Rapid changes in alcoholic hepatitis histology under steroids: correlationwith soluble intercellular adhesion molecule-1 in hepatic venous blood

Background/Aims: In alcoholic hepatitis (AH), enhanced expression of interc ellular adhesion molecule-1 (ICAM-1) correlates to neutrophil infiltration and histology. In severe AH under steroids, the evolution of the hepatocyte membranous ICAM-1 expression and its soluble form (sICAM-1) is not known. Methods: Twenty-six consecutive patients with biopsy-proven severe AH had l iver tissue studies for hepatocyte membranous ICAM-1 expression by immunost aining. Lobular neutrophils (mean per high power field) were counted after chloracetate esterase staining. Histological damage was assessed semiquanti tatively. Circulating levels of sICAM-1 and TNF alpha in peripheral and hep atic vein were measured using immunoassays. After 8 days on steroids, 19 pa tients had repeat biopsy. Results: At baseline, hepatocyte membranous ICAM-1 correlated both to histo logy (r = 0.55, P < 0.01) and to lobular neutrophils (r = 0.56, P < 0.01). On steroids, sICAM-1 in hepatic vein and TNF alpha in both vascular beds de creased. Hepatocyte membranous ICAM-1 and hepatocellular damage decreased, but lobular neutrophils increased. Changes in sICAM-1 in hepatic vein corre lated to histological changes (r = 0.68, P < 0.01). Conclusions: In severe AH under steroids, the short term histological impro vement was associated with a decrease in circulating TNF alpha, a decrease in ICAM-1 expression, and correlated to hepatic vein sICAM-1 changes. (C) 2 001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.