CRIg-expressing peritoneal macrophages are associated with disease severity in patients with cirrhosis and ascites

Infections are an important cause of morbidity and mortality in patients with decompensated cirrhosis and ascites. Hypothesizing that innate immune dysfunction contributes to susceptibility to infection, we assessed ascitic fluid macrophage phenotype and function. The expression of complement receptor of the immunoglobulin superfamily (CRIg) and CCR2 defined two phenotypically and functionally distinct peritoneal macrophage subpopulations. The proportion of CRIg^hi macrophages differed between patients and in the same patient over time, and a high proportion of CRIg^hi macrophages was associated with reduced disease severity (model for end-stage liver disease) score. As compared with CRIg^lo macrophages, CRIg^hi macrophages were highly phagocytic and displayed enhanced antimicrobial effector activity. Transcriptional profiling by RNA sequencing and comparison with human macrophage and murine peritoneal macrophage expression signatures highlighted similarities among CRIg^hi cells, human macrophages, and mouse F4/80^hi resident peritoneal macrophages and among CRIg^lo macrophages, human monocytes, and mouse F4/80^lo monocyte-derived peritoneal macrophages. These data suggest that CRIg^hi and CRIg^lo macrophages may represent a tissue-resident population and a monocyte-derived population, respectively. In conclusion, ascites fluid macrophage subset distribution and phagocytic capacity is highly variable among patients with chronic liver disease. Regulating the numbers and/or functions of these macrophage populations could provide therapeutic opportunities in cirrhotic patients.