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Lang E, Gatidis S, Freise NF, Bock H, Kubitz R, Lauermann C, Orth HM, Klindt C, Schuier M, Keitel V, Reich M, Liu G, Schmidt S, Xu HC, Qadri SM, Herebian D, Pandyra AA, Mayatepek E, Gulbins E, Lang F, Häussinger D, Lang KS, Föller M, Lang PA. Conjugated bilirubin triggers anemia by inducing erythrocyte death. Hepatology 2015; 61:275-84. [PMID: 25065608 PMCID: PMC4303990 DOI: 10.1002/hep.27338] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/24/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Hepatic failure is commonly associated with anemia, which may result from gastrointestinal bleeding, vitamin deficiency, or liver-damaging diseases, such as infection and alcohol intoxication. At least in theory, anemia during hepatic failure may result from accelerated clearance of circulating erythrocytes. Here we show that bile duct ligation (BDL) in mice leads to severe anemia despite increased reticulocyte numbers. Bilirubin stimulated suicidal death of human erythrocytes. Mechanistically, bilirubin triggered rapid Ca(2+) influx, sphingomyelinase activation, formation of ceramide, and subsequent translocation of phosphatidylserine to the erythrocyte surface. Consistent with our in vitro and in vivo findings, incubation of erythrocytes in serum from patients with liver disease induced suicidal death of erythrocytes in relation to their plasma bilirubin concentration. Consistently, patients with hyperbilirubinemia had significantly lower erythrocyte and significantly higher reticulocyte counts compared to patients with low bilirubin levels. CONCLUSION Bilirubin triggers suicidal erythrocyte death, thus contributing to anemia during liver disease.
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Affiliation(s)
- Elisabeth Lang
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany,Department of Physiology, University of TübingenTübingen, Germany
| | - Sergios Gatidis
- Department of Physiology, University of TübingenTübingen, Germany
| | - Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Hans Bock
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Ralf Kubitz
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Christian Lauermann
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Caroline Klindt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Maximilian Schuier
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Maria Reich
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Guilai Liu
- Department of Physiology, University of TübingenTübingen, Germany
| | | | - Haifeng C Xu
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Syed M Qadri
- Department of Physiology, University of TübingenTübingen, Germany
| | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University of DüsseldorfDüsseldorf, Germany
| | | | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University of DüsseldorfDüsseldorf, Germany
| | - Erich Gulbins
- Department of Molecular Biology, University of Duisburg-EssenEssen, Germany
| | - Florian Lang
- Department of Physiology, University of TübingenTübingen, Germany
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany
| | - Karl S Lang
- Institute of Immunology, University of Duisburg-EssenEssen, Germany
| | - Michael Föller
- Department of Physiology, University of TübingenTübingen, Germany
| | - Philipp A Lang
- Department of Gastroenterology, Hepatology and Infectious Diseases, University of DüsseldorfDüsseldorf, Germany,Department of Molecular Medicine II, Heinrich Heine University DüsseldorfDüsseldorf, Germany
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Vrethem M, Reiser N, Lauermann C, Svanborg E. Polyneuropathy associated with IgM vs IgG monoclonal gammopathy: comparison between clinical and electrophysiological findings. Acta Neurol Scand 2010; 122:52-7. [PMID: 20003083 DOI: 10.1111/j.1600-0404.2009.01259.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The neuropathy associated with IgM monoclonal gammopathy (IgM-MG) is regarded as a sensorimotor, mainly demyelinating neuropathy. It is not fully known whether the neuropathy in IgG-MG is caused by the same mechanisms and shows the same electrophysiological characteristics. We aimed at making a comparison between clinical and neurophysiological findings in these two conditions. PATIENTS AND METHODS Twenty-seven patients with IgM-associated neuropathy [18 with anti-myelin-associated glycoprotein (anti-MAG) antibodies] were compared with 15 age-matched patients with IgG-associated neuropathy. RESULTS Patients with IgM-associated neuropathy (especially those with anti-MAG antibodies) had significantly clinically more severe disabilities with involvement of both motor and sensory functions compared with patients with IgG-associated neuropathy in whom clinical sensory disturbances were more prominent than motor dysfunction. Motor and sensory conduction velocities were significantly lower and distal latencies significantly longer in the IgM group than in the IgG group concerning the median, ulnar and peroneal nerves. Fifty-four per cent of the patients in the IgM group did not present a sensory response of the median nerve vs 13% in the IgG group. There was also a significant difference concerning absent responses from the peroneal and sural nerves in the IgM vs IgG group (peroneal: 48% vs 13%, sural: 88% vs 27%). CONCLUSION Polyneuropathy associated with IgM-MG, especially when associated with anti-MAG antibodies, appears to have more of a demyelinating involvement that meets the criteria for demyelination. This was not as clear in those associated with IgG. The IgG neuropathy showed less and milder deficit in the electrophysiological studies.
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