Spots that were only stained by sera at the onset of hepatic failure were excised and subjected to in-gel trypsin digestion. We identified 240 spots with a good correspondence between observed and theoretical MM and pI values, a significant score, and a suggestive combination of the number of matching peptides and percentage coverage (Supporting Table 2). These 240 identifications corresponded to 103 proteins. The presence of multiple isoforms of the same protein explained the discrepancy SB431542 ic50 between the number
of identified proteins and that of the spots detected. Genes encoding these proteins were analyzed using the Gene Ontology database (version 7.0; available at Pantherdb.org). The terms “molecular function” and “biological process” were studied. Proteins involved in catalytic activity as a molecular function and a metabolic process as a biological function were dominant (Fig. 4). Only 12 of the proteins identified in any cellular fraction were detected by all three patient sera (Table 2), namely 60S acidic ribosomal protein P0, arginase 1, adenosine triphosphate (ATP) synthase subunit alpha, carboxylesterase 3, catalase (CAT), pyruvate dehydrogenase complex, hydroxyl methyl glutaryl-CoA (coenzyme A) synthase, long-chain–specific acyl-CoA dehydrogenase, check details medium-chain–specific acyl-CoA dehydrogenase,
transitional endoplasmic reticulum ATPase, ubiquinol cytochrome C complex core protein 1, and very-long-chain–specific acylCoA dehydrogenase. In all 5 patients diagnosed with non-GVHD hepatitis,
immunosuppressive therapy with corticosteroids (n = 5) and cyclosporine (n = 2) was resumed. Within a mean period of 20 weeks after this resumption, their liver function parameters had normalized. Although the biological parameters improved in P1, the patient presented with ascites and edema. A second liver biopsy performed 6 weeks after the first revealed a marked reduction in inflammatory markers and extensive fibrosis (Fig. 5). Ascites was controlled with diuretic therapy and the liver parameters selleck chemicals were still within the healthy range 6 months later. In the case of P5, corticosteroids were withdrawn 1 year after the episode of acute hepatitis, and a further episode of acute hepatitis occurred 4 years later. A new liver biopsy revealed interface and centrolobular necroinflammatory hepatitis with plasmocytes. A new course of corticosteroid therapy was initiated, and a normalization of liver function parameters was achieved rapidly. In P1-P4, very slow tapering of the corticosteroid therapy was pursued from 10 mg/day, with a reduction of approximately 1 mg every month. No recurrence of liver disease was observed in any of these patients (Fig. 6). The results reported in this study shed new light on the characterization of potentially severe non-GVHD hepatitis resembling AIH that occurs after BMT.
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