Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1394
Peer-review started: February 28, 2021
First decision: May 2, 2021
Revised: May 12, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 27, 2021
Processing time: 235 Days and 17 Hours
Gut permeability is distorted in patients with liver cirrhosis and the observed deregulation of the intestinal integrity plays a crucial role in the development of bacterial translocation. Bacterial translocation contributes to the occurrence or aggravation of serious complications in patients with liver cirrhosis. Zonulin is a recently recognized protein, synthesized by the intestinal and liver cells, and thought to play an important role in the regulation of tight junctions between intestinal cells.
Increased zonulin levels have been observed in such diseases as celiac disease and inflammatory bowel disease and have shown correlation to the impairment of intestinal permeability. The exact mechanism that leads to the deregulation of the intestinal integrity in liver cirrhosis is not thoroughly investigated. Zonulin may have a role in the observed alterations of the gut barrier in advanced chronic liver disease.
We aimed to investigate if serum zonulin levels are altered in patients with different stages of liver cirrhosis and investigate their possible impact on patients’ prognosis.
We included 116 cirrhotic patients who attended our outpatient clinic during a 12-mo period. Serum zonulin levels were measured, as were epidemiological, laboratory and clinical data, and data from elastography and ultrasonography at baseline. Sixty-three patients were followed up for at least 1year and data from clinical events (death, liver transplantation and liver disease decompensation) were collected.
Our study included mainly Child-Turcotte-Pugh (CTP)-A (67%) and CTP-B patients (28%). We observed that serum zonulin levels are increased in patients with more advanced liver disease, such as patients with CTP–B stage, patients with ascites, or those with history of hepatic encephalopathy. What is more, serum zonulin levels were independently associated with the probability of decompensation within the next year.
According to our study results, serum zonulin levels are increased in patients with advanced chronic liver disease. What is more, a new agent, zonulin, is found to be implicated in the progress towards advanced liver disease.
Our findings highlight once more the significance of gut barrier deregulation in the setting of liver cirrhosis and emphasize the need of further studies in the field, aiming to reveal the complex pathophysiological interplay which leads to bacterial translocation. Especially, the role of zonulin should be further investigated, due to its possible therapeutic implications, as a zonulin antagonist alreadyexists and is being tested in studies of celiac disease.