Clin Mol Hepatol > Accepted Articles
Association between serum TNF-α and sarcopenia in liver cirrhosis
Ji Won Han1, Da In Kim2, Hee Chul Nam1, U Im Chang2, Jin Mo Yang2, Do Seon Song2
1Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Correspondence :  Do Seon Song ,
Tel: 82-31-889-8970, Fax: 82-31-253-8898, Email:
Received: March 15, 2021  Revised: June 22, 2021   Accepted: June 30, 2021

Sarcopenia is an independent prognostic factor of liver cirrhosis (LC). However, the association between LC-related systemic inflammation and sarcopenia is unclear.
Sprague-Dawley rats were treated with thioacetamide (TAA) or saline as a control. Rifaximin was administered to TAA-induced rats. ELISA was performed to measure inflammatory mediators in rat serum. RT-PCR was performed to measure the molecular expression in tissues. Hematoxylin and eosin (H&E) staining and immunohistochemistry were performed to investigate tissue pathology. Serum tumor necrosis factor-α (TNF-α) levels, liver stiffness (LS), and the L3 skeletal muscle index (L3SMI) were measured in 60 patients with chronic liver disease (CLD).
LC and sarcopenia were successfully induced by TAA. Serum TNF-α levels were increased in LC rats and correlated with myostatin expression, muscle weight, and myofiber diameter. The expression of intestinal occludin and ZO-1 was reduced in LC rats and was associated with serum TNF-α levels and sarcopenia. In patients with LS≥7 kPa or sarcopenia, serum TNF-α levels were significantly increased, which was also confirmed when we raised the LS cutoff to 10 kPa. The value of the L3SMI was inversely correlated with serum TNF-α levels in patients with LS≥7 kPa. TNF-α was reduced by rifaximin, which might have resulted in reduced expression of muscular MuRF1 and myostatin and improvements in myofiber diameters within muscle tissues.
These results suggest that TNF-α is associated with LC-related sarcopenia. Rifaximin might be effective in reducing TNF-α levels and improving sarcopenia in LC, but these results need to be validated in future studies.
KeyWords: sarcopenia, liver cirrhosis, TNF-α, rifaximin

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