FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 331:1122-1128 October 27, 1994 Number 17 Next

Impaired Function of Macrophage Fc Receptors and Bacterial Infection in Alcoholic Cirrhosis

	Full Text Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Bacterial infection is a frequent and often fatal complication in patients with cirrhosis. Macrophages play an important part in the host defense against infection because their Fc receptors recognize antibody-coated bacteria.

Methods We prospectively studied macrophage Fc-receptor function in vivo and in vitro in 49 patients with alcoholic cirrhosis, 10 alcoholics without cirrhosis, and 20 normal volunteers.

Results The clearance of IgG-sensitized autologous red cells was decreased in 37 of the 49 patients with cirrhosis but in none of the subjects without cirrhosis. In the 49 patients clearance was inhibited by a mean (±SE) of 47 ±3 percent at 1 hour and 53 ±3 percent at 1 1/2 hours, as compared with the clearance in the normal controls (P<0.001). The impairment of macrophage Fc-receptor-dependent clearance correlated with the degree of liver insufficiency but not with age, sex, nutritional status, HLA haplotype, or the presence of circulating immune complexes. The clearance of unsensitized and heat-altered autologous erythrocytes was normal. In vitro recognition of IgG-sensitized red cells by monocytes from the patients was not significantly decreased. During a two-year follow-up period, 11 patients had severe bacterial infections, and in 4 they were fatal. The mean clearance of IgG-sensitized red cells in these 11 patients (half-time, 126.2 ±22 hours) was significantly impaired, as compared with that in the 38 patients without severe infection (half-time, 32.2 ±18 hours, P<0.001).

Conclusions The function of macrophage Fc receptors is impaired in patients with alcoholic cirrhosis, and this impairment probably contributes to the high incidence of bacterial infections among such patients.

Source Information

From the Department of Medicine, Hospital of the University of Cadiz, Puerto Real, Spain (F.G., P.R.), and the University of Pennsylvania School of Medicine, Philadelphia (A.D.S.).

Address reprint requests to Dr. Schreiber at the University of Pennsylvania School of Medicine, 7 Silverstein Bldg., 3400 Spruce St., Philadelphia, PA 19104.

Full Text of this Article

This article has been cited by other articles:

• Ashrafian, H. (2003). Hepcidin: the Missing Link between Hemochromatosis and Infections. Infect. Immun. 71: 6693-6700 [Full Text]  
• Canetti, C., Hu, B., Curtis, J. L., Peters-Golden, M. (2003). Syk activation is a leukotriene B4-regulated event involved in macrophage phagocytosis of IgG-coated targets but not apoptotic cells. Blood 102: 1877-1883 [Abstract] [Full Text]  
• Gomez, F., Ruiz, P., Lopez, R., Rivera, C. (2002). Treatment with Megestrol Acetate Improves Human Immunodeficiency Virus-Associated Immune Thrombocytopenia. CVI 9: 583-587 [Abstract] [Full Text]  
• Trevisani, F, Castelli, E, Foschi, F G, Parazza, M, Loggi, E, Bertelli, M, Melotti, C, Domenicali, M, Zoli, G, Bernardi, M (2002). Impaired tuftsin activity in cirrhosis: relationship with splenic function and clinical outcome. Gut 50: 707-712 [Abstract] [Full Text]  
• Fiuza, C., Salcedo, M., Clemente, G., Tellado, J. M. (2002). Granulocyte Colony-Stimulating Factor Improves Deficient In Vitro Neutrophil Transendothelial Migration in Patients with Advanced Liver Disease. CVI 9: 433-439 [Abstract] [Full Text]  
• Gomez, F., Ruiz, P., Bernal, J. A., Escobar, M., Garcia-Egido, A., Lopez-Saez, J. J. B. (2001). Enhancement of Splenic-Macrophage Fc{gamma} Receptor Expression by Treatment with Estrogens. CVI 8: 806-810 [Abstract] [Full Text]  
• Gomez, F., Ruiz, P., Lopez, R., Rivera, C., Romero, S., Bernal, J. A. (2000). Effects of Androgen Treatment on Expression of Macrophage Fcgamma Receptors. CVI 7: 682-686 [Abstract] [Full Text]  
• Bezdicek, P., Worgall, S., Kovesdi, I., Kim, M.-K., Park, J.-G., Vincent, T., Leopold, P. L., Schreiber, A. D., Crystal, R. G. (1999). Enhanced Liver Uptake of Opsonized Red Blood Cells After In Vivo Transfer of Fcgamma RIIA cDNA to the Liver. Blood 94: 3448-3455 [Abstract] [Full Text]  
• Hagiwara, S.-I., Takeya, M., Suzuki, H., Kodama, T., van der Laan, L. J. W., Kraal, G., Kitamura, N., Takahashi, K. (1999). Role of Macrophage Scavenger Receptors in Hepatic Granuloma Formation in Mice. Am. J. Pathol. 154: 705-720 [Abstract] [Full Text]  
• Berlakovich, G. A., Rockenschaub, S., Taucher, S., Kaserer, K., Muhlbacher, F., Steiniger, R. (1998). Underlying Disease as a Predictor for Rejection After Liver Transplantation. Arch Surg 133: 167-172 [Abstract] [Full Text]  
• Schiff, D. E., Rae, J., Martin, T. R., Davis, B. H., Curnutte, J. T. (1997). Increased Phagocyte Fcgamma RI Expression and Improved Fcgamma -Receptor-Mediated Phagocytosis After In Vivo Recombinant Human Interferon-gamma Treatment of Normal Human Subjects. Blood 90: 3187-3194 [Abstract] [Full Text]