The soluble mannose receptor is released from the liver in cirrhotic patients, but is not associated with bacterial translocation

BACKGROUND AND AIMS: Intestinal bacterial translocation (BT) is involved in activation of liver macrophages in cirrhotic patients. Macrophages play a key role in liver inflammation and are involved in the pathogenesis of cirrhosis and complications. BT may be determined by presence of bacterial DNA (bDNA) and macrophage activation by the soluble mannose receptor (sMR). We hypothesize that sMR is released from hepatic macrophages in cirrhosis and associated with bDNA, portal pressure and complications.

METHODS: We investigated 28 cirrhotic patients set for transjugular intrahepatic portosystemic shunt (TIPS) insertion due to refractory ascites (n=17), acute (n=3), or recurrent variceal bleeding (n=8). We analysed plasma from the portal and hepatic veins for bDNA and sMR with qPCR and ELISA.

RESULTS: The median sMR level was elevated in the hepatic vein compared with the portal vein (0.57(IQR0.31) vs. 0.55(0.40) mg/L, p=0.005). sMR levels were similar in bDNA-positive and -negative patients. The sMR level in the portal and hepatic veins correlated with the portal pressure prior to TIPS insertion (r=0.52, p<0.008, both) and the levels correlated with Child-Pugh score (r=0.63 and r=0.56, p<0.004, both). We observed higher sMR levels in patients with acute variceal bleeding compared to other indications (p<0.05).

CONCLUSION: This study showed hepatic sMR excretion with a higher level in the hepatic than the portal vein, though with no associations to bDNA. We observed associations between sMR levels and portal pressure and higher levels in patients with acute variceal bleeding indicating the sMR as a marker of complications of cirrhosis, but not BT. This article is protected by copyright. All rights reserved.