Hyaluronic Acid (HA) Level in Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis (SBP)
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- Category: Vol. 81, December 2013
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Hyaluronic Acid (HA) Level in Ascitic Fluid of Cirrhotic Patients with Spontaneous Bacterial Peritonitis (SBP), ZAIN E.A. SAYED, EMAD F.M. KHOLEF, MOHAMED O. ABDELMALEK and KHALED M. ATTALLAH
Abstract
Introduction: Spontaneous bacterial peritonitis (SBP) is a common problem that affects liver cirrhotic patients. It is also, a major contributor to the deterioration and aggravation of liver failure complications. Complement deficiency con-sidered as a major complication of liver cirrhosis and bacterial overgrowth in the intestine is the major source of bacterial peritonitis. Hyaluronan or hyaluronic acid (HA) is a connective tissue polysaccharide, synthesized by many cell types, although mesenchymal cells are believed to be predominant. Serum level of HA is regulated by the influx from the tissues via lymphatic system and its receptor-mediated clearance by liver endothelial cells. So, marked increase in serum levels are noted in liver diseases, especially in patients with cirrhosis, when the clearance is impaired. Hyaluronic acids have an important role in controlling tissue permeation, bacterial invasiveness and macromolecular transport between cells. HA was observed to enhance cellular infiltration and migration by facilitating cell detachment. It also, increases the proin-flammatory cytokines TNF-a and IL-8 production. It is interesting to note that HA not only can promote the inflam-mation, but can also moderate the inflammatory response. This may contribute to the stabilization of granulation tissue matrix. The innate immune system uses Toll Like Receptors (TLRs) to recognize microbes and initiate host defense. The repeating disaccharide structure of HA has features of patho-gen-associated molecular patterns. Many pathogen-associated molecular patterns on pathogens utilize Toll-like receptors to initiate innate immune responses.
Aims and Methods: To measure the level of complement-3 (C3) and hyaluronic acid in ascetic fluid of liver cirrhosis patients with and without spontaneous bacterial peritonitis.
Results: In our study we found that there was a significant decrease in C3 level in ascitic fluid of cirrhotic patients in comparison to ascitic fluid of patients with other causes (i.e. Nephrotic syndrome) (p<0.05). Also, HA level was found to be highly significantly lower in ascitic fluid of cirrhotic patients in comparison to ascitic fluid of patient with other causes (i.e. Nephrotic syndrome) (p<0.001). HA level in serum of liver cirrhosis patients was significantly higher than the contro group (p<0.001). There was a highly significant decrease in HA level in ascitic fluid of cirrhotic patients with SBP in comparison to HA level in ascitic fluid of cirrhotic patients without SBP (p<0.001).
Conclusion: C3 and HA are significantly decreased in ascitic fluid of cirrhotic patients. HA significantly decreased in ascitic fluid of cirrhotic patients with SBP in comparison to patients without SBP.