Acute liver cell damage in patients with anorexia nervosa: A possible role of starvation-induced hepatocyte autophagy

被引:130
|
作者
Rautou, Pierre-Emmanuel [1 ,2 ]
Cazals-Hatem, Dominique [3 ]
Mareau, Richard [1 ,2 ]
Francoz, Claire [1 ]
Feldmann, Gerard [2 ]
Lebrec, Didier [1 ,2 ]
Ogier-Denis, Eric [1 ,2 ]
Bedossa, Pierre [2 ]
Valla, Dominique [1 ,2 ]
Durand, Francois [1 ,2 ]
机构
[1] Hop Beaujon, Serv Hepatol, F-92110 Clichy, France
[2] Univ Paris 07, Ctr Rech Biomed Bichat Beaujon CRB3, INSERM, U773, Paris, France
[3] Hop Beaujon, Serv Anat Pathol, F-92110 Clichy, France
关键词
D O I
10.1053/j.gastro.2008.05.055
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: Acute liver insufficiency is a rare complication of anorexia nervosa. The mechanisms for this complication are unclear. The aim of this study was to describe patient characteristics and clarify the mechanisms involved. Methods: Liver specimens from 12 patients (median age, 24 years; median body mass index, 11.3 kg/m(2)), with a prothrombin index 50% and/or an International Normalized Ratio >1.7 and anorexia nervosa as the only cause for acute liver injury were analyzed. A detailed pathologic examination was performed, including under electron microscopy. Results: Liver cell glycogen depletion was a constant finding. There was a contrast between the increase in serum alanine aminotransferase (56 times normal on average; 1,904 IU/L) and the absence of significant hepatocyte necrosis on histology. Centrilobular changes (trabecular atrophy and/or sinusoidal fibrosis) were observed in 6 patients. There were rare or no (<5%) terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive hepatocytes, suggesting that apoptosis was not the primary mechanism. Hepatocytes from 4 patients showed numerous autophagosomes, a morphologic hallmark of autophagy, on electron microscopy. In contrast, the mitochondria, endoplasmic reticulum, and nuclei were normal in most cells. These features were absent in 11 control patients. The outcome was favorable in all patients, with a rapid return to normal liver function. Conclusions: Anorexia nervosa with extremely poor nutritional status should be added to the list of conditions causing acute liver insufficiency. Our findings show that starvation-induced autophagy in the human liver may be involved in liver cell death during anorexia nervosa, even though other mechanisms of liver cell damage could also play a role.
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收藏
页码:840 / 848
页数:9
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