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Masuzaki R, Kanda T, Sasaki R, Matsumoto N, Ogawa M, Matsuoka S, Karp SJ, Moriyama M. Noninvasive Assessment of Liver Fibrosis: Current and Future Clinical and Molecular Perspectives. Int J Mol Sci 2020; 21:E4906. [PMID: 32664553 PMCID: PMC7402287 DOI: 10.3390/ijms21144906] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/29/2020] [Accepted: 07/09/2020] [Indexed: 01/18/2023] Open
Abstract
Liver fibrosis is one of the risk factors for hepatocellular carcinoma (HCC) development. The staging of liver fibrosis can be evaluated only via a liver biopsy, which is an invasive procedure. Noninvasive methods for the diagnosis of liver fibrosis can be divided into morphological tests such as elastography and serum biochemical tests. Transient elastography is reported to have excellent performance in the diagnosis of liver fibrosis and has been accepted as a useful tool for the prediction of HCC development and other clinical outcomes. Two-dimensional shear wave elastography is a new technique and provides a real-time stiffness image. Serum fibrosis markers have been studied based on the mechanism of fibrogenesis and fibrolysis. In the healthy liver, homeostasis of the extracellular matrix is maintained directly by enzymes called matrix metalloproteinases (MMPs) and their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs). MMPs and TIMPs could be useful serum biomarkers for liver fibrosis and promising candidates for the treatment of liver fibrosis. Further studies are required to establish liver fibrosis-specific markers based on further clinical and molecular research. In this review, we summarize noninvasive fibrosis tests and molecular mechanism of liver fibrosis in current daily clinical practice.
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Affiliation(s)
- Ryota Masuzaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Tatsuo Kanda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Reina Sasaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Naoki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Masahiro Ogawa
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Shunichi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
| | - Seth J. Karp
- Division of Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA;
| | - Mitsuhiko Moriyama
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Itabashi-Ku, Tokyo 173-8610, Japan; (T.K.); (R.S.); (N.M.); (M.O.); (S.M.); (M.M.)
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Noninvasive Assessment of Liver Fibrosis By Transient Elastography and FIB4/APRI for Prediction of Treatment Response in Chronic Hepatitis C-An Experience from a Tertiary Care Hospital. J Clin Exp Hepatol 2016; 6:282-290. [PMID: 28003717 PMCID: PMC5157918 DOI: 10.1016/j.jceh.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/11/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver fibrosis and its sequel cirrhosis represent a major health care burden, and assessment of fibrosis by biopsy is gradually being replaced by noninvasive methods. In clinical practice, the determination of fibrosis stage is important, since patients with advanced fibrosis have faster progression to cirrhosis and antiviral therapy is indicated in these patients. AIMS To assess the role of transient elastography (TE) and compare it with APRI and FIB4 for predicting liver fibrosis and assessing the effect of host and viral factors on fibrosis and treatment outcome in CHC patients. METHODS In a retrospective analysis, 330 CHC patients underwent liver stiffness measurement (LSM) by TE and tests needed for calculating APRI and FIB4 scores at baseline. 228 patients received a combination of Pegylated IFN-based antiviral therapy and were analyzed for therapeutic response. RESULTS The study included 330 patients (median age 39 years [range 18-67]), predominantly males (n = 227, 68.8%) with baseline LSMs. The median liver stiffness was 7.8 kPa (range 3.2-69.1 kPa). LSMs and its thresholds for severe fibrosis progression (≥9.5 kPa) and cirrhosis (≥12.5 kPa) were significantly higher in patients with age ≥40 years, diabetes mellitus, and patients with significant alcohol intake (P = 0.003 to P < 0.001). By taking TE as a reference, the diagnostic accuracy of FIB4 scores for predicting cirrhosis (AUROC 0.896) was good (+LR 13.4) compared to APRI (AUROC 0.823) with moderate likelihood ratio (+LR 6.9). Among 228 treated patients the SVR rate in genotype 3 was 70% versus 57.8% in genotype 1. Fibrosis score F4 (P = 0.023) and HCV genotype (P = 0.008) were independent predictors of SVR. CONCLUSION The study shows that LSM by TE and fibrosis assessment by FIB4/APRI scores can be used with fair reliability to predict fibrosis and treatment response in patients with CHC infection.
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Key Words
- ALT, alanine transaminases
- APRI, AST to Platelet ratio index
- AST, aspartate transaminases
- BMI, body mass index
- CHB, chronic hepatitis B
- CLD, chronic liver disease
- DM, diabetes mellitus
- ETR, end of treatment response
- EVR, early virological response
- FIB4, fibrosis-4 score
- HCV, hepatitis C
- IQR/M, interquartile range/median
- LB, liver biopsy
- LF, liver fibrosis
- LSM, liver stiffness measurement
- NPV, negative predictive value
- PEG INF, Pegylated Interferon
- PPV, positive predictive value
- RBV, Ribavarin
- RGT, response guided treatment
- ROC, receiver operating characteristic
- RVR, rapid virological response
- SVR, sustained virological response
- TE, transient elastography
- chronic hepatitis C
- kPa, kilopascals
- liver biopsy
- liver fibrosis
- noninvasive markers
- transient elastography
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Sultanik P, Kramer L, Soudan D, Bouam S, Meritet JF, Vallet-Pichard A, Fontaine H, Bousquet L, Boueyre E, Corouge M, Sogni P, Pol S, Mallet V. The relationship between liver stiffness measurement and outcome in patients with chronic hepatitis C and cirrhosis: a retrospective longitudinal hospital study. Aliment Pharmacol Ther 2016; 44:505-13. [PMID: 27407002 DOI: 10.1111/apt.13722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/13/2016] [Accepted: 06/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a relationship between liver stiffness measurement (LSM) and outcome of HCV patients. AIM To evaluate the performance of LSM to predict outcome of HCV patients at risk of liver-related complication. METHODS We established a retrospective longitudinal cohort of 341 HCV patients with unequivocal cirrhosis. All underwent LSM and were followed from September 2006 to July 2015. Outcome measure was a composite end-point of end-stage liver disease (ESLD) and/or hepatocellular carcinoma (HCC). Cox models and areas under receiver operating characteristic (AUROC) curves were used to evaluate independent risk factors of outcome. RESULTS Overall, LSM was below the 12.5 kPa threshold in 129 (37.8%) patients, including three-fourth and one-third of patients with or without a sustained virological response respectively. Liver disease progressed in 136 (39.9%) patients after a median observational period of 23.5 months. Older age, male gender, alcohol use disorders, metabolic syndrome and LSM were independent risk factors of liver disease progression. Age, alcohol use disorders and LSM were independently associated with ESLD. Age, gender and metabolic syndrome, but not LSM, were associated with HCC. The AUROC curves for disease progression, ESLD and HCC were 0.67, 0.70 and 0.58 respectively. Patients with a liver stiffness >12.5 kPa were at the highest risk of liver disease progression; below 12.5 kPa, liver stiffness was not discriminant. CONCLUSION Liver stiffness measurement is not a surrogate of disease progression of HCV patients with cirrhosis. HCV patients with cirrhosis should undergo the recommended follow-up, regardless of liver stiffness measurement.
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Affiliation(s)
- P Sultanik
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
| | - L Kramer
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France
| | - D Soudan
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France
| | - S Bouam
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Medical Information Service, Paris, France
| | - J-F Meritet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Virology Service, Paris, France
| | - A Vallet-Pichard
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
| | - H Fontaine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
| | - L Bousquet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France
| | - E Boueyre
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France
| | - M Corouge
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France
| | - P Sogni
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
| | - S Pol
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
| | - V Mallet
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal, Paris, France.,Hepatology Service, Paris, France.,Institut National de la Santé et de la Recherche Médicale Unité 1223, Institut Pasteur, Paris, France
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Diagnostic challenges in primary hepatocellular carcinoma: case reports and review of the literature. Case Rep Oncol Med 2015; 2015:878763. [PMID: 25922775 PMCID: PMC4397422 DOI: 10.1155/2015/878763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/09/2015] [Indexed: 01/10/2023] Open
Abstract
Hepatocellular carcinoma is the fifth most common malignancy and the third leading mortality cause worldwide. It typically develops secondarily to liver cirrhosis, due to hepatitis B or C infection, alcohol abuse, metabolic disease, and so forth. According to the American Association for the Study of Liver Diseases (AASLD) guidelines, which constitute diagnostic standards, the diagnosis of primary hepatocellular carcinoma (HCC) should be based on contrast-enhanced imaging. Lesion hyperenhancement should be observed throughout the arterial phase, followed by the washout during the venous phase. The diagnosis can also be based on the histopathological evaluation of liver biopsy specimen. Although the standards are clear, we often see patients with advanced HCC in clinical practice, who cannot be offered any effective treatment. Patients with chronic liver disease, presenting with inconclusive and changeable test results, constitute a separate problem. In such cases the diagnostic process is typically long-term and delayed. In this paper we present three case reports where the diagnosis could not be made promptly and the patients died as a result of a delayed diagnostic process.
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Imai Y, Taira JI, Okada M, Ando M, Sano T, Miyata Y, Sugimoto K, Nakamura I, Moriyasu F. The close linkage between the elasticity modulus measured by real-time mapping shear wave elastography and the presence of hepatocellular carcinoma in patients with a sustained virological response to interferon for chronic hepatitis C. J Med Ultrason (2001) 2014; 42:341-7. [PMID: 26576785 DOI: 10.1007/s10396-014-0604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/28/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE Some patients develop hepatocellular carcinoma (HCC) after sustained virological response (SVR) to interferon therapy for chronic hepatitis C (CH-C). The aim of this study was to examine the linkage between liver elasticity and the presence/absence of HCC in patients after SVR. METHODS We enrolled 42 patients who underwent real-time mapping shear wave elastography (SWE) after SVR to interferon therapy for CH-C. Of the 42 patients, six had HCC and 36 did not. We retrospectively compared the elasticity modulus and other clinical parameters between patients with and without HCC. RESULTS Elasticity modulus measured by SWE, age, and serum albumin was significantly different between patients with and without HCC. Age, Fibrosis-4 index, serum gamma-globulin, total protein, and albumin levels were significantly correlated with the elasticity modulus. Areas under receiver operating characteristic curves of elasticity modulus, gamma-globulin, and age for the presence of HCC were 0.963, 0.888, and 0.778, respectively. In patients with an elasticity modulus ≥6.5 kPa, both sensitivity and specificity for the presence of HCC were 83.3 %. CONCLUSION The study demonstrated the close linkage between the elasticity modulus measured by SWE and the presence of HCC in patients after SVR.
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Affiliation(s)
- Yasuharu Imai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Jun-Ichi Taira
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mayumi Okada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Mayumi Ando
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takatomo Sano
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yuhki Miyata
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ikuo Nakamura
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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7
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Makara M, Horváth G, Szalay F, Tornai I, Hunyady B. [Organizational characteristics of treatment for chronic hepatitis in Hungary: Hepatitis Registry and Priority Index]. Orv Hetil 2013; 154:1151-5. [PMID: 23853348 DOI: 10.1556/oh.2013.29671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hepatitis Registry was developed by the Hepatology Section of the Hungarian Gastroenterology Society with the contribution of the Foundation for Liver Patients. The main task was to register all interferon based treatments of chronic hepatitis C and B and to facilitate the preauthorization process. The registry helped to clarify the number and characteristics of hepatitis C patients waiting for triple therapy; 3000 previously failed patients are still eligible for protease inhibitor therapy, 40% of them already developed cirrhosis stage and 40% are null responders to the previous therapy. As a file is created for treatment authorization, the system counts automatically the Priority Index according to the calculation set in the guideline. Priority Index reflects the urgency of treatment. The most prominent parameter of the Index is the degree of fibrosis, but it also takes into account the progression rate, prognostic factors, and special situations.
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Affiliation(s)
- Mihály Makara
- Egyesített Szent István és Szent László Kórház Budapest.
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Kim MN, Kim BK, Han KH. Hepatocellular carcinoma in patients with chronic hepatitis C virus infection in the Asia-Pacific region. J Gastroenterol 2013; 48:681-8. [PMID: 23463401 PMCID: PMC3698419 DOI: 10.1007/s00535-013-0770-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/05/2013] [Indexed: 02/04/2023]
Abstract
Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related mortality worldwide. Although hepatitis B still remains the most common risk factor worldwide, chronic hepatitis C virus (HCV) infection is the driving force for the increased incidence of HCC especially in Western countries and Japan. In hepatitis B virus (HBV)-endemic areas, after successful vaccination programs against HBV, chronic HCV infection is now emerging as an important cause of chronic liver diseases. Unlike patients with chronic hepatitis B, those with chronic hepatitis C (CHC) develop HCC in the presence of established cirrhosis in most cases. However, a significant minority of CHC develops HCC in the absence of cirrhosis. Although HCV is a RNA virus with little potential for integrating its genetic material into host genome, various HCV proteins, including core, envelope, and nonstructural proteins, have oncogenic properties by inducing oxidative stress, disturbing cellular regulatory pathways associated with proliferation and apoptosis, and suppressing host immune responses. Overall, a combination of virus-specific, host genetic, environmental, and immune-related factors are likely to determine progression to HCC. Strategies aimed at eliminating the virus may provide opportunities for effective prevention of the development of HCC. Pegylated interferon plus ribavirin therapy appears to be effective at reducing the risk of HCC in patients who achieve sustained virologic responses. In summary, with the emerging importance of CHC, mechanisms of HCV-associated hepatocellular carcinogenesis should be clarified to provide insight into advanced therapeutic and preventive approaches, which eventually decrease the incidence and mortality of HCC.
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Affiliation(s)
- Mi Na Kim
- />Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno Seodaemun-gu, Seoul, South Korea
| | - Beom Kyung Kim
- />Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno Seodaemun-gu, Seoul, South Korea
| | - Kwang-Hyub Han
- />Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsanno Seodaemun-gu, Seoul, South Korea
- />Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
- />Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- />Liver Cirrhosis Clinical Research Center, Seoul, South Korea
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Kim BK, Fung J, Yuen MF, Kim SU. Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives. World J Gastroenterol 2013; 19:1890-1900. [PMID: 23569334 PMCID: PMC3613104 DOI: 10.3748/wjg.v19.i12.1890] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
Accurate determination of the presence and degree of fibrosis in liver is of great importance, because the prognosis and management strategies for chronic liver disease depend mainly on these factors. To date, liver biopsy (LB) remains the “gold standard” for assessing the severity of liver fibrosis; however, LB is often limited by its invasiveness, sampling error, and intra/inter-observer variability in histological interpretation. Furthermore, repeated LB examinations within a short time interval are indeed ineligible in a real clinical practice. Thus, due to the pressing need for non-invasive surrogates for liver fibrosis, transient elastography (TE), as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical consequences of fibrosis progression: the development of portal hypertension-related complications and hepatocellular carcinoma. This indicates that the role of transient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more detailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discussed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
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Miyamura T, Kanda T, Nakamoto S, Wu S, Jiang X, Arai M, Fujiwara K, Imazeki F, Yokosuka O. Roles of ITPA and IL28B genotypes in chronic hepatitis C patients treated with peginterferon plus ribavirin. Viruses 2012; 4:1264-78. [PMID: 23012624 PMCID: PMC3446761 DOI: 10.3390/v4081264] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/27/2012] [Accepted: 08/06/2012] [Indexed: 12/12/2022] Open
Abstract
It has been reported that inosine triphosphatase (ITPA) gene variants protect against ribavirin-induced anemia in patients treated for chronic hepatitis C. IL28B variants also influence the treatment response of peginterferon plus ribavirin treatment in these patients. In the present study, we examined how ITPA and IL28B genotypes have clinical impacts on treatment-induced hematotoxicities and treatment response in HCV-infected patients treated with peginterferon plus ribavirin. ITPA genotypes (rs1127354 and rs6051702) and IL28B genotype (rs8099917) were determined by TaqMan SNP assay. We compared clinical background, treatment course and treatment response in terms of these genotypes. Only IL28B rs8099917 major type could predict sustained virological response. ITPA rs1127354 major type leads to significantly greater ribavirin-induced anemia than ITPA rs1127354 minor type between days 0 and 84. We noticed that IL28B rs8099917 minor genotype was associated with higher reduction of neutrophils and platelets. ITPA rs1127354 is useful for the prediction of ribavirin-induced anemia in the early phase after the commencement of peginterferon plus ribavirin treatment and IL28B rs8099917 is useful for the prediction of sustained virological response. Use of the combination of these two genotypes could lead to safe and effective treatment of chronic hepatitis C patients.
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Affiliation(s)
- Tatsuo Miyamura
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Tatsuo Kanda
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Shingo Nakamoto
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
- Department of Molecular Virology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan;
| | - Shuang Wu
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Xia Jiang
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Makoto Arai
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Keiichi Fujiwara
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Fumio Imazeki
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
| | - Osamu Yokosuka
- Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan; (T.M.); (S.N.); (S.W.); (X.J.); (M.A.); (K.F.); (F.I.); (O.Y.)
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