Distinct structural and dynamic components of portal hypertension in different animal models and human liver disease etiologies.
Hepatology
; 75(3): 610-622, 2022 03.
Article
em En
| MEDLINE
| ID: mdl-34716927
ABSTRACT
BACKGROUND AND AIMS:
Liver fibrosis is the static and main (70%-80%) component of portal hypertension (PH). We investigated dynamic components of PH by a three-dimensional analysis based on correlation of hepatic collagen proportionate area (CPA) with portal pressure (PP) in animals or HVPG in patients. APPROACH ANDRESULTS:
Different animal models (bile duct ligation n = 31, carbon tetrachloride n = 12, thioacetamide n = 12, choline-deficient high-fat diet n = 12) and patients with a confirmed single etiology of cholestatic (primary biliary cholangitis/primary sclerosing cholangitis n = 16), alcohol-associated (n = 22), and metabolic (NASH n = 19) liver disease underwent CPA quantification on liver specimens/biopsies. Based on CPA-to-PP/HVPG correlation, potential dynamic components were identified in subgroups of animals/patients with lower-than-expected and higher-than-expected PP/HVPG. Dynamic PH components were validated in a patient cohort (n = 245) using liver stiffness measurement (LSM) instead of CPA. CPA significantly correlated with PP in animal models (Rho = 0.531; p < 0.001) and HVPG in patients (Rho = 0.439; p < 0.001). Correlation of CPA with PP/HVPG varied across different animal models and etiologies in patients. In models, severity of hyperdynamic circulation and specific fibrosis pattern (portal fibrosis p = 0.02; septa width p = 0.03) were associated with PH severity. In patients, hyperdynamic circulation (p = 0.04), vascular dysfunction/angiogenesis (VWF-Ag p = 0.03; soluble vascular endothelial growth factor receptor 1 p = 0.03), and bile acids (p = 0.04) were dynamic modulators of PH. The LSM-HVPG validation cohort confirmed these and also indicated IL-6 (p = 0.008) and hyaluronic acid (HA p < 0.001) as dynamic PH components.CONCLUSIONS:
The relative contribution of "static" fibrosis on PH severity varies by type of liver injury. Next to hyperdynamic circulation, increased bile acids, VWF-Ag, IL-6, and HA seem to indicate a pronounced dynamic component of PH in patients.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Colágeno
/
Pressão na Veia Porta
/
Hipertensão Portal
/
Fígado
/
Cirrose Hepática
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limite:
Animals
/
Humans
Idioma:
En
Revista:
Hepatology
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Áustria