Alpha-fetoprotein, tissue polypeptide antigen and ferritin in diagnosing primary hepatocellular carcinoma in patients with liver cirrhosis

The cytoskeleton of digestive epithelia in health and disease

The mammalian cell cytoskeleton consists of a diverse group of fibrillar elements that play a pivotal role in mediating a number of digestive and nondigestive cell functions, including secretion, absorption, motility, mechanical integrity, and mitosis. The cytoskeleton of higher-eukaryotic cells consists of three highly abundant major protein families: microfilaments (MF), microtubules (MT), and intermediate filaments (IF), as well as a growing number of associated proteins. Within digestive epithelia, the prototype members of these three protein families are actins, tubulins, and keratins, respectively. This review highlights the important structural, regulatory, functional, and unique features of the three major cytoskeletal protein groups in digestive epithelia. The emerging exciting biological aspects of these protein groups are their involvement in cell signaling via direct or indirect interaction with a growing list of associated proteins (MF, MT, IF), the identification of several disease-causing mutations (IF, MF), the functional role that they play in protection from environmental stresses (IF), and their functional integration via several linker proteins that bridge two or potentially all three of these groups together. The use of agents that target specific cytoskeletal elements as therapeutic modalities for digestive diseases offers potential unique areas of intervention that remain to be fully explored.

Diagnosis of hepatocellular carcinoma by concanavalin A affinity electrophoresis of serum alpha-fetoprotein

BACKGROUND

Concanavalin A (Con A) affinity electrophoresis of serum alpha-fetoprotein (AFP) can distinguish hepatocellular carcinoma (HCC) from other malignancies when the serum AFP concentration is elevated. However, Con A has not been able to distinguish HCC from benign chronic liver disease such as cirrhosis or chronic hepatitis.

METHODS

The Con A affinity electrophoresis of serum AFP was analyzed in patients with a serum AFP concentration greater than 50 ng/mL by antibody affinity electrophoresis and Western blotting in an attempt to distinguish hepatocellular carcinoma from benign chronic liver disease. Before the assay, the serum AFP concentrations were adjusted between 100 ng/ml and 300 ng/ml by concentrating or diluting the samples.

RESULTS

Of 180 patients with HCC, 44 (24%) had a single band and 91 (51%), 35 (19%), and 10 (6%) had 2, 3, and 4 bands, respectively. All 35 patients with chronic hepatitis had a single band. All but 1 of 72 patients with cirrhosis had a single band. Multiple AFP bands on Con A affinity electrophoresis appear to be diagnostic of HCC. This method has a sensitivity of 76%, a specificity of 99%, a positive predictive value of 99%, and a negative predictive value of 71% for detecting HCC. The number of AFP bands correlated with serum AFP concentration and tumor size in patients with HCC.

CONCLUSIONS

This assay is useful for distinguishing HCC from benign chronic liver diseases.

Serum des-gamma-carboxyprothrombin concentration determined by the avidin-biotin complex method in small hepatocellular carcinomas

BACKGROUND

Des-gamma-carboxyprothrombin (DCP) is a useful tumor marker for hepatocellular carcinoma (HCC). The present method for measurement of DCP concentration, however, does not have adequate sensitivity to detect small HCCs.

METHODS

The serum DCP concentration was investigated by the avidin-biotin complex (ABC) method in patients with an HCC smaller than 20 mm in maximum dimension. A serum DCP concentration greater than 4.0 arbitrary units per liter using the ABC method was considered abnormal.

RESULTS

Of 115 patients with small HCC, 45 (39.1%) had an abnormal DCP concentration. Ten of 141 patients with chronic hepatitis (7.1%), 18 of 115 (15.7%) with cirrhosis, and 0 of 30 normal control patients had abnormal DCP concentrations. This method yielded a sensitivity of 39.1%, a specificity of 89.1%, a positive predictive value of 61.6%, and a negative predictive value of 76.5% for detection of small HCC. The detectability of HCC increased to 56.5% when alpha-fetoprotein (AFP) was was measured (> 40 ng/ml). Abnormal DCP concentrations were seen in 8 of 34 (23.5%), 24 of 42 (57.1%), and 5 of 7 (71.4%) patients with Edmondson's Grade I, II, and III tumors, respectively. There was a significant relationship between DCP concentrations and histologic grade (P = 0.0017), but there was no association between DCP concentration and other patient characteristics. Elevation of serum AFP concentrations in patients with hepatitis B surface antigen positivity, however, was more frequent than that in patients who were antihepatitis C virus (HCV) positive. Therefore, the measurement of serum DCP concentrations may be more useful than that of serum AFP concentrations in patients with anti-HCV positivity.

CONCLUSIONS

The measurement of serum DCP concentrations by the ABC method is a useful diagnostic tool for the monitoring of small HCC.