Blood Biomarkers of Intestinal Epithelium Damage Regenerating Islet-derived Protein 3�� and Trefoil Factor 3 Are Persistently Elevated in Patients with Alcoholic Hepatitis.
Jing Yang: School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Fahim Syed: Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Ying Xia: School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Arun J Sanyal: Division of Gastroenterology and Hepatology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Vijay H Shah: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Naga Chalasani: Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Xiaoqun Zheng: Department of Clinical Laboratory, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Qigui Yu: Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Yongliang Lou: School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Wei Li: Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA. ORCID
BACKGROUND: Heavy alcohol consumption disrupts gut epithelial integrity, leading to increased permeability of the gastrointestinal tract and subsequent translocation of microbes. Regenerating islet-derived protein 3�� (REG3��) and Trefoil factor 3 (TFF3) are mainly secreted to the gut lumen by Paneth and Goblet cells, respectively, and are functionally linked to gut barrier integrity. Circulating levels of REG3�� and TFF3 have been identified as biomarkers for gut damage in several human diseases. We examined whether plasma levels of REG3�� and TFF3 were dysregulated and correlated with conventional markers of microbial translocation (MT) and pro-inflammatory mediators in heavy drinkers with and without alcoholic hepatitis (AH). METHODS: Cross-sectional and longitudinal studies were performed to monitor plasma levels of REG3�� and TFF3 in 79 AH patients, 66 heavy drinkers without liver disease (HDC), and 46 healthy controls (HC) at enrollment and at 6- and 12-month follow-ups. Spearman correlation was used to measure the relationships of REG3�� and TFF3 levels with MT, disease severity, inflammation, and effects of abstinence from alcohol. RESULTS: At enrollment, AH patients had significantly higher levels of REG3�� and TFF3 than HDC and HC. The elevated REG3�� levels were positively correlated with the 30-day fatality rate. Plasma levels of REG3�� and TFF3 in AH patients differentially correlated with conventional MT markers (sCD14, sCD163, and LBP) and several highly up-regulated inflammatory cytokines/chemokines/growth factors. At follow-ups, although REG3�� and TFF3 levels were decreased in AH patients with alcohol abstinence, they did not fully return to baseline levels. CONCLUSIONS: Circulating levels of REG3�� and TFF3 were highly elevated in AH patients and differentially correlated with AH disease severity, MT, and inflammation, thereby serving as potential biomarkers of MT and gut epithelial damage in AH patients.
