Circulating levels of soluble receptor for advanced glycation end products and ligands of the receptor for advanced glycation end products in patients with acute liver failure

Animal studies suggest that receptor for advanced glycation end products (RAGE)–dependent mechanisms contribute to acetaminophen‐induced liver damage. We examined whether circulating levels of soluble receptor for advanced glycation end products (sRAGE) or RAGE ligands, including extracellular newly identified receptor for advanced glycation end products binding protein (EN‐RAGE), high‐mobility group box 1 (HMGB1), and Nε‐(Carboxymethyl)lysine adducts (CML), could aid in prognostication after an acetaminophen overdose. Sixty well‐characterized acetaminophen‐related acute liver failure (ALF) patients (30 spontaneous survivors and 30 patients who underwent transplantation and/or died) who were enrolled in the National Institutes of Health–sponsored Acute Liver Failure Study Group, were matched by age, met standard criteria for encephalopathy, and had an international normalized ratio > 1.5 were retrospectively studied. HMGB1, EN‐RAGE, CML, and sRAGE were detected by enzyme‐linked immunosorbent assay methods in sera from ALF patients and 30 healthy controls. Levels of sRAGE, EN‐RAGE, and HMGB1 (but not CML) were significantly greater (P