title: Bacterial DNA activates cell mediated immune response and nitric oxide overproduction in peritoneal macrophages from patients with cirrhosis and ascites.
abstract: OBJECTIVE
  Translocation of intestinal bacteria to ascitic fluid is probably the first step in the development of episodes of spontaneous bacterial peritonitis in patients with cirrhosis. We have recently reported the detection of bacterial DNA in blood and ascitic fluid from patients with advanced cirrhosis, what we consider as molecular evidence of bacterial translocation. Several studies have shown the immunogenic role of bacterial DNA in vitro, and we hypothesised that the presence of bacterial DNA could activate the type I immune response in peritoneal macrophages from these patients, leading to greater cytokine synthesis (interleukin (IL)-2 and IL-12, tumour necrosis factor alpha, and interferon gamma) and effector molecules such as nitric oxide.
  
  
  METHODS
  Peritoneal macrophages obtained from patients with cirrhosis and culture negative non-neutrocytic ascitic fluid were collected and characterised by flow cytometry. Inducible nitric oxide synthase, nitric oxide levels, and cytokine production were measured by immunoenzymometric assays in basal and harvested conditions according to the presence/absence of bacterial DNA.
  
  
  RESULTS
  The ability of peritoneal macrophages to synthesise nitric oxide and levels of all cytokines were significantly increased in patients with bacterial DNA. There was a positive correlation between inducible nitric oxide synthase and nitric oxide levels.
  
  
  CONCLUSIONS
  The presence of bacterial DNA in patients with decompensated cirrhosis is associated with marked activation of peritoneal macrophages, as evidenced by nitric oxide synthesising ability, together with enhanced cytokine production.
authors.affiliation: Department of Immunology, Hospital General Universitario, Pintor Baeza s/n, Alicante, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Francés
authors.forename: C
authors.initials: C
authors.lastname: Muñoz
authors.forename: P
authors.initials: P
authors.lastname: Zapater
authors.forename: F
authors.initials: F
authors.lastname: Uceda
authors.forename: I
authors.initials: I
authors.lastname: Gascón
authors.forename: S
authors.initials: S
authors.lastname: Pascual
authors.forename: M
authors.initials: M
authors.lastname: Pérez-Mateo
authors.forename: J
authors.initials: J
authors.lastname: Such
mesh_terms: D000368:Aged; D001201:Ascites / Q000276:immunology*; D001202:Ascitic Fluid / Q000276:immunology; D016207:Cytokines / Q000378:metabolism; D004269:DNA, Bacterial / Q000276:immunology*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D008103:Liver Cirrhosis / Q000276:immunology*; D017737:Macrophages, Peritoneal / Q000276:immunology*; D008297:Male; D009569:Nitric Oxide / Q000096:biosynthesis*; D019001:Nitric Oxide Synthase / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II
chemical_list: D016207:Cytokines; D004269:DNA, Bacterial; D009569:Nitric Oxide; C496319:NOS2 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II