Critical Role of the Liver in the Induction of Systemic Inflammation in Rats With Preascitic Cirrhosis

Systemic activation of the inflammatory immune system contributes to the progression of cirrhosis with ascites Immune cells become activated after interacting at the mesenteric lymph nodes (MLNs) with bacteria translocated from the gut, and thereafter reach the bloodstream through recirculation It is unknown whether systemic activation of the immune system is present in pre-ascitic cirrhosis, in which gut bacterial translocation has not been described The purpose of this study was to determine whether systemic activation of the immune system initiates in rats with compensated carbon tetrachloride (CCI4)-induced cirrhosis, and if so to establish the activation site of immune cells We studied the activation status of immune cells in peripheral blood, MLNs, and hepatic lymph nodes (HLNs) Systemic inflammation was present in rats with cirrhosis, as shown by expansion (P < 0 01) of circulating total and inflammatory monocytes and recently activated CD134(+) T helper (T-h) cells The same populations of cells were increased (P < 0 01) in MLNs and HLNs Bacterial translocation was absent in rats with cirrhosis or control rats, but bacterial DNA fragments were present In the MLNs of 54% of rats with cirrhosis The liver was the source of activated immune cells present in the blood, as shown by the direct correlation between activated Th cells in the blood and HLNs, but not in MLNs, and the normalization by gut decontamination with antibiotics of activated cells m MLNs, but not in the blood or HLNs Conclusion. In experimental cirrhosis, systemic activation of the immune system occurs before ascites development and is driven by recirculation of cells activated in HLNs In addition, in compensated cirrhosis, bacterial DNA fragments reach the MLNs, where they elicit a local inflammatory response (HEPATOLOGY 2010,52 2086-2095)