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Воспалительные цитокины, растворимые рецепторы интерлейкина-6 и фрагментированный цитокератин-18 как индикаторы неалкогольного стеатогепатита
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Shipovskaya AA, Dudanova OP, Kurbatova IV. Inflammatory cytokines, soluble interleukin-6 receptors, and fragmented cytokeratin-18 as indicators of non-alcoholic steatohepatitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2025;97(2):115–120. DOI: 10.26442/00403660.2025.02.203123
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Материалы и методы. Обследованы 173 пациента с НАСГ в возрасте 47,0±10,8 года, из них 118 (68,2%) – мужчины, 55 (31,8%) – женщины. В крови определяли ФНО-α (Human TNFα Platinum ELISA, eBioscience, Австрия), ИЛ-1β, 8, 6 («Вектор-Бест», Россия), рИЛ-6Р (Human sIL-6R ELISA, eBioscience, Австрия), ФЦК-18 (TPS ELISA, Biotech, Швеция), инсулин (Insulin TEST System, США), рассчитывали индекс инсулинорезистентности (Homeostasis Model Assessment of Insulin Resistance – HOMA-IR) и индекс фиброза печени (Nonalcoholic Fatty Liver Disease Fibrosis Score – NFS).
Результаты. Наиболее высокий уровень у пациентов с НАСГ по сравнению со здоровыми лицами отмечен со стороны ИЛ-6 – 8,4±1,6 пг/мл против 2,8±0,9 пг/мл (p=0,001), ФЦК-18 – 295,3±56,3 Ед/л против 110,5±30,2 Ед/л (p=0,0001), затем ИЛ-8 – 17,3±6,7 пг/мл против 7,6±1,9 пг/мл (p=0,003), ФНО-α – 6,3±0,4 пг/мл против 4,1±0,8 пг/мл (p=0,0001), рИЛ-6Р – 151,5±21,2 нг/мл против 95,9±12,5 нг /мл (p<0,05), не изменялся ИЛ-1β – 5,3±1,4 пг/мл против 4,7±1,5 пг/мл (p=0,3) соответственно. Максимальные корреляционные связи ФЦК-18 продемонстрировал с ФНО-α (r=0,73), HOMA-IR (r=0,73), аланинаминотрансферазой (r=0,71), скоростью оседания эритроцитов (r=0,23), ИЛ-6 (r=0,22); p<0,05. ФНО-α коррелировал с ФЦК-18 (r=0,73), холестерином (r=0,61), альбумином (r=-0,42), фибриногеном (r=0,21), числом лейкоцитов (r=0,21); p<0,05. ИЛ-8 коррелировал с триглицеридами (r=0,79) и липопротеидами высокой плотности (r=-0,77), ИЛ-6 – с NFS (r=0,63) и ФЦК-18 (r=0,22), рИЛ-6Р – с аспартатаминотрансферазой (r=0,62); p<0,05.
Заключение. ФНО-α, ИЛ-8, 6, рИЛ-6Р и ФЦК-18 целесообразно использовать в качестве неинвазивных биомаркеров НАСГ.
Ключевые слова: неалкогольный стеатогепатит, неалкогольная жировая болезнь печени, провоспалительные цитокины, интерлейкин-6, интерлейкин-8, растворимые рецепторы интерлейкина-6, фактор некроза опухоли α, фрагментированный цитокератин-18
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Aim. To evaluate inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukin (IL)-1β, 8, 6, soluble IL-6 receptors (sIL-6R) and fragmented cytokeratin-18 (FCK-18) as indicators of non-alcoholic steatohepatitis (NASH).
Materials and methods. 173 NASH patients aged 47.0±10.8 years were examined: 118 (68.2%) – men, 55 (31.8%) – women. The following markers were determined: TNF-α (Human TNFα Platinum ELISA, eBioscience, Austria), IL-1β, 8, 6 (Vector-Best, Russia), sIL-6R (Human sIL-6R ELISA, eBioscience, Austria), FCK-18 (TPS ELISA, Biotech, Sweden), insulin (Insulin TEST System, USA), HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) and NAFLD fibrosis score (NFS) were calculated.
Results. The highest level in NASH patients compared with healthy individuals was observed for IL-6 – 8.4±1.6 pg/ml versus 2.8±0.9 pg/ml (p=0.001), FCK-18 – 295.3±56.3 U/l versus 110.5±30.2 U/l (p=0.0001), then IL-8 – 17.3±6.7 pg/ml vs 7.6±1.9 pg/ml (p=0.003), TNF-α – 6.3±0.4 pg/ml versus 4.1±0.8 pg/ml (p=0.0001), sIL-6R – 151.5±21.2 ng/ml vs 95.9±12.5 ng/ml (p<0.05); IL-1β did not change – 5.3±1.4 pg/ml versus 4.7±1.5 pg/ml (p=0.3) respectively. FCK-18 showed the highest correlations with TNF-α (r=0.73), HOMA-IR (r=0.73), alanine aminotransferase (r=0.71), erythrocyte sedimentation rate (r=0.23), IL-6 (r=0.22); p<0.05. TNF-α correlated with FCK-18 (r=0.73), cholesterol (r=0.61), albumin (r=-0.42), fibrinogen (r=0.21), leukocyte count (r=0.21); p<0.05. IL-8 correlated with triglycerides (r=0.79) and HDL (r=-0.77), IL-6 – with NFS (r=0.63) and FCK-18 (r=0.22), rIL-6R – with aspartate aminotransferase (r=0.62); p<0.05.
Conclusion. TNF-α, IL-8, 6, sIL-6R and FCK-18 should be used as non-invasive biomarkers of NASH.
Keywords: non-alcoholic steatohepatitis, non-alcoholic fatty liver disease, proinflammatory cytokines, interleukin-6, interleukin-8, soluble IL-6 receptors, tumor necrosis factor α, fragmented cytokeratin-18
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5. Giraldez MD, Carneros D, Garbers C, et al. New insights into IL-6 family cytokines in metabolism, hepatology and gastroenterology. Nat Rev Gastroenterol Hepatol. 2021;18(11):787-803. DOI:10.1038/s41575-021-00473-x
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7. Feldstein AE, Wieckowska A, Lopez AR, et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology. 2009;50(4):1072-8. DOI:10.1002/hep.23050
8. Eguchi A, Iwasa M, Yamada M, et al. A new detection system for serum fragmented cytokeratin 18 as a biomarker reflecting histologic activities of human nonalcoholic steatohepatitis. Hepatol Commun. 2022;6(8):1987-99. DOI:10.1002/hep4.1971
9. Lee J, Vali Y, Anstee Q, et al. Accuracy of cytokeratin-18 (M30 and M65) in detecting non-alcoholic steatohepatitis and fibrosis: A systematic review and meta-analysis. Journal of Hepatology. 2020;73. DOI:10.1371/journal.pone.0238717
10. Ajmera V, Perito ER, Bass NM, et al. Novel plasma biomarkers associated with liver disease severity in adults with nonalcoholic fatty liver disease. Hepatology. 2017;65(1):65-77. DOI:10.1002/hep.28776
11. Fontes-Cal TCM, Mattos RT, Medeiros NI, et al. Crosstalk Between Plasma Cytokines, Inflammation, and Liver Damage as a New Strategy to Monitoring NAFLD Progression. Front Immunol. 2021;12:708959. DOI:10.3389/fimmu.2021.708959
12. Auguet T, Bertran L, Binetti J, et al. Relationship between IL-8 Circulating Levels and TLR2 Hepatic Expression in Women with Morbid Obesity and Nonalcoholic Steatohepatitis. Int J Mol Sci. 2020;21(11):4189. DOI:10.3390/ijms21114189
13. Duan Y, Pan X, Luo J, et al. Association of Inflammatory Cytokines With Non-Alcoholic Fatty Liver Disease. Front Immunol. 2022;13:880298. DOI:10.3389/fimmu.2022.880298
14. Dinarello CA. Overview of the IL-1 family in innate inflammation and acquired immunity. Immunol Rev. 2018;281(1):8-27. DOI:10.1111/imr.12621
15. Ćurčić IB, Kizivat T, Petrović A, et al. Therapeutic Perspectives of IL1 Family Members in Liver Diseases: An Update. J Clin Transl Hepatol. 2022;10(6):1186-13. DOI:10.14218/JCTH.2021.00501
16. Hohenester S, Kanitz V, Schiergens T, et al. IL-18 but Not IL-1 Signaling Is Pivotal for the Initiation of Liver Injury in Murine Non-Alcoholic Fatty Liver Disease. Int J Mol Sci. 2020;21(22):8602. DOI:10.3390/ijms21228602
17. de Vasconcelos NM, Lamkanfi M. Recent insights on inflammasomes, gasdermin pores, and pyroptosis. Cold Spring Harbor perspectives in biology. 2020;12(5):a036392. DOI:10.1101/cshperspect.a0363
18. Skuratovskaia D, Komar A, Vulf M, et al. IL-6 Reduces Mitochondrial Replication, and IL-6 Receptors Reduce Chronic Inflammation in NAFLD and Type 2 Diabetes. Int J Mol Sci. 2021;22(4):1774. DOI:10.3390/ijms22041774
19. Seo YY, Cho YK, Bae JC, et al. Tumor Necrosis Factor-α as a Predictor for the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Follow-Up Study. Endocrinol Metab (Seoul). 2013;28(1):41-5. DOI:10.3803/EnM.2013.28.1.41
20. Glass O, Henao R, Patel K, et al. Serum Interleukin-8, Osteopontin, and Monocyte Chemoattractant Protein 1 Are Associated With Hepatic Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Hepatol Commun. 2018;2(11):1344-35. DOI:10.1002/hep4.123
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1. Ivashkin VT, Maevskaya MV, Zharkova MS, et al. Clinical Practice Guidelines of the Russian Scientific Liver Society, Russian Gastroenterological Association, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians and National Society for Preventive Cardiology on Diagnosis and Treatment of Non-Alcoholic Liver Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(4):104-40 (in Russian). DOI:10.22416/1382-4376-2022-32-4-104-140
2. Lazebnik LB, Golovanova EV, Turkina SV, et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;185(1):4-52 (in Russian). DOI:10.31146/1682-8658-ecg-185-1-4-52
3. Krivosheev AB, Autenshlyus AI, Boyko KYu, et al. The cytokine and porphyrine spectrums in patients with non-alcoholic fatty lever disease. Experimental and Clinical Gastroenterology. 2018;155(7):37-42 (in Russian).
4. Gao B, Tsukamoto H. Inflammation in Alcoholic and Nonalcoholic Fatty Liver Disease: Friend or Foe? Gastroenterology. 2016;150(8):1704-9. DOI:10.1053/j.gastro.2016.01.025
5. Giraldez MD, Carneros D, Garbers C, et al. New insights into IL-6 family cytokines in metabolism, hepatology and gastroenterology. Nat Rev Gastroenterol Hepatol. 2021;18(11):787-803. DOI:10.1038/s41575-021-00473-x
6. Kurbatova IV, Topchieva LV, Dudanova OP, Shipovskaya AA. The role of the soluble interleukin-6 receptor in the progression of nonalcoholic fatty liver disease. Bulletin of Experimental Biology and Medicine. 2022;174(11):585-91 (in Russian). DOI:10.47056/0365-9615-2022-174-11-585-91
7. Feldstein AE, Wieckowska A, Lopez AR, et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology. 2009;50(4):1072-8. DOI:10.1002/hep.23050
8. Eguchi A, Iwasa M, Yamada M, et al. A new detection system for serum fragmented cytokeratin 18 as a biomarker reflecting histologic activities of human nonalcoholic steatohepatitis. Hepatol Commun. 2022;6(8):1987-99. DOI:10.1002/hep4.1971
9. Lee J, Vali Y, Anstee Q, et al. Accuracy of cytokeratin-18 (M30 and M65) in detecting non-alcoholic steatohepatitis and fibrosis: A systematic review and meta-analysis. Journal of Hepatology. 2020;73. DOI:10.1371/journal.pone.0238717
10. Ajmera V, Perito ER, Bass NM, et al. Novel plasma biomarkers associated with liver disease severity in adults with nonalcoholic fatty liver disease. Hepatology. 2017;65(1):65-77. DOI:10.1002/hep.28776
11. Fontes-Cal TCM, Mattos RT, Medeiros NI, et al. Crosstalk Between Plasma Cytokines, Inflammation, and Liver Damage as a New Strategy to Monitoring NAFLD Progression. Front Immunol. 2021;12:708959. DOI:10.3389/fimmu.2021.708959
12. Auguet T, Bertran L, Binetti J, et al. Relationship between IL-8 Circulating Levels and TLR2 Hepatic Expression in Women with Morbid Obesity and Nonalcoholic Steatohepatitis. Int J Mol Sci. 2020;21(11):4189. DOI:10.3390/ijms21114189
13. Duan Y, Pan X, Luo J, et al. Association of Inflammatory Cytokines With Non-Alcoholic Fatty Liver Disease. Front Immunol. 2022;13:880298. DOI:10.3389/fimmu.2022.880298
14. Dinarello CA. Overview of the IL-1 family in innate inflammation and acquired immunity. Immunol Rev. 2018;281(1):8-27. DOI:10.1111/imr.12621
15. Ćurčić IB, Kizivat T, Petrović A, et al. Therapeutic Perspectives of IL1 Family Members in Liver Diseases: An Update. J Clin Transl Hepatol. 2022;10(6):1186-13. DOI:10.14218/JCTH.2021.00501
16. Hohenester S, Kanitz V, Schiergens T, et al. IL-18 but Not IL-1 Signaling Is Pivotal for the Initiation of Liver Injury in Murine Non-Alcoholic Fatty Liver Disease. Int J Mol Sci. 2020;21(22):8602. DOI:10.3390/ijms21228602
17. de Vasconcelos NM, Lamkanfi M. Recent insights on inflammasomes, gasdermin pores, and pyroptosis. Cold Spring Harbor perspectives in biology. 2020;12(5):a036392. DOI:10.1101/cshperspect.a0363
18. Skuratovskaia D, Komar A, Vulf M, et al. IL-6 Reduces Mitochondrial Replication, and IL-6 Receptors Reduce Chronic Inflammation in NAFLD and Type 2 Diabetes. Int J Mol Sci. 2021;22(4):1774. DOI:10.3390/ijms22041774
19. Seo YY, Cho YK, Bae JC, et al. Tumor Necrosis Factor-α as a Predictor for the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Follow-Up Study. Endocrinol Metab (Seoul). 2013;28(1):41-5. DOI:10.3803/EnM.2013.28.1.41
20. Glass O, Henao R, Patel K, et al. Serum Interleukin-8, Osteopontin, and Monocyte Chemoattractant Protein 1 Are Associated With Hepatic Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Hepatol Commun. 2018;2(11):1344-35. DOI:10.1002/hep4.123
1ФГБОУ ВО «Петрозаводский государственный университет», Петрозаводск, Россия;
2ФГБУН ФИЦ «Карельский научный центр Российской академии наук», Петрозаводск, Россия
*odudanova@gmail.com
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Anastasia A. Shipovskaya1, Olga P. Dudanova*1, Irina V. Kurbatova2
1Petrozavodsk State University, Petrozavodsk, Russia;
2Karelian Scientific Center of the Russian Academy of Sciences, Petrozavodsk, Russia
*odudanova@gmail.com