Significance of circulating intercellular adhesion molecules [sICAM-1] and thrombopoietin [TPO] in hepatitis C vinis related liver cirrhosis

ABSTRACT

Chronic hepatitis C is a major health problem that causes mortality in the worldwide distribution. The systemic levels of many soluble adhesion molecules and cytokines are altered in autoimmune diseases and liver infection. Among mediators that show altered serum levels are sICAM-1 expressed by immunocompetent cells and thrombopoitin [TPO]. The aim of this study was to evaluate the serum sICAM and TPO and their correlations with clinical and laboratory data in patients with hepatitis C-related cirrhosis. 40 patients with HCV-related cirrhosis and 20 healthy subjects were enrolled in this study. They were subjected to the following investigations complete blood picture, liver and kidney functions, prothrombin time[PT], abdominal sonography and estimation of serum TPO and sICAM-1. Compared to controls, the patients group showed significant increase in spleen size [P<0.025], portal vein diameter [P<0.0025], ALT, AST, bilirubin, sICAM-1 [P<0.0005], and PT [P<0.05]. However there was significant decrease in serum albumin levels [P<0.01], platelets count [P<0.0005], RBCs count, haemoglobin concentrations [P<0.025] and serum TPO levels [P<0.0025]. The serum creatinine levels and WBCS count showed insignificant changes with control. The serum TPO levels were negatively correlated to ALT [r=-0.97, P<0.0001], PT [r=-0.96, P<0.0001], spleen size [r=-0.95, P<0.0001], and portal vein diameter [r=-0.96, P<0.0001] and positively correlated to platelets [r=0.84, P<0.0005]. While serum sICAM-l were positively correlated to ALT [r=0.99, P<0.0001], PT [r=0.94, P<0.0005], spleen size [r=0.95, P<0.0001], and portal vein diameter [r=0.85, P<0.005] and negatively correlated to platelets count [r=-0.7l, P<0.005]. Our results suggested that impaired synthesis of TPO by cirrhotic liver may contribute to the development of thrombocytopenia and related to liver cirrhosis together with increased splenic sequestration of platelets by the enlarged spleen. So recombinant human TPO should be evaluated in the treatment of thrombocytopenia in HCV-related cirrhosis. In addition, sICAM-1 elevation in plasma of patients suffering from HCV-related cirrhosis was related to the degree of cirrhosis and portal hypertension. So, sICAM-1 may be used as a marker of the disease activity and may provide diagnostic and prognostic information. However this needs to be further studied to detect the cut off level of sICAM-1 in Egyptian HCV-related liver cirrhosis