title: Intestinal mucosal proliferation, apoptosis and  oxidative stress in patients with liver cirrhosis.
abstract: BACKGROUND
  Intestinal mucosal barrier dysfunction in liver cirrhosis and its implicated mechanisms is of great clinical importance because it is associated with the development of serious complications from diverse organs through promotion of systemic endotoxemia.
  
  
  OBJECTIVE
  The present study was designed to investigate whether enterocytes' proliferation, apoptosis and intestinal oxidative stress are altered in the intestinal mucosa of patients with compensated and decompensated liver cirrhosis.
  
  
  METHODS
  Twelve healthy controls (group A) and twenty four cirrhotic patients at a compensated (n = 12, group B) or decompensated condition (n = 12, group C) were subjected to duodenal biopsy. In intestinal specimens mucosal apoptotic and mitotic activity and their ratio were recorded by means of morphological assessment and mucosal lipid hydroperoxides were measured. Plasma endotoxin concentration, an index of gut barrier function, was also determined.
  
  
  RESULTS
  Cirrhotic patients presented significantly higher serum endotoxin concentrations as compared to healthy controls (P < 0.001), whilst endotoxemia was higher in decompensated disease (P < 0.05 vs. compensated cirrhosis). Intestinal mucosal mitotic count was significantly lower in patients with compensated and decompensated cirrhosis compared to controls (P < 0.01, respectively), whilst a trend towards increased apoptosis was recorded. The mitotic/apoptotic ratio was significantly reduced in groups B (P < 0.05) and C (P < 0.01) as compared to controls. Intestinal lipid peroxidation was significantly increased in decompensated cirrhotics (P < 0.001 vs. groups A and B).
  
  
  CONCLUSIONS
  The present study demonstrates for the first time that human liver cirrhosis is associated with decreased intestinal mucosal proliferation and proliferation/apoptosis ratio even at early stages of cirrhosis and increased intestinal oxidative stress in advanced liver disease.
authors: Department of Internal Medicine, University Hospital of Patras, Patras, Greece. sassim@upatras.gr
authors: Stelios F
authors: SF
authors: Assimakopoulos
authors: Athanassios C
authors: AC
authors: Tsamandas
authors: Georgios I
authors: GI
authors: Tsiaoussis
authors: Elli
authors: E
authors: Karatza
authors: Dimitrios
authors: D
authors: Zisimopoulos
authors: Ioannis
authors: I
authors: Maroulis
authors: Eleni
authors: E
authors: Kontogeorgou
authors: Christos D
authors: CD
authors: Georgiou
authors: Chrisoula D
authors: CD
authors: Scopa
authors: Konstantinos C
authors: KC
authors: Thomopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D001706:Biopsy; D016022:Case-Control Studies; D049109:Cell Proliferation; D004386:Duodenum / Q000737:chemistry* / Q000382:microbiology / Q000473:pathology*; D019446:Endotoxemia / Q000097:blood / Q000382:microbiology; D004731:Endotoxins / Q000097:blood; D020895:Enterocytes / Q000737:chemistry / Q000473:pathology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000737:chemistry* / Q000382:microbiology / Q000473:pathology*; D015227:Lipid Peroxidation; D008054:Lipid Peroxides / Q000032:analysis; D008103:Liver Cirrhosis / Q000097:blood / Q000378:metabolism* / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D018384:Oxidative Stress; D010539:Permeability
chemical_list: D004731:Endotoxins; D008054:Lipid Peroxides