Peritoneal level of CD206 associates with mortality and an inflammatory macrophage phenotype in patients with decompensated cirrhosis and spontaneous bacterial peritonitis

Autor(en)

Sven Stengel, Stefanie Quickert, Philipp Lutz, Oluwatomi Ibidapo-Obe, Arndt Steube, Nilay Köse-Vogel, Melina Yarbakht, Philipp A Reuken, Martin Busch, Annette Brandt, Ina Bergheim, Sachin D Deshmuk Deshmuk, Andreas Stallmach, Tony Bruns

Abstrakt

Background & Aims: Peritoneal macrophages (PMs) regulate inflammation and control bacterial infections in patients with decompensated cirrhosis. We aimed to characterize PMs and associate their activation with outcomes of patients with spontaneous bacterial peritonitis (SBP). Methods: We isolated PMs from ascites samples of 66 patients with decompensated cirrhosis (19 with SBP) and analyzed them by flow cytometry, quantitative real-time polymerase chain reaction, functional analysis, and RNA microarrays. We used ascites samples of a separate cohort of 111 patients with decompensated cirrhosis (67 with SBP) and quantified the soluble form of the mannose receptor (CD206) and tumor necrosis factor by enzyme-linked immunosorbent assay (test cohort). We performed logistic regression analysis to identify factors associated with 90-day mortality. We validated our findings using data from 71 patients with cirrhosis and SBP. Data from 14 patients undergoing peritoneal dialysis for end-stage renal disease but without cirrhosis were included as controls. Results: We used surface levels of CD206 to identify subsets of large PMs (LPM) and small PMs (SPM), which differed in granularity and maturation markers, in ascites samples from patients with cirrhosis. LPMs vs SPMs from patients with cirrhosis had different transcriptomes; we identified more than 4000 genes that were differentially regulated in LPMs vs SPMs, including those that regulate the cycle, metabolism, self-renewal, and immune cell signaling. LPMs had an inflammatory phenotype, were less susceptible to tolerance induction, and released more tumor necrosis factor than SPMs. LPMs from patients with cirrhosis produced more inflammatory cytokines than LPMs from controls. Activation of PMs by Toll-like receptor agonists and live bacteria altered levels of CD206 on the surface of LPMs and release of soluble CD206. Analysis of serial ascites fluid from patients with SBP revealed loss of LPMs in the early phase of SBP, but levels increased after treatment. In the test and validation cohorts, patients with SBP and higher concentrations of soluble CD206 in ascites fluid (>0.53 mg/L) were less likely to survive for 90 days than those with lower levels. Conclusions: Surface level of CD206 can be used to identify mature, resident, inflammatory PMs in patients with cirrhosis. Soluble CD206 is released from activated LPMs and increased concentrations in patients with cirrhosis and SBP indicate reduced odds of surviving for 90 days.

Organisation(en)

Department für Ernährungswissenschaften

Externe Organisation(en)

Universitätsklinikum Jena, Universität Wien, Rheinische Friedrich-Wilhelms-Universität Bonn

Journal

Gastroenterology

Band

158

Seiten

1745-1761

Anzahl der Seiten

17

ISSN

0016-5085

DOI

https://doi.org/10.1053/j.gastro.2020.01.029

Publikationsdatum

05-2020

Peer-reviewed

Ja

ÖFOS 2012

303009 Ernährungswissenschaften

Schlagwörter

ASJC Scopus Sachgebiete

Gastroenterology, Hepatology

Link zum Portal

https://ucris.univie.ac.at/portal/de/publications/peritoneal-level-of-cd206-associates-with-mortality-and-an-inflammatory-macrophage-phenotype-in-patients-with-decompensated-cirrhosis-and-spontaneous-bacterial-peritonitis(3f5704ab-1b04-4a73-aec0-e14280afb953).html