Improved survival ratios correlate with myeloid dendritic cell restoration in acute-on-chronic liver failure patients receiving methylprednisolone therapy.
Acute-on-chronic liver failure (ACLF) is a severe life-threatening complication. Liver transplantation is the only available therapeutic option; however, several limitations have restricted its use in patients. The use of corticosteroids as an optional therapy for ACLF has received a great deal of interest. The rationale behind its use is the possible role of the immune system in initiating and perpetuating hepatic damage. In order to assess the relationship between myeloid dendritic cells (mDCs) and the efficacy of methylprednisolone (MP) treatment for hepatitis B virus (HBV)-associated ACLF patients, we recruited 30 HBV-associated ACLF patients who had received MP treatment at 10-day intervals; 26 patients received conservative medical (CM) management as a control. The functionality of DC subsets was lower in these ACLF patients compared with healthy subjects. In addition, compared with survivors, dead/transplanted patients had lower functional mDC in both groups. Furthermore, a decreased numbers of mDC at baseline was associated with high mortality of ACLF patients. Importantly, MP treatment resulted in a significant decrease in 28-day mortality, and all MP patients exhibited an initial rapid decrease in circulating mDC numbers within 10 days of MP treatment. Subsequently, MP survivors displayed a continuous increase in mDC numbers accompanied by a decrease in total bilirubin levels by more than 30%. However, MP dead/transplanted patients lacked these sequential responses compared with survivors. This evidence suggests strongly that the higher mDC numbers at baseline and the recovery of mDC number at the end of treatment may represent a prognostic marker for favorable response to corticosteroid treatment in ACLF patients.
Department of Hepatology, Beijing You An Hospital, Capital Medical University, Beijing, China.
Juan
J
Zhao
Ji-Yuan
JY
Zhang
Hong-Wei
HW
Yu
Yu-Lan
YL
He
Jing-Jing
JJ
Zhao
Juan
J
Li
Yue-Ke
YK
Zhu
Qin-Wei
QW
Yao
Jin-Huan
JH
Wang
Hai-Xia
HX
Liu
Shu-Yun
SY
Shi
Zheng-Sheng
ZS
Zou
Xiang-Sheng
XS
Xu
Chun-Bao
CB
Zhou
Fu-Sheng
FS
Wang
Qing-Hua
QH
Meng
D000328:Adult; D016022:Case-Control Studies; D003713:Dendritic Cells / Q000378:metabolism* / Q000473:pathology; D058625:End Stage Liver Disease / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D019694:Hepatitis B, Chronic / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D022423:Myeloid Cells / Q000378:metabolism* / Q000473:pathology
D005938:Glucocorticoids; D008775:Methylprednisolone