Unblocking IL-10 restored proinflammatory mediator and HO-1 expression to previously observed levels in response AZD5363 supplier to LPS stimulation. Conclusion: Although the described association does not necessarily mean causality, an

IL-10–mediated HO-1–induced anti-inflammatory mechanism is present in patients with cirrhosis receiving norfloxacin, that is directly associated with cell-modulating events in these patients. (HEPATOLOGY 2011;) Bacterial translocation (BT) is known as the process by which bacteria exit the intestinal lumen in certain diseases, such as decompensated cirrhosis, access mesenteric lymph nodes and, eventually, colonize other organs.1 This mechanism is involved in the pathogenesis of spontaneous bacterial peritonitis (SBP), one of the most representative and clinically relevant complications of cirrhosis.2, 3 To reduce the incidence of this complication,

oral norfloxacin is administered, either as primary prophylaxis (400 mg twice a day for 1 week) to patients with upper gastrointestinal bleeding or as secondary prophylaxis (indefinitely, 400 mg daily) to those who have survived a previous episode of SBP. In this last condition, norfloxacin administration significantly reduces the incidence of bacterial infections4, 5 and, used as primary prophylaxis, also reduces noninfectious related clinical complications, such as hepatorenal syndrome, thus improving survival.6 BT in cirrhosis is related to an increased blood secretion of proinflammatory soluble mediators such as cytokines and nitric oxide (NO),7 which may be potentially harmful and can lead to severe clinical complications such Venetoclax ic50 as circulatory dysfunction and hepatorenal syndrome.6, 8 In fact, it has been recently shown that bacterial DNA translocation, a surrogate medchemexpress marker of BT, is associated with a marked worsening of the intrahepatic endothelial dysfunction in cirrhosis (Hepatology 2010, in press) and with an increased risk of death.9 Selective

intestinal decontamination (SID) with norfloxacin as secondary prophylaxis of SBP not only removes bacterial products but also modulates patients’ proinflammatory reaction, showing a direct cellular effect on neutrophil response to oxidative stress by reducing secretion of reactive oxygen species and increasing the apoptosis rate.10 Both processes affect modulation of nuclear factor-kappa B (NF-κB), which triggers proinflammatory gene transcription. Nevertheless, an effective inflammatory reaction also requires an adequate interaction with active anti-inflammatory mediators aimed at keeping a proper homeostasis. The present work was designed to investigate the anti-inflammatory counteracting mechanisms occurring within patients with decompensated cirrhosis and how norfloxacin participates in the restoration of the inflammatory balance, completing norfloxacin’s previously described immunomodulatory actions.