Smooth muscle antibodies and cryoglobulinemia are associated with advanced liver fibrosis in Brazilian hepatitis C virus carriers

Andrade, Luís Jesuíno de Oliveira; Melo, Paulo Roberto Santana de; Atta, Ajax Mercês; Atta, Maria Luiza Brito de Sousa; Jesus, Larissa Santana de; Sousa, Gabriel Menezes de; Silva, Carolina Alves Costa; Paraná, Raymundo

doi:10.1590/s1413-86702011000100012

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…The idea that mixed cryoglobulinemia is a valuable prognostic indicator of the increased risk of progression of CHC in liver cirrhosis is confirmed by the presence of a higher degree of liver fibrosis on the METAVIR scale in patients with CHC with mixed cryoglobulinemia, in contrast to patients without this manifestation, for the same average indexes of histological activity of the process [9]. In the development of cryoglobulinema syndrome at the stage of liver cirrhosis the disruption of the function of removal of immune complexes, in particular, mixed cryoglobulins, by the reticuloendothelial system plays a role [10]. In modern literature, the discussion of the features of pathogenetic mechanisms of liver damage in patients with CHC with mixed cryoglobulinemia is continued.…”

Section: Research Results and Their Discussionmentioning

confidence: 87%

The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C

2018

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The purpose of the work was to analyze the connections of morphological changes in the liver with the manifestation of clinical signs of extrahepatic manifestations in patients with CHC. Material and methods. The study included 86 patients with CHC. The correlation analysis of expressiveness degree of liver fibrosis and histological activity depending on the presence of clinical signs of extrahepatic manifestations of disease and changes of autoimmune parameters was carried out. Results. It was found that the incidence of mixed cryoglobulins in the blood of patients with CHC had a dependence on the degree of fibrosis of the liver. In the presence of liver fibrosis F 3-4 mixed cryoglobulins were found in 94.2 % versus 64.7 % of patients with stages of liver fibrosis F 12 (P < 0.01). In patients with stages of liver fibrosis F 3-4, the quantitative content of mixed cryoglobulins, RF-IgM and CIC was higher than those of patients with stages of liver fibrosis F 1-2. In patients with fibrosis in the liver F 3-4 cryoglobulinema incidence of vasculitis with formation of Meltzer's triad was higher than in patients with liver fibrosis F 1-2 (19.2 % versus 2.9 %, P < 0.05). Content of mixed cryoglobulins correlated with the degree of fibrosis of the liver (r= +0.49, P < 0.01). A factor A3 was more often detected in patients with stage F 3-4, compared with patients with stage F 1-2 of fibrosis (81.5 % versus 19,2 %, P < 0.01). Conclusions. CHC patients with liver fibrosis F 3-4 are characterized with more frequent appearance of mixed cryoglobulins, higher content of RF-IgM and CIC in serum than in patients with liver fibrosis F 1-2. This explains the higher frequency of clinical manifestations of extrahepatic manifestations of immunocomplex genesis in patients with F 3-4 fibrosis. Histological activity of A3 in patients with CHC is most often combined with fibrosis of the liver F 3-4, which causes a high frequency of cryoglobulinemic vasculitis development in these patients.

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Section: Research Results and Their Discussionmentioning

confidence: 87%

The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C

2018

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“…We had previously demonstrated that advanced stage of fibrosis in Brazilian patients is associated with cryoglobulinemia. 21 Determination of the serum levels of kappa and lambda FLC, including the FLC ratio, is a valuable immunological tool for detecting the presence of polyclonal activation and monoclonal dyscrasias of B-lymphocytes and plasma cells. 10,12,22 Although chronic HCV infection has been associated with Bmalignancy, only two studies, both performed with French patients, investigated these biomarkers in cases of chronic hepatitis C. They demonstrated an increase of kappa FLC serum levels in patients with mixed cryoglobulinemia, observing an abnormal FLC ratio in patients with MC vasculitis and B-NHL, with a significant correlation between elevated FLC ratios and cryoglobulin level and severe HCV-related B-NHL.…”

Section: Discussionmentioning

confidence: 99%

Serum levels of immunoglobulin free light chains in patients with chronic hepatitis C presenting cryoglobulinemia

Oliveira

Cabral

Jesus

et al. 2014

The Brazilian Journal of Infectious Diseases

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Hepatitis C virus (HCV) infects B-lymphocytes, provokes cellular dysfunction and causes lymphoproliferative diseases such as cryoglobulinemia and non-Hodgkin's B-cell lymphoma. In the present study, we investigated the serum levels of kappa and lambda free light chains (FLC) of immunoglobulins and the kappa/lambda FLC ratio in Brazilian patients with chronic HCV infection and cryoglobulinemia. We also analyzed the immunochemical composition of the cryoglobulins in these patients. Twenty-eight cryoglobulinemic HCV patients composed the target group, while 37 HCV patients without cryoglobulinemia were included as controls. The median levels of kappa and lambda FLC were higher in patients with cryoglobulinemia compared to controls (p=0.001 and p=0.003, respectively), but the kappa/lambda FLC ratio was similar in patients with and without cryoglobulinemia (p>0.05). The median FLC ratio was higher in HCV patients presenting with advanced fibrosis of the liver compared to HCV patients without fibrosis (p=0.004). Kappa and lambda FLC levels were strongly correlated with the IgA, IgG and IgM levels in the patients with cryoglobulinemia. In patients without cryoglobulinemia, the kappa FLC level was only correlated with the IgG level, whereas the lambda FLC were weakly correlated with the IgA, IgG and IgM levels. An immunochemical pattern of mixed cryoglobulins (MC), predominantly IgM, IgG, IgA and kappa light chain, was verified in these immune complexes. We concluded that HCV-infected patients presenting cryoglobulinemia have vigorous polyclonal B-lymphocyte activation due to chronic HCV infection and persistent immune stimulation.

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HCV and Autoimmunity in Rheumatic Diseases

Altomare

Corrado

Maruotti

et al. 2022

CRR

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: HCV is a global health problem affecting mainly the liver and often characterized by extrahepatic manifestions mediated by autoimmune reactions. Among these, arthritis and arthralgia are most frequent, as well as the presence of cryoglobulinemia that may induce vasculitis, and sicca syndrome. Thus, HCV appears to be a trigger for autoimmune response as demonstrated by the finding of autoantibody in a high percentage of serum of these patients. Therefore, it is important that clinicians recognize these autoimmune manifestations as symptoms due to an autoimmune activity triggered by HCV, in order to give the correct diagnosis and start an effective therapy strategy. Therefore, clinical examination, searching of markers of infection as well as autoantibody patterns should be performed to make a correct differential diagnosis. The treatment should be based on antiviral drugs associated to immunosuppressive drugs according to autoimmune manifestations.

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Smooth muscle antibodies and cryoglobulinemia are associated with advanced liver fibrosis in Brazilian hepatitis C virus carriers

Cited by 4 publications

References 13 publications

The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C

The interaction of morphological changes in the liver with the development of extrahepatic manifestations in patients with chronic hepatitis C

Serum levels of immunoglobulin free light chains in patients with chronic hepatitis C presenting cryoglobulinemia

HCV and Autoimmunity in Rheumatic Diseases

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