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Infection

, Volume 46, Issue 6, pp 793–799 | Cite as

Endotoxinemia contributes to steatosis, insulin resistance and atherosclerosis in chronic hepatitis C: the role of pro-inflammatory cytokines and oxidative stress

  • Rosa Zampino
  • Aldo Marrone
  • Luca Rinaldi
  • Barbara Guerrera
  • Riccardo Nevola
  • Adriana Boemio
  • Natalina Iuliano
  • Mauro Giordano
  • Nicola Passariello
  • Ferdinando C. Sasso
  • Emanuele Albano
  • Luigi E. AdinolfiEmail author
Original Paper

Abstract

Purpose

Endotoxin is a component of the outer membrane of gram-negative bacteria that live in the intestine. Endotoxinemia is reported in non-alcoholic fatty liver disease and in cirrhotic patients, causing various biological and clinical effects in the host. It is not known whether endotoxinemia occurs in chronic hepatitis C patients (CHC), therefore we evaluated the occurrence of endotoxinemia and its effect on inflammation, liver damage, insulin resistance (IR) and atherosclerosis.

Methods

Consecutive CHC patients assessed by liver biopsy were enrolled. Endotoxinemia was evaluated by LAL test. IR was estimated by HOMA-IR. Serum TNF-α, IL-8, adiponectin and MCP-1 were measured with ELISA tests. Oxidative stress was estimated by circulating IgG against malondialdehyde adducts with human serum albumin (MDA-HAS). Carotid atherosclerosis was assessed by ultrasonography.

Results

Endotoxinemia was found in 60% of the 126 patients enrolled. A serum level-dependent association between endotoxinemia, steatosis (p < 0.001) and HOMA-IR (p < 0.006) was observed. Patients with endotoxinemia showed significant increase in TNF-α and IL8 levels. TNF-α correlated with steatosis (p <  0.001) and HOMA-IR (p < 0.03), whereas IL8 correlated with steatosis (p =  <0.001), TNF-α (p < 0.04) and atherosclerosis (p < 0.01). The highest levels of endotoxinemia were associated with oxidative stress and a higher prevalence of carotid atherosclerosis. Multivariate logistic regression analysis showed that the independent factors associated with endotoxinemia were hepatic steatosis, HOMA-IR, IL8 and MDA-HAS.

Conclusions

Endotoxinemia occurs with high frequency in CHC patients and contributes to the development of hepatic steatosis, IR and atherosclerosis through increased pro-inflammatory cytokines and oxidative stress. Anti-endotoxin treatment could be of clinical relevance.

Keywords

Endotoxin Chronic hepatitis C Steatosis Insulin resistance 

Notes

Compliance with ethical standards

Conflict of interest

There are none to declare.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rosa Zampino
    • 1
  • Aldo Marrone
    • 1
  • Luca Rinaldi
    • 1
  • Barbara Guerrera
    • 1
  • Riccardo Nevola
    • 1
  • Adriana Boemio
    • 1
  • Natalina Iuliano
    • 1
  • Mauro Giordano
    • 1
  • Nicola Passariello
    • 1
  • Ferdinando C. Sasso
    • 1
  • Emanuele Albano
    • 2
  • Luigi E. Adinolfi
    • 1
    Email author
  1. 1.Department of Medical, Surgical, Neurological, Metabolic, and Aging SciencesUniversity of Campania “L. Vanvitelli”NaplesItaly
  2. 2.Department of Health Sciences and Interdisciplinary Research Center for Autoimmune DiseasesUniversity Amedeo Avogadro of East PiedmontNovaraItaly

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