Antibodies to food antigens contribute to hypergammaglobulinemia in patients with decompensated liver cirrhosis

Portal hypertension is the major driver in disease progression from the compensated stage to the decompensated stage of liver cirrhosis. Hypergammaglobulinemia (HGG), characterized by elevated immunoglobulin G (IgG) levels, is a common feature of decompensated liver cirrhosis (dCirr). However, the mechanisms underlying HGG and their antigen specificity are incompletely understood. With its immune tolerant environment, the healthy liver mediates local and systemic tolerance to self and foreign antigens, including food antigens. We hypothesize that ingested food antigens bypass the liver in the context of portal hypertension, thereby failing to undergo tolerization and subsequently eliciting immune responses.

We analyzed food-specific IgGs against 90 different food antigens in a cohort of 11 healthy controls (HCs), 22 individuals with dCirr and 8 with a transjugular intrahepatic portosystemic shunt (TIPS). As the generation of IgGs is a T-cell-dependent process, we analyzed T-cell markers of tolerance induction as well as food antigen-specific T-cell responses targeting immuno-dominant regions of four different food antigens in peripheral blood.

Individuals with dCirr showed significantly higher food-specific antibodies (mean values: 9.4 µg/ml in dCirr patients, 16.6 µg/ml with TIPS and 1.9 µg/ml in HCs) with percentages of food-specific IgGs relative to the total IgGs of 1.6% in HCs, 3.8% in dCirr and 5.8% in patients with TIPS. While there was no difference in markers indicative of tolerance induction, food-specific CD4 T-cells were enriched in dCirr compared to HCs.

In conclusion, our data demonstrate that food-specific immune responses might contribute to HGG in dCirr patients with portal hypertension.

Publication History

Article published online:
23 January 2024