Intestinal Protein Leakage in the Acquired Immunodeficiency Syndrome

Abstract

Body wasting, protein catabolism, and hypoalbuminemia are complicating features of the acquired immunodeficiency syndrome (AIDS). Given their multifactorial causes, the contributing role of intestinal protein loss has not yet been fully elucidated. To quantify enteric protein leakage, determination of fecal alpha 1-antitrypsin (AAT) excretion has been established as an accurate and reliable endogenous marker. We estimated AAT concentration by standard immune nephelometry in duplicate random stool samples of 49 patients with AIDS, and we compared it to that of 43 patients with chronic inflammatory bowel disease and to 34 healthy controls. When compared with healthy persons, patients with AIDS had increased fecal AAT excretion regardless of current opportunistic intestinal infections and fecal AAT excretion similar to that of patients with quiescent chronic inflammatory bowel disease. The ratio of fecal and serum AAT concentration was not different between AIDS patients and healthy controls, although it was consistently increased in those with chronic inflammatory bowel disease. Significant intestinal protein leakage occurs in patients with AIDS, probably due to primary impairment of gut permeability. Enteric protein loss may be an important feature of human immunodeficiency virus-associated enteropathy with altered mucosal barrier function.

Absence of Epithelial Immunoglobulin a Transport, with Increased Mucosal Leakiness, in Polymeric Immunoglobulin Receptor/Secretory Component–Deficient Mice

“…Thus, individuals with selective IgA deficiency show an increased frequency of mucosal disorders such as celiac disease (36) and IBD, particularly Crohn's disease (Hammarström, L., personal communication), despite generally eliciting compensatory SIgM responses (35). Also, increased mucosal leakiness is observed in patients with AIDS who have defective production of intestinal IgA antibodies against the infecting virus (37,38).…”

Dysregulation of Systemic and Mucosal Humoral Responses to Microbial and Food Antigens as a Factor Contributing to Microbial Translocation and Chronic Inflammation in HIV-1 Infection

“…Altered production of mucosal antibodies may interfere with the essential role they play in the regulation of immune responses to common microbial and food antigens [ 25 , 26 ]. Increased translocation of microbial products and whole bacteria is observed in SIV-infected macaques [ 12 ] and in HIV-1-infected patients with low levels of HIV-1-specific IgA antibodies [ 27 ]. It is likely that the perturbation of production of mucosal antigen-specific antibodies in HIV-1-infected individuals accelerates the translocation of bacteria, bacterial products, and other environmental antigens into the systemic compartment and significantly contributes to chronic inflammation in HIV-1 infection.…”

Enteraler Eiweißverlust: Pathophysiologie, Ursachen, Diagnostik und Therapie mit Fallbeispielen

“…Unverträglichkeitsreaktionen (Eosinophile Enteropathie [50], Kuhmilchallergie [39,52], Zöliakie [30] chronisch-entzündliche Darmerkrankungen Morbus Crohn [3] Kolitis ulzerosa [74,78] Morbus Behcet [58] Autoimmunenteropathie [56,57,86] Graft-versus-Host-Erkrankung [88] Infektionen Viren (Adenoviren; Masern [23]; HIV [4,47]; M. Menetrier: CMV, Hepatitis C [75]) bakterielle Infektionen der Darmwand (Klostridien [17], Shigellen [6], Salmonellen [29], Yersinien [49], Tuberkulose [53]) bakterielle Überwucherung des Dünndarms [38] Parasiten (Lamblien [25,79], Schistosomiasis [26]…”