelian Research Centre of the Russian Academy of Sciences, Petrozavodsk, Russia