Effect of granulocyte-macrophage colony-stimulating factor on leukocyte function in cirrhosis

Effects of antibiotics on expression and function of Toll-like receptors 2 and 4 on mononuclear cells in patients with advanced cirrhosis

“…These include changes in intestinal permeability, altered gut motility, gastrointestinal bleeding, bacterial overgrowth and changes in hepatic clearance, all of which may favour bacterial translocation and the development of endotoxemia [2,[36][37][38][39]. Other changes include dysfunction of the reticuloendothelial system, 90% of which is located within the liver [40,41], a reduction in the phagocytic capacity of monocytes and impaired function of macrophage Fc receptors [42,43], acquired deficiency of complement C3 due to reduced hepatic synthesis [44], deficient neutrophil recruitment and impaired phagocytic activity [45], reduced opsonic activity of ascitic fluid [46], decreased natural killer cell activity [47] and a marked reduction in leukocyte chemotaxis [48]. Finally, the cirrhotic patient is often subjected to invasive procedures that increase risk of nosocomial infection.…”

The intestinal flora and bacterial infection in cirrhosis

“…Roles for N-acetylcysteine [123] and terlipressin [122], in combination with albumin infusion, have been proposed for patients with hepatorenal syndrome associated with SBP. Granulocyte-macrophage colony stimulating factor has been shown in vitro to reverse defects in neutrophil phagocytosis and chemotaxis in cirrhotic patients [124] and may have a role in the management of SBP in selected patients, such as those with severe infection and an incomplete initial response to antibiotics, although this remains to be properly assessed. Survivors of an episode of SBP should be evaluated for OLT in view of the high risk of recurrence and poor overall prognosis.…”

Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates

“…1,2 Proposed mechanisms for increased risk of infection are changes in humoral immunity with a decreased synthesis in the complement system, 3 a decrease in the phagocytosis capability of the hepatic reticuloendothelial system, 4 an alteration in the function of neutrophils, 5,6 and a reduction in opsonic activity of ascitic fluid. 7 In addition, rupture of natural barriers induced by invasive diagnostic or therapeutic procedures may be involved in the pathogenesis of infections.…”