Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy
Background: During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Transient Elastography (TE) is a clinical...
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Case Western Reserve University
2018-09-01
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Series: | Pathogens and Immunity |
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Online Access: | http://paijournal.com/index.php/paijournal/article/view/242 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lenche Kostadinova Carey L. Shive Elizabeth Zebrowski Brianna Fuller Kelsey Rife Amy Hirsch Anita Compan Anita Moreland Yngve Falck-Ytter Daniel L. Popkin Donald D. Anthony |
spellingShingle |
Lenche Kostadinova Carey L. Shive Elizabeth Zebrowski Brianna Fuller Kelsey Rife Amy Hirsch Anita Compan Anita Moreland Yngve Falck-Ytter Daniel L. Popkin Donald D. Anthony Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy Pathogens and Immunity hepatitis C cellular immunity T cell monocyte inflammation |
author_facet |
Lenche Kostadinova Carey L. Shive Elizabeth Zebrowski Brianna Fuller Kelsey Rife Amy Hirsch Anita Compan Anita Moreland Yngve Falck-Ytter Daniel L. Popkin Donald D. Anthony |
author_sort |
Lenche Kostadinova |
title |
Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy |
title_short |
Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy |
title_full |
Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy |
title_fullStr |
Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy |
title_full_unstemmed |
Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV Therapy |
title_sort |
soluble markers of immune activation differentially normalize and selectively associate with improvement in ast, alt, albumin, and transient elastography during ifn-free hcv therapy |
publisher |
Case Western Reserve University |
series |
Pathogens and Immunity |
issn |
2469-2964 |
publishDate |
2018-09-01 |
description |
Background: During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Transient Elastography (TE) is a clinical measure of liver stiffness that facilitates evaluation of liver damage stage. While a portion of the TE score is attributable to liver fibrosis and relatively irreversible damage, another component of the TE score is attributable to liver inflammation or edema. Markers of inflammation during chronic HCV infection include soluble markers of immune activation, which are also associated with morbid outcome (including cardiovascular disease and liver-disease progression). Whether soluble markers of immune activation or changes in their level during HCV therapy relate to normalization of AST, ALT, Albumin, or TE score, is not clear.
Methods: We evaluated soluble markers of immune activation (plasma sCD14, IL-6, sCD163, autotaxin [ATX], and Mac2BP) and TE score, and their relationship in 20 HCV-infected patients before, during, and after HCV-directed IFN-free direct-acting antiviral (DAA) therapy. We evaluated normalization of parameters and the relationship between each over a 6-month window.
Results: Before therapy, serum AST levels positively correlated with plasma levels of sCD14, sCD163, and Mac2BP, while ALT levels positively correlated with Mac2BP. Serum albumin level negatively correlated with plasma IL-6 and ATX levels. IFN-free therapy uniformly resulted in sustained virological response at 12 and 24 weeks after therapy completion. After initiation of therapy AST and ALT normalized, while levels of ATX, Mac2BP, sCD163, and TE score partially normalized over 6 months. Additionally, change in AST level and APRI score correlated with change in sCD163, IL-6, and Mac2BP levels, and change in ALT correlated with change in IL-6 and Mac2BP levels. Improvement in TE score correlated with a decrease in the level of sCD14 at week 4, and almost statistically significant with decrease in sCD14 at weeks 20-24 after initiation of IFN-free HCV therapy.
Conclusions: Soluble markers of immune activation normalize or partially normalize at different rates after initiation of curative HCV DAA therapy, and TE scores improve, with wide variability in the degree of absolute improvement in liver stiffness from patient to patient. Decline magnitude of sCD14 was associated with improvement in TE score, while magnitude of improvement in AST correlated with reduction in sCD163 levels. These data provide support for a model where monocyte/Kupffer cell activation may account for a portion of the liver inflammation and edema, which is at least partially reversible following initiation of HCV DAA therapy. |
topic |
hepatitis C cellular immunity T cell monocyte inflammation |
url |
http://paijournal.com/index.php/paijournal/article/view/242 |
work_keys_str_mv |
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doaj-a651cb373a704c528bb45bc7a62bed872020-11-24T22:04:19ZengCase Western Reserve UniversityPathogens and Immunity2469-29642018-09-013114916310.20411/pai.v3i1.24284Soluble Markers of Immune Activation Differentially Normalize and Selectively Associate with Improvement in AST, ALT, Albumin, and Transient Elastography During IFN-Free HCV TherapyLenche Kostadinova0Carey L. Shive1Elizabeth Zebrowski2Brianna Fuller3Kelsey Rife4Amy Hirsch5Anita Compan6Anita Moreland7Yngve Falck-Ytter8Daniel L. Popkin9Donald D. Anthony10The Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Medicine, University Hospitals Medical Center, and the Center for AIDS Research, Case Western Reserve University, Cleveland, OhioThe Louis Stokes VA Medical Center, Cleveland, Ohio; Department of Dermatology, University Hospitals Medical Center, Case Western Reserve University, Cleveland, OhioProfessor of Medicine, Case Western Reserve University Division of Rheumatology & Division of Infectious Diseases & HIV MedicineBackground: During chronic hepatitis C virus (HCV) infection, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels mark active liver inflammation and tissue damage, while albumin reflects synthetic liver function and nutritional status. Transient Elastography (TE) is a clinical measure of liver stiffness that facilitates evaluation of liver damage stage. While a portion of the TE score is attributable to liver fibrosis and relatively irreversible damage, another component of the TE score is attributable to liver inflammation or edema. Markers of inflammation during chronic HCV infection include soluble markers of immune activation, which are also associated with morbid outcome (including cardiovascular disease and liver-disease progression). Whether soluble markers of immune activation or changes in their level during HCV therapy relate to normalization of AST, ALT, Albumin, or TE score, is not clear. Methods: We evaluated soluble markers of immune activation (plasma sCD14, IL-6, sCD163, autotaxin [ATX], and Mac2BP) and TE score, and their relationship in 20 HCV-infected patients before, during, and after HCV-directed IFN-free direct-acting antiviral (DAA) therapy. We evaluated normalization of parameters and the relationship between each over a 6-month window. Results: Before therapy, serum AST levels positively correlated with plasma levels of sCD14, sCD163, and Mac2BP, while ALT levels positively correlated with Mac2BP. Serum albumin level negatively correlated with plasma IL-6 and ATX levels. IFN-free therapy uniformly resulted in sustained virological response at 12 and 24 weeks after therapy completion. After initiation of therapy AST and ALT normalized, while levels of ATX, Mac2BP, sCD163, and TE score partially normalized over 6 months. Additionally, change in AST level and APRI score correlated with change in sCD163, IL-6, and Mac2BP levels, and change in ALT correlated with change in IL-6 and Mac2BP levels. Improvement in TE score correlated with a decrease in the level of sCD14 at week 4, and almost statistically significant with decrease in sCD14 at weeks 20-24 after initiation of IFN-free HCV therapy. Conclusions: Soluble markers of immune activation normalize or partially normalize at different rates after initiation of curative HCV DAA therapy, and TE scores improve, with wide variability in the degree of absolute improvement in liver stiffness from patient to patient. Decline magnitude of sCD14 was associated with improvement in TE score, while magnitude of improvement in AST correlated with reduction in sCD163 levels. These data provide support for a model where monocyte/Kupffer cell activation may account for a portion of the liver inflammation and edema, which is at least partially reversible following initiation of HCV DAA therapy.http://paijournal.com/index.php/paijournal/article/view/242hepatitis Ccellular immunityT cellmonocyteinflammation |