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Vatsalya V, Verster JC, Sagaram M, Royer AJ, Hu H, Parthasarathy R, Schwandt ML, Kong M, Ramchandani VA, Feng W, Agrawal R, Zhang X, McClain CJ. Novel paradigms for the gut-brain axis during alcohol withdrawal, withdrawal-associated depression, and craving in patients with alcohol use disorder. Front Psychiatry 2023; 14:1203362. [PMID: 37840804 PMCID: PMC10570744 DOI: 10.3389/fpsyt.2023.1203362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Patients with alcohol use disorder (AUD) exhibit symptoms such as alcohol withdrawal, depression, and cravings. The gut-immune response may play a significant role in manifesting these specific symptoms associated with AUD. This study examined the role of gut dysfunction, proinflammatory cytokines, and hormones in characterizing AUD symptoms. Methods Forty-eight AUD patients [men (n = 34) and women (n = 14)] aged 23-63 years were grouped using the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA) as clinically significant (CS-CIWA [score > 10] [n = 22]) and a clinically not-significant group (NCS-CIWA [score ≤ 10] [n = 26]). Clinical data (CIWA, 90-day timeline followback [TLFB90], and lifetime drinking history [LTDH]) and blood samples (for testing proinflammatory cytokines, hormones, and markers of intestinal permeability) were analyzed. A subset of 16 AUD patients was assessed upon admission for their craving tendencies related to drug-seeking behavior using the Penn-Alcohol Craving Score (PACS). Results CS-CIWA group patients exhibited unique and significantly higher levels of adiponectin and interleukin (IL)-6 compared to NCS-CIWA. In the CS group, there were significant and high effects of association for the withdrawal score with gut-immune markers (lipopolysaccharide [LPS], adiponectin, IL-6, and IL-8) and for withdrawal-associated depression with gut-immune markers (scored using MADRS with LPS, soluble cells of differentiation type 14 [sCD14], IL-6, and IL-8). Craving (assessed by PACS, the Penn-Alcohol Craving Scale) was significantly characterized by what could be described as gut dysregulation (LBP [lipopolysaccharide binding protein] and leptin) and candidate proinflammatory (IL-1β and TNF-α) markers. Such a pathway model describes the heavy drinking phenotype, HDD90 (heavy drinking days past 90 days), with even higher effects (R2 = 0.955, p = 0.006) in the AUD patients, who had higher ratings for cravings (PACS > 5). Discussion The interaction of gut dysfunction cytokines involved in both inflammation and mediating activity constitutes a novel pathophysiological gut-brain axis for withdrawal symptoms and withdrawal-associated depression and craving symptoms in AUD. AUD patients with reported cravings show a significant characterization of the gut-brain axis response to heavy drinking. Trial registration ClinicalTrials.gov, identifier: NCT# 00106106.
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Affiliation(s)
- Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Robley Rex VA Medical Center, Louisville, KY, United States
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Joris C. Verster
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Manasa Sagaram
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Amor J. Royer
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Huirong Hu
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
| | - Ranganathan Parthasarathy
- Clincial Laboratory for the Intervention Development of AUD and Organ Severity, Louisville, KY, United States
| | - Melanie L. Schwandt
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
| | | | - Wenke Feng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
| | | | - Xiang Zhang
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
- Department of Chemistry, University of Louisville, Louisville, KY, United States
- Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY, United States
| | - Craig J. McClain
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY, United States
- Robley Rex VA Medical Center, Louisville, KY, United States
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States
- Alcohol Research Center, University of Louisville, Louisville, KY, United States
- Hepatobiology & Toxicology Center, University of Louisville, Louisville, KY, United States
- Center for Regulatory and Environmental Analytical Metabolomics, University of Louisville, Louisville, KY, United States
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Stangl BL, Vogt EL, Blau LE, Ester CD, Gogineni A, Diazgranados N, Vatsalya V, Ramchandani VA. Pharmacodynamic determinants of hangover: An intravenous alcohol self-administration study in non-dependent drinkers. Addict Behav 2022; 135:107428. [PMID: 35995014 PMCID: PMC9482023 DOI: 10.1016/j.addbeh.2022.107428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/13/2021] [Accepted: 07/11/2022] [Indexed: 11/01/2022]
Abstract
Alcohol hangover refers to the combination of negative mental and physical symptoms that can be experienced after an episode of alcohol consumption, typically emerging as blood alcohol concentration (BAC) approaches zero. Hangover has been associated with heavy drinking and may be relevant in the transition to alcohol use disorder (AUD). Our aim was to examine hangover prevalence and associated symptoms following intravenous alcohol self-administration (IV-ASA), and to identify possible predictors of hangover in non-dependent drinkers. Ninety-five drinkers without AUD completed an IV-ASA session. Pharmacodynamic measures of alcohol consumption included peak and average breath alcohol concentrations. Subjective measures of alcohol response included the Drug Effects Questionnaire and Biphasic Effects of Alcohol Scale. The Alcohol Hangover Scale assessed hangover symptoms from the end of the session until the following morning. 78% of participants endorsed at least one hangover symptom following IV-ASA. There was no association between hangover scores and IV-ASA measures of alcohol consumption. Additional mediation and moderation analysis revealed that self-reported intoxication was a significant mediator of the relationship between recent drinking and hangover symptoms. Hangover symptoms may be an early marker of the relationship between subjective response to alcohol and heavy drinking for those with no prior history of AUD. In particular, the effects of hangover go beyond exposure to alcohol and the individual's subjective response to this exposure is associated with their experience of hangover. Future studies should further characterize the determinants of hangover across different populations of drinkers to better understand the risk for AUD and inform prevention methods.
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Affiliation(s)
- Bethany L Stangl
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Emily L Vogt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Lauren E Blau
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Corbin D Ester
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | | | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Vatsalya Vatsalya
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA; Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA.
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Sagaram M, Parthasarathy R, Condon SL, Closson CF, Kong M, Schwandt ML, Jophlin LL, Feng W, Barve AJ, Vatsalya V. Theragnostic Efficacy of K18 Response in Alcohol Use Disorder with Clinically Significant Fibrosis Using Gut-Liver Axis. Int J Mol Sci 2022; 23:5852. [PMID: 35628661 PMCID: PMC9143806 DOI: 10.3390/ijms23105852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Fibrosis in early-stage alcohol-associated liver disease (ALD) is commonly under-diagnosed in routine clinical practice. This study characterized the liver-injury and cell death response in alcohol use disorder (AUD) patients with ALD who also exhibited fibrosis and assessed the efficacy of standard of care (SOC) treatment in the improvement in liver injury. (2) Methods: Forty-eight heavy-drinking AUD patients aged 21−65 yrs. without clinical manifestations of liver injury were grouped by Fibrosis-4 (FIB-4) score, as negative (Gr.1 < 1.45, n = 21) or positive (Gr.2 ≥ 1.45, n = 27). Patients received 2-weeks (2 w) inpatient SOC. Data on demographics, drinking patterns, liver-injury, immune markers, and liver cell death (K18s) markers were analyzed at baseline (BL) and after 2 w SOC. (3) Results: Lifetime drinking (LTDH, yrs.) and acute heavy drinking (Heavy Drinking Days Past 90 Days [HDD90]) markers were significantly higher in Gr.2 vs. Gr.1. BL ALT, AST, AST:ALT and K18M65 were considerably higher in Gr.2. Dysregulated gut dysfunction and elevated immune activity were evident in Gr.2 characterized by TNF-α, IL-8 and LPS levels. After SOC, Gr.2 showed improvement in AST, ALT, AST/ALT ratio; and in the K18M65, K18M30 and K18M65/M30 ratio vs. Gr.1. The true positivity of BL IL-8 response to predict the improvement in K18M65 to normal levels among Gr.2 patients against those who did not have improvement after 2 w SOC was very high (AUROC = 0.830, p = 0.042). (4) Conclusions: Gut dysfunction, elevated cytokine response and necrotic liver cell death were elevated in AUD patients with early-stage ALD. K18 showed promise as a predictive theragnostic factor to differentiate among the AUD patients with early-stage ALD and baseline fibrosis who had improvement in liver injury against those who did not, by the levels of baseline IL-8.
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Affiliation(s)
- Manasa Sagaram
- Internal Medicine Residency Program, University of Louisville, Louisville, KY 40202, USA;
| | - Ranganathan Parthasarathy
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
| | - Sally L. Condon
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
| | - Charles F. Closson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY 40202, USA;
- Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
| | - Melanie L. Schwandt
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA;
| | - Loretta L. Jophlin
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
| | - Wenke Feng
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
| | - Ashutosh J. Barve
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
- Robley Rex VA Medical Center, Louisville, KY 40206, USA
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, KY 40202, USA; (R.P.); (S.L.C.); (C.F.C.); (L.L.J.); (W.F.); (A.J.B.)
- Alcohol Research Center, University of Louisville, Louisville, KY 40202, USA
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA;
- Robley Rex VA Medical Center, Louisville, KY 40206, USA
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Faulkner CS, White CM, Manatsathit W, Lamb B, Vatsalya V, McClain CJ, Jophlin LL. Positive blood phosphatidylethanol concentration is associated with unfavorable waitlist-related outcomes for patients medically appropriate for liver transplantation. Alcohol Res 2022; 46:581-588. [PMID: 35102553 PMCID: PMC9150771 DOI: 10.1111/acer.14786] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Excessive alcohol use is a leading etiology of liver disease and indication for liver transplantation. Accurate measurement of alcohol use remains a challenge in the management of patients in the pre-, peri-, and post-liver transplant settings. Blood 16:0-18:1 phosphatidylethanol (PEth) concentration is a sensitive and specific biomarker of binge and moderate, chronic alcohol use. As PEth has the longest detection window of available blood-based direct alcohol biomarkers for moderate to heavy drinking, it shows promise as an indicator of patterns and chronicity of drinking. However, the utility of PEth in clinical liver transplantation is understudied. This study examines the association of PEth results with liver transplantation waitlist-focused patient outcomes. METHODS Retrospective data for all patients tested for PEth for a one-year period at a tertiary care medical center with an active liver transplantation program were abstracted. Indications for PEth testing, liver transplantation waitlist-related outcomes (e.g., listing and delisting) following testing and associations of PEth results with other parameters were analyzed. RESULTS Over a one-year period, 153 PEth tests were performed on 109 individuals. The most frequent indications for PEth testing were as an objective indicator of alcohol use patterns (86.3%) and to assess alcohol as a putative etiology of liver injury (13.7%). Of the 109 patients, 56 were medically appropriate for liver transplantation. Medically acceptable candidates with unfavorable transplantation waitlist-related outcomes (delisting, deferment of transplant evaluation, deferment of listing until completion of recommended alcohol rehabilitation, and being deemed not a transplant candidate) were at least 3.41 times more likely to have a positive PEth test than those with favorable transplantation waitlist-related outcomes (odds ratio 3.41, confidence interval 3.41 to ∞, p = 0.001). CONCLUSION This single-center study reporting a comprehensive account of PEth utilization at a liver transplant center demonstrates that liver transplantation waitlist-related outcomes are associated with PEth test results. Patients with positive PEth tests were more likely to have unfavorable transplant waitlist-related outcomes. PEth testing has not been validated as a predictor of relapse to drinking in post-transplant patients and because its utility in the pre-transplant setting is unclear its use could lead to disparities in the selection of patients for liver transplantation.
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Affiliation(s)
- Claire S Faulkner
- Department of Medicine, University of Arizona, College of Medicine, Phoenix, Arizona, USA.,Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Collin M White
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Wuttiporn Manatsathit
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bernadette Lamb
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Robley Rex VA Medical Center, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA
| | - Craig J McClain
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Robley Rex VA Medical Center, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA.,Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky, USA
| | - Loretta L Jophlin
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA
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The Alcohol Hangover Research Group: Ten Years of Progress in Research on the Causes, Consequences, and Treatment of the Alcohol Hangover. J Clin Med 2020; 9:jcm9113670. [PMID: 33207574 PMCID: PMC7696633 DOI: 10.3390/jcm9113670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022] Open
Abstract
The alcohol hangover is defined as the combination of negative mental and physical symptoms, which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero. Here, we present the book "The alcohol hangover: causes, consequences, and treatment", written to celebrate the 10th anniversary of the Alcohol Hangover Research Group (AHRG), summarizing recent advances in the field of alcohol hangover research.
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Vatsalya V, Kong M, Marsano LM, Kurlawala Z, Chandras KV, Schwandt ML, Ramchandani VA, McClain CJ. Interaction of Heavy Drinking Patterns and Depression Severity Predicts Efficacy of Quetiapine Fumarate XR in Lowering Alcohol Intake in Alcohol Use Disorder Patients. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820955185. [PMID: 32963470 PMCID: PMC7488613 DOI: 10.1177/1178221820955185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/06/2020] [Indexed: 11/17/2022]
Abstract
Background: Shared etiological pathways of dopamine and serotonin neurotransmission play
a central role in heavy alcohol intake and exacerbation in the symptoms of
depression. We investigated the treatment efficacy of Quetiapine fumarate extended
release (XR) in lowering alcohol intake in alcohol use disorder (AUD)
patients indicated by the shared alleviation of depression ratings and
patterns of heavy drinking. Methods: Hundred and eight male and female heavy drinking AUD patients in the age
range of 18 to 64 years. participated in a randomized clinical trial (RCT)
to receive 12 weeks of quetiapine XR or placebo (N = 115). Participants were
sub-grouped by the severity grading of depression using Montgomery-Asberg
Depression Rating Scale (MADRS) (clinically relevant ⩾8 [CR], clinically
non-relevant ⩽7 [CNR]) at baseline in both the groups. Drinking history and
depression ratings were assessed at the patients’ visits. Results: Heavy drinking days (HDD) and total drinks (TD) were significantly fewer in
CR patients at the treatment end. A true positive response in AUROC analysis
supported the lowering of TD in CR patients. The number of drinking days
(NDD) and average drinks per drinking day (AvgD) were lower in the CNR
patients at treatment-end. Significant associations with increasing effect
sizes were observed for all the heavy drinking measures (HDD, TD, NDD, and
AvgD) and MADRS scores by the end of the treatment course. Conclusions: Baseline elevated depressive symptoms could likely predict the course of
heavy alcohol drinking during the treatment, and efficacy outcome of a
treatment. AUD patients with baseline clinically significant depression had
a progressive lowering in heavy drinking markers significantly corresponding
to the lowering of depression symptoms by the end of treatment with
Quetiapine fumarate XR. ClinicalTrials.gov: NCT#0049862 (https://clinicaltrials.gov/ct2/show/NCT00498628?term=litten&draw=2&rank=3)
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Affiliation(s)
- Vatsalya Vatsalya
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA.,National Institute on Alcohol Abuse and Alcoholism NIH, Bethesda, MD, USA
| | - Maiying Kong
- Department of Biostatistics and Bioinformatics, University of Louisville, KY, USA
| | - Luis M Marsano
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Zimple Kurlawala
- Department of Pharmacology and Toxicology, University of Louisville, KY, USA
| | | | - Melanie L Schwandt
- National Institute on Alcohol Abuse and Alcoholism NIH, Bethesda, MD, USA
| | | | - Craig J McClain
- Department of Medicine, University of Louisville, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA.,Department of Pharmacology and Toxicology, University of Louisville, KY, USA.,University of Louisville Alcohol Research Center, Louisville, KY, USA.,Hepatobiology & Toxicology Program, University of Louisville, Louisville, KY, USA
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Dysregulation in Plasma ω3 Fatty Acids Concentration and Serum Zinc in Heavy Alcohol-Drinking HCV Patients. Adv Virol 2020; 2020:7835875. [PMID: 32565809 PMCID: PMC7301182 DOI: 10.1155/2020/7835875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 12/20/2022] Open
Abstract
Alcohol use disorder (AUD) patients comorbid with hepatitis C virus (HCV) infection (HCV + AUD) could have progressively severe clinical sequels of liver injury and inflammation. Serum zinc and several polyunsaturated fatty acids (PUFAs) get dysregulated in AUD as well as HCV. However, the extent of dysregulation of PUFAs and zinc deficiency and their interaction in HCV + AUD as a comorbid pathology has not been studied. We examined the role of dysregulation of FAs and low zinc in HCV + AUD patients. 138 male and female participants aged 21-67 years were grouped as HCV-only (Gr. 1; n = 13), HCV + AUD (Gr. 2; n = 25), AUD without liver injury (Gr. 3; n = 37), AUD with liver injury (Gr. 4; n = 51), and healthy volunteers (Gr. 5 or HV; n = 12). Drinking history, individual demographic measures, fasting fatty acids, liver function, and zinc were measured and analyzed. HCV + AUD patients showed the highest ALT level compared to the rest of the groups. Serum zinc concentrations were the lowest, and the proinflammatory shift was the highest (characterized by ω6 : ω3 ratio) in the HCV + AUD patients. Total ω3, eicosapentaenoic acid (EPA), and docosapentaenoic acid (DPA5,3) were the lowest in HCV + AUD patients. Total ω3, α-linoleic acid (α-LA) along with covariable number of drinking days past 90 days (NDD90), eicosapentaenoic acid (EPA), and docosapentaenoic acid (DPA5,3) independently showed significant association with low zinc in the HCV + AUD patients. Heavy drinking pattern showed that NDD90 has a significant mediating role in the representation of the relationship between candidate ω3 PUFAs and zinc uniquely in the HCV + AUD patients. Low serum zinc showed a distinctively stronger association with total and candidate ω3s in the HCV + AUD patients compared to the patients with HCV or AUD alone, supporting dual mechanism involved in the exacerbation of the proinflammatory response in this comorbid cohort. This trial is registered with NCT#00001673.
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