Altered biosynthesis of leukotrienes and lipoxins and host defense disorders in patients with cirrhosis and ascites

Background & Aims: Advanced cirrhosis is associated with impaired leukocyte function, but the mechanism underlying this host defense alteration is unknown. The aim of this study was to investigate the lipoxygenase pathway of arachidonic acid metabolism and its influence in leukocyte trafficking in patients with cirrhosis and ascites, Methods: Neutrophils (polymorphonuclear leukocytes [PMN]) were isolated from patients with cirrhosis and ascites and healthy subjects, and 5-lipoxygenase (5-LO) messenger RNA levels and 5-LO-derived products were measured, The effect of leukotrienes (LT) and lipoxins (LX) on PMN adhesion and migration was also assessed, Results: PMN from patients with cirrhosis showed increased 5-LO messenger RNA expression. However, in vitro generation of LTB4, cysteinyl-containing LT and Ut was significantly decreased in cirrhotic patients. interestingly, a close relationship between the activity of the renin-angiotensin system and LXA(4) biosynthesis was observed both in vitro and in vivo. PMN isolated from cirrhotic patients with ascites showed significantly decreased adhesion and migration in response to LTB4. LXA(4) did not provoke PMN adhesion and migration, but rather abrogated the differences between control and cirrhotic PMN. Cirrhotic monocytes showed marked impairment in adherence to laminin when stimulated with either LTB4 or LXA(4). Conclusions: These results show the existence of altered biosynthesis of LT and LX and defective response to these lipoxygenase products in leukocytes from patients with cirrhosis and ascites, This abnormality may be relevant to the pathogenesis of host defense disorders in chronic liver disease.