Improved survival ratios correlate with myeloid dendritic cell restoration in acute-on-chronic liver failure patients receiving methylprednisolone therapy

• Published in: Cellular & molecular immunology Vol. 9; no. 5; pp. 417 - 422
• Main Authors: Zhao, Juan, Zhang, Ji-Yuan, Yu, Hong-Wei, He, Yu-Lan, Zhao, Jing-Jing, Li, Juan, Zhu, Yue-Ke, Yao, Qin-Wei, Wang, Jin-Huan, Liu, Hai-Xia, Shi, Shu-Yun, Zou, Zheng-Sheng, Xu, Xiang-Sheng, Zhou, Chun-Bao, Wang, Fu-Sheng, Meng, Qing-Hua
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2012; Nature Publishing Group
• Subjects: Adult; Antibodies; Bilirubin; Biomedical and Life Sciences; Biomedicine; Case-Control Studies; Cell survival; Corticoids; Corticosteroids; Dendritic cells; Dendritic Cells - metabolism; Dendritic Cells - pathology; End Stage Liver Disease - drug therapy; End Stage Liver Disease - etiology; End Stage Liver Disease - mortality; Female; Glucocorticoids - therapeutic use; Hepatitis B; Hepatitis B virus; Hepatitis B, Chronic - complications; Hepatocytes; Humans; Immune system; Immunology; Kaplan-Meier Estimate; Liver; Liver diseases; Liver failure; Liver Failure, Acute - drug therapy; Liver Failure, Acute - mortality; Liver transplantation; Male; Medical Microbiology; Methylprednisolone; Methylprednisolone - therapeutic use; Microbiology; Middle Aged; Mortality; Myeloid Cells - metabolism; Myeloid Cells - pathology; Patients; research-article; Vaccine; 急性; 患者; 慢性; 树突状细胞; 生存率; 甲基强的松龙; 细胞修复; 肝功能衰竭; methylprednisolone; plasmacytoid dendritic cells; myeloid dendritic cells; acute-on-chronic liver failure
• ISSN: 1672-7681; 2042-0226
• DOI: 10.1038/cmi.2011.51

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 （H BV）-associated ACLF patients, we recruited 30 HBV-associated ACLF patients who had received MP treatment at lO-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.