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Bossen L, Vesterhus M, Hov JR, Färkkilä M, Rosenberg WM, Møller HJ, Boberg KM, Karlsen TH, Grønbæk H. Circulating Macrophage Activation Markers Predict Transplant-Free Survival in Patients With Primary Sclerosing Cholangitis. Clin Transl Gastroenterol 2021; 12:e00315. [PMID: 33646203 PMCID: PMC7925135 DOI: 10.14309/ctg.0000000000000315] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/13/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Primary sclerosing cholangitis (PSC) is a progressive liver disease characterized by bile duct inflammation and fibrosis. The role of macrophages in PSC development and progression is less studied. Macrophage activation markers soluble (s)CD163 and mannose receptor (sMR) are associated with disease severity and outcome in other liver diseases, but not previously investigated in PSC. We evaluated sCD163 and sMR regarding disease severity and prognosis in patients with PSC. METHODS We investigated 2 independent PSC cohorts from Oslo (n = 138) and Helsinki (n = 159) and analyzed blood sCD163 and sMR levels. The Mayo score, Enhanced Liver Fibrosis Test, and Amsterdam-Oxford model were assessed for comparison. RESULTS Median (interquartile range) sCD163 was 3.32 (2.27-5.60) and 1.96 (1.47-2.70) mg/L in the Oslo and Helsinki cohorts, respectively, reflecting differences in disease severity between cohorts. Median sMR was similar in both cohorts, 0.28 (0.22-0.44) and 0.28 mg/L (0.20-0.36), respectively. In both cohorts, sCD163 and sMR levels raised with increasing disease severity (liver enzymes, Mayo score, and enhanced liver fibrosis test). Patients with high baseline levels of sCD163 had shorter transplant-free survival than patients with low baseline levels. Furthermore, sCD163 was associated with transplant-free survival in univariate cox-regression analyses. Both sCD163 and sMR performed better in the Oslo cohort of more severely diseased patients than those in the Helsinki cohort of more mildly diseased patients. DISCUSSION Macrophage activation markers are elevated according to disease severity suggesting an important role of macrophages in PSC. Furthermore, sCD163 was identified as a prognostic marker and predictor of transplant-free survival in PSC (see Visual Abstract, Supplementary Digital Content 4, http://links.lww.com/CTG/A516).
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MESH Headings
- Adult
- Antigens, CD/analysis
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/analysis
- Antigens, Differentiation, Myelomonocytic/metabolism
- Biomarkers/blood
- Biomarkers/metabolism
- Case-Control Studies
- Cholangitis, Sclerosing/blood
- Cholangitis, Sclerosing/immunology
- Cholangitis, Sclerosing/mortality
- Cholangitis, Sclerosing/surgery
- Disease Progression
- End Stage Liver Disease/blood
- End Stage Liver Disease/epidemiology
- End Stage Liver Disease/immunology
- End Stage Liver Disease/surgery
- Female
- Finland/epidemiology
- Humans
- Liver Transplantation/statistics & numerical data
- Macrophage Activation
- Macrophages/immunology
- Macrophages/metabolism
- Male
- Membrane Glycoproteins/analysis
- Membrane Glycoproteins/metabolism
- Middle Aged
- Norway/epidemiology
- Prognosis
- Receptors, Cell Surface/analysis
- Receptors, Cell Surface/metabolism
- Receptors, Immunologic/analysis
- Receptors, Immunologic/metabolism
- Registries/statistics & numerical data
- Retrospective Studies
- Risk Assessment/methods
- Severity of Illness Index
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Affiliation(s)
- Lars Bossen
- Department of Hepatology & Gastroenterology, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Aarhus University Hospital, Aarhus, Denmark;
| | - Mette Vesterhus
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Oslo University Hospital Rikshospitalet, Oslo, Norway;
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway;
- Department of Clinical Science, University of Bergen, Bergen, Norway;
| | - Johannes R. Hov
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Oslo University Hospital Rikshospitalet, Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway;
- Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway;
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway;
| | - Martti Färkkilä
- Helsinki University, Clinic of Gastroenterology, Helsinki University Hospital, Helsinki, Finland;
| | - William M. Rosenberg
- UCL Institute for Liver and Digestive Health, Division of Medicine, University College London & Royal Free London, NHS Foundation Trust, London, UK;
| | - Holger J. Møller
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
| | - Kirsten M. Boberg
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Oslo University Hospital Rikshospitalet, Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway;
- Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway;
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway;
| | - Tom H. Karlsen
- Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Oslo University Hospital Rikshospitalet, Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway;
- Section of Gastroenterology, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway;
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway;
| | - Henning Grønbæk
- Department of Hepatology & Gastroenterology, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Aarhus University Hospital, Aarhus, Denmark;
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