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Braz AMM, Winckler FC, Binelli LS, Chimeno LG, Lopes LBM, Lima RS, Simões RP, Grotto RMT, Golim MDA, Silva GF. Inflammation response and liver stiffness: predictive model of regression of hepatic stiffness after sustained virological response in cirrhotics patients with chronic hepatitis C. Clin Exp Med 2021; 21:587-597. [PMID: 33835323 DOI: 10.1007/s10238-021-00708-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
Cirrhotic patients with chronic hepatitis C should be monitored for the evaluation of liver function and screening of hepatocellular carcinoma even after sustained virological response (SVR). The stage of inflammatory resolution and regression of fibrosis is likely to happen, once treatment and viral clearance are achieved. However, liver examinations by elastography show that 30-40% of patients do not exhibit a reduction of liver stiffness. This work was a cohort study in cirrhotic patients whose purpose was to identify immunological factors involved in the regression of liver stiffness in chronic hepatitis C and characterize possible serum biomarkers with prognostic value. The sample universe consisted of 31 cirrhotic patients who underwent leukocyte immunophenotyping, quantification of cytokines/chemokines and metalloproteinase inhibitors in the pretreatment (M1) and in the evaluation of SVR (M2). After exclusion criteria application, 16 patients included were once more evaluated in M3 (like M1) and classified into regressors (R) or non-regressors (NR), decrease or not ≥ 25% stiffness, respectively. The results from ROC curve, machine learning (ML) and linear discriminant analysis showed that TCD4 + lymphocytes (absolute) are the most important biomarkers for the prediction of the regression (AUC = 0.90). NR patients presented levels less than R of liver stiffness since baseline, whereas NK cells were increased in NR. Therefore, it was concluded that there is a difference in the profile of circulating immune cells in R and NR, thus allowing the development of a predictive model of regression of liver stiffness after SVR. These findings should be validated in greater numbers of patients.
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Affiliation(s)
- Aline Márcia Marques Braz
- Graduate Program in Pathophysiology in Clinical Medicine, Department of Clinical Medicine, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Flow Cytometry Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, São Paulo, Brazil
| | - Fernanda Cristina Winckler
- Graduate Program in Pathophysiology in Clinical Medicine, Department of Clinical Medicine, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Larissa Sarri Binelli
- Flow Cytometry Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, São Paulo, Brazil
| | - Luis Guilherme Chimeno
- Flow Cytometry Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, São Paulo, Brazil
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Lia Beatriz Mantovani Lopes
- Flow Cytometry Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, São Paulo, Brazil
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Rodrigo Santos Lima
- Graduate Program in Pathology, Department of Pathology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Rafael Plana Simões
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Department of Biotechnology and Bioprocess Engineering, São Paulo State University (UNESP), Faculty of Agronomic Sciences, Botucatu, São Paulo, Brazil
| | - Rejane Maria Tommasini Grotto
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Graduate Program in Pathology, Department of Pathology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Department of Biotechnology and Bioprocess Engineering, São Paulo State University (UNESP), Faculty of Agronomic Sciences, Botucatu, São Paulo, Brazil
- Molecular Biology Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Marjorie de Assis Golim
- Flow Cytometry Laboratory, Applied Biotechnology Laboratory - LBA, Clinical Hospital of Botucatu Medical School, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, Botucatu, São Paulo, Brazil.
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil.
| | - Giovanni Faria Silva
- Graduate Program in Pathophysiology in Clinical Medicine, Department of Clinical Medicine, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
- Graduate Program in Research and Development (Medical Biotechnology, São Paulo State University (UNESP), Botucatu Medical School, Botucatu, São Paulo, Brazil
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Himmerich H, Patsalos O, Lichtblau N, Ibrahim MAA, Dalton B. Cytokine Research in Depression: Principles, Challenges, and Open Questions. Front Psychiatry 2019; 10:30. [PMID: 30792669 PMCID: PMC6374304 DOI: 10.3389/fpsyt.2019.00030] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/18/2019] [Indexed: 01/18/2023] Open
Abstract
Cytokines have been implicated in the pathology of depression. Currently, the evidence is based on cross-sectional studies and meta-analytic research comparing blood concentrations of T helper type 1 (TH1), T helper type 2 (TH2), pro-inflammatory or anti-inflammatory cytokines of patients with a depressive disorder to those of healthy controls. Additionally, multiple longitudinal studies have investigated cytokine levels during antidepressant treatment. According to the current literature, it seems that peripheral levels of interleukin (IL)-6, IL-10, IL-12, IL-13, and tumor necrosis factor (TNF)-α are elevated and that interferon (IFN)-γ levels are lower in patients with depression compared to healthy controls. However, the overlap of cytokine values between acutely depressed patients, remitted and recovered patients and healthy controls is considerable. Thus, the discriminative power of cytokine concentrations between depressed and non-depressed people is likely weak. Treatment with certain antidepressants appears to decrease peripheral levels of IL-6, IL-10, and TNF-α. However, weight gain-inducing psychopharmacological substances, such as the antidepressant mirtazapine, have been reported to potentially increase the production of pro-inflammatory cytokines. Even though cytokines are often discussed as biomarkers for depression, they have also been shown to be altered in other psychiatric disorders. Moreover, many environmental, social, psychological, biological, and medical factors are also associated with cytokine changes. Thus, cytokine alterations seem extremely unspecific. The interpretation of the results of these studies remains a challenge because it is unknown which type of cells are most responsible for cytokine changes measured in the blood nor have the main target cells or target tissues been identified. The same cytokine can be produced by multiple cell types, and the same cell can produce various cytokines. Additionally, redundancy, synergy, antagonism, and signaling cascades of cytokine signaling must be considered. Cytokines might not be associated with the diagnosis of depression according to the currently used diagnostic manuals, but rather with specific subtypes of depression, or with depressive symptoms across different psychiatric diagnoses. Therefore, the currently available diagnostic systems may not be the ideal starting point for psychiatric cytokine research.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Olivia Patsalos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Nicole Lichtblau
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Mohammad A. A. Ibrahim
- Department of Clinical Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London, United Kingdom
| | - Bethan Dalton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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