title: The soluble mannose receptor is released from the liver in cirrhotic patients, but is not associated with bacterial translocation.
abstract: Intestinal bacterial translocation is involved in activation of liver macrophages in cirrhotic patients. Macrophages play a key role in liver inflammation and are involved in the pathogenesis of cirrhosis and complications. Bacterial translocation may be determined by presence of bacterial DNA and macrophage activation, by the soluble mannose receptor. We hypothesize that the soluble mannose receptor is released from hepatic macrophages in cirrhosis and associated with bacterial DNA, portal pressure and complications.
  
  
  
  We investigated 28 cirrhotic patients set for transjugular intrahepatic portosystemic shunt insertion as a result of refractory ascites (n=17), acute (n=3), or recurrent variceal bleeding (n=8). We analysed plasma from the portal and hepatic veins for bacterial DNA and soluble mannose receptor with qPCR and ELISA.
  
  
  
  The median soluble mannose receptor level was elevated in the hepatic vein compared with the portal vein (0.57(interquartile range 0.31) vs 0.55(0.40) mg/L, P=.005). The soluble mannose receptor levels were similar in bacterial DNA-positive and -negative patients. The soluble mannose receptor level in the portal and hepatic veins correlated with the portal pressure prior to transjugular intrahepatic portosystemic shunt insertion (r=.52, P<.008, both) and the levels correlated with Child-Pugh score (r=.63 and r=.56, P<.004, both). We observed higher soluble mannose receptor levels in patients with acute variceal bleeding compared to other indications (P<.05).
  
  
  
  This study showed hepatic soluble mannose receptor excretion with a higher level in the hepatic than the portal vein, though with no associations to bacterial DNA. We observed associations between soluble mannose receptor levels and portal pressure and higher levels in patients with acute variceal bleeding indicating the soluble mannose receptor as a marker of complications of cirrhosis, but not bacterial translocation.
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Tea L
authors.initials: TL
authors.lastname: Laursen
authors.affiliation: Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Sidsel
authors.initials: S
authors.lastname: Rødgaard-Hansen
authors.affiliation: Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Møller
authors.affiliation: Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Mortensen
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Stine
authors.initials: S
authors.lastname: Karlsen
authors.affiliation: Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Nielsen
authors.affiliation: Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Frevert
authors.affiliation: Department of Hepatology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens O
authors.initials: JO
authors.lastname: Clemmesen
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Centre of Functional Imaging and Research, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Møller
authors.affiliation: Mycoplasma Laboratory, Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jørgen S
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bendtsen
authors.affiliation: Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Grønbaek
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology; D018988:Bacterial Translocation; D015415:Biomarkers / Q000097:blood; D004269:DNA, Bacterial / Q000032:analysis; D003718:Denmark; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D037181:Lectins, C-Type / Q000097:blood*; D008103:Liver Cirrhosis / Q000276:immunology / Q000382:microbiology* / Q000601:surgery; D008262:Macrophage Activation; D008264:Macrophages / Q000276:immunology; D008297:Male; D000090323:Mannose Receptor; D037241:Mannose-Binding Lectins / Q000097:blood*; D008875:Middle Aged; D017082:Portal Pressure; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011956:Receptors, Cell Surface / Q000097:blood*; D012995:Solubility
chemical_list: D015415:Biomarkers; D004269:DNA, Bacterial; D037181:Lectins, C-Type; D000090323:Mannose Receptor; D037241:Mannose-Binding Lectins; D011956:Receptors, Cell Surface
keywords: bacterial DNA; bacterial translocation; cirrhosis; soluble mannose receptor; transjugular intrahepatic portosystemic shunt