Splanchnic sympathectomy prevents translocation and spreading of E coli but not S aureus in liver cirrhosis

Abstract

In cirrhosis with bacterial peritonitis, hyperactivity of the splanchnic sympathetic nervous system contributes to the translocation of E coli but not S aureus to MLN and extraintestinal sites. This indicates a key role for sympathetic drive in the impairment in host defence against Gram-negative bacteria in cirrhosis.

Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis

“…Adrenal dysfunction attenuates the vascular effect of angiotensin-II, norepinephrine and vasopressin in decompensated cirrhosis, further activating sympathetic tone [110]. Since sympathetic hyperactivity impairs intestinal motility and immunity, a vicious circle favoring bacterial overgrowth [112], BT, bacterial infections and/or systemic inflammatory response [113] can ensue. Finally, RAI may also be involved in the development of an excessive compensatory anti-inflammatory response following severe sepsis.…”

Chlorisondamine, a sympathetic ganglionic blocker, moderates the effects of whole-body irradiation (WBI) on early host defense to a live bacterial challenge

“…Detrimental effects of the SNS appear to result from the sympathetic inhibition of innate immunity against Gram-negative bacteria reducing the host's ability to eliminate the pathogen, including peritoneal cytokine secretion [27], adhesion and influx of neutrophils and monocytes [22,24,[28][29][30], and phagocytosis of bacteria [24,31,32]. Additionally, the sympathetic hyperactivity in the splanchnic circulation directly influences bacterial growth, and promotes translocation from the gut and spreading of Escherichia coli [22,24,25,33].…”

“…Additionally, the sympathetic hyperactivity in the splanchnic circulation directly influences bacterial growth, and promotes translocation from the gut and spreading of Escherichia coli [22,24,25,33].…”

“…The SNS is one of two major stress pathways activated in response to tissue injury or infection [19][20][21][22], and can increase mortality from Gram-negative bacterial infections [23]. Sympathetic activity rises during bacteremia in man [19], and after inoculation of rodents with bacteria [20,21].…”

Changes of Intestinal Functions in Liver Cirrhosis

“…Intestinal autonomic dysfunction plus parasympathetic hypofunction and sympathetic hyperactivity are observed in advanced stages of cirrhosis [20,119,120]. Splanchnic sympathectomy has been shown to prevent endogenous BT [121]. Besides the improved bacterial phagocytosis observed after sympathectomy, additional proposed beneficial effects are an accelerated intestinal transit time, prevention of Gram-negative bacterial overgrowth and improvement in gastrointestinal permeability.…”