Hepatocyte Growth Factor and Viral Load Variations in HD Session, Comparison with Molecular Absorbent Recirculating System (MARS) Therapy
Abstract:A decrease in hepatitis C viral load in HD patients along HD sessions has been described. It has also been proposed that hepatocyte growth factor (HGF) stimulation by HD could have some protective effect in hepatitis C virus (HCV) liver disease outcome. Aims:
(i) Measurement of HCV viral load variation and quantitation of HGF stimulation in CKD patients (HCV+ and HCV–) on HD, along the HD session. (ii) Study whether albumin HD (MARS) decreases HCV viral load and stimulates HGF, compared to HD sessions. Methods:
We performed two MARS and two HD sessions in vitro by using an extracorporeal circuit with blood bag contaminated with HCV serum with a known HCV viral load. (We used only a single blood bag for each testing.) In vivo we performed three MARS sessions. The total number of treatments was 6 in 2 patients (3 treatments each) and one HD session in 2 HCV+ patients and 5 HCV– patients (included in HD program in our center), taking samples at the start of the following HD session, to compare the results with those obtained in vitro. We took samples at the beginning, middle, and at the end of MARS sessions in vivo and in vitro and starting (15 min) and at the end and before starting the following HD session in vivo. (The interval between 2 HD sessions in HCV+ patients was 2 days.) We determined HCV viral load using Amplicor (Roche) and HGF using ELISA (R&D System). Results:
We found a decrease of viral load in vitro and in vivo both by MARS and HD. HD in vitro: ×decrease HCV viral load, 54.67%. HD in vitro × decrease viral load 30.6% × HD in vivo. We found a decrease of 30% in viral load, remaining 27.9% lower at the start of the following session. MARS in vitro: ×viral load decrease 3% (1 session in 2 experiments). MARS in vivo: ×viral load decrease of 44.5% (6 sessions in 2 patients). We did not find HCV viral load in ultrafiltrate or albumin from MARS procedure. Analyzing HGF stimulation we found the following: Conclusions:
MARS and HD sessions decreased HCV viral load and stimulated HGF both in vitro and in vivo. It is necessary to confirm these results because it could offer protective effect for HCV chronic liver disease outcome. HD seems to be the best option for patients with HCV hepatopathy. On the other hand, patients with liver disease who need to be treated with MARS could obtain not only a good clearance of toxin binding to albumin, but also the positive effects described.
Document Type: Research Article
Affiliations: Department of Nephrology, Hospital Universitario de la Princesa and Fundación para el Estudio de Hepatitis Virales, Madrid, Spain.
Publication date: January 1, 2004