Combined analysis of serum γ-glutamyl transferase isoenzyme II, α-L-fucosidase and α-fetoprotein detected using a commercial kit in the diagnosis of hepatocellular carcinoma

Prognostic role of gamma-glutamyl transferase in metastatic melanoma patients treated with immune checkpoint inhibitors

BACKGROUND

Hepatic immune-related adverse events (irAE) including elevated liver function tests (transaminases) occur in 1.4-22.3% of melanoma patients receiving immune checkpoint inhibitors (ICPI) and constitute a potentially serious toxicity that is challenging to treat. In contrast to the liver transaminases alanine aminotransferase (ALT) and aspartate aminotransferase (AST), only little is known about the frequency and impact of gamma-glutamyl transferase (GGT) elevations.

METHODS

GGT determined prior to and during therapy of metastatic melanoma patients treated with ICPI were retrospectively assessed in two independent cohorts (PD-1: n = 218, Ipi + Nivo: n = 148). Overall survival (OS) and best objective response were analyzed according to baseline and immune-related GGT (irGGT) elevations during treatment.

RESULTS

In multivariate analysis, OS was reduced in patients with elevated baseline GGT (PD-1 group: hazard ratio [HR] 1.76, p = .0073; Ipi + Nivo group: HR 1.77, p = .032). Immune-related GGT elevation was recorded in 17% (PD-1 group) and 38.5% (Ipi + Nivo group). Of these patients, the majority (81 and 68%, respectively) had normal ALT and AST and showed no clinical signs of hepatotoxicity. Patients who experienced irGGT elevation had superior response (PD-1 group: odds ratio [OR] 3.57, p = .00072; Ipi + Nivo group: OR 1.74, p = .12) and OS (PD-1 group: HR 0.37, p = .0016; Ipi + Nivo group: HR 0.33, p = .00050).

CONCLUSIONS

The frequency of hepatic irAE is currently underestimated. The addition of the sensitive enzyme GGT to the laboratory panel before and during therapy with ICPI allows to detect two to three times more patients developing hepatic or hepatobiliary toxicity than known so far. Immune-related GGT elevations correlate with response and favorable survival. Precis for use in the Table of Contents The frequency of hepatotoxicity under immune checkpoint blockade is currently underestimated. We suggest the addition of gamma-glutamyl transferase to the laboratory panel in checkpoint inhibitor patients for the detection of hepatobiliary toxicity.

Effect of co-administration of Bee honey and some chemotherapeutic drugs on dissemination of hepatocellular carcinoma in rats

Alternative and complimentary usage of the natural compound has raised hopes of finding curative options for liver hepatocarcinogenesis. In the present study, the curative effect of bee honey against diethylnitrosamine (DEN) (50 mg/kg) and carbon tetrachloride (CCl4) (2 mg/Kg)-induced hepatocellular carcinoma (HCC) in male rats in the presence or absence of some chemotherapeutic drugs, Cisplatin (Cis), Cyclophosphamide (CY) and 5- Fluorouracil (5-FU) were investigated. The obtained results demonstrated that treatment with DEN/CCl4 caused oxidative stress as assigned by the increase in malondialdehyde (MDA) and fall in glutathione (GSH) content. Meantime detraction in the antioxidants, including superoxide dismutase (SOD), catalase (CAT), glutathione-s-transferase (GST) and glutathione peroxidase (GPx) was observed. Also, the results showed induction of inflammation as reflected by an increase in the levels of both α- fetoprotein and α- fucosidase in the liver. This was accompanied by changes in the hepatic function biomarkers which characterized by the increased levels of transaminases (AST, ALT), alkaline phosphatase (ALP) and γ-Glutamyl transferase (γ-GT) and decrease in total protein content in the serum. In conclusion, the combination of the selected drugs and bee honey may be an effective chemo- preventive and therapeutic strategy for treating DEN and CCl4-induced HCC.

Electrochemical Assay of the Alpha Fetoprotein-L3 Isoform Ratio To Improve the Diagnostic Accuracy of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is now the major malignant disease with high morbidity and mortality, which seriously endangers human lives and health. Alpha fetoprotein (AFP) assay is a commonly used serological biomarker for clinical diagnosis of HCC, but it lacks specificity. Analysis of its isoform AFP-L3, especially the AFP-L3 ratio in total AFP (AFP-L3%), can significantly improve the specificity for HCC identification. Herein, an electrochemical approach has been first proposed for simple, accurate, and fast determination of AFP-L3% in clinical samples. On the basis of two independent electrochemical signals generated from the synthesized nanoparticles, 4-mercaptophenylboronic acid (MPA)-functionalized copper nanoparticles (MPA-CuNPs) and the Lens culinaris agglutinin (LCA)-functionalized silver nanoparticles (LCA-AgNPs), simultaneous quantification of the AFP-L3 and total AFP in serum sample has been achieved, thus achieving directly the electrochemical assay of AFP-L3%. To be noted, both the assay time and the assay procedure have been significantly compressed when compared to that of available techniques in clinical use. Therefore, with the integration of electrochemical techniques, this new approach for AFP-L3% analysis would be promising for the accurate diagnosis of HCC.

Current Status and Future Prospects of Biomarkers in the Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) has one of the highest death rates of any cancer in the world, and its incidence is increasing worldwide. Early-stage diagnosis of HCC is thus crucial for medical treatment. Detection of tumor biomarkers is one of the main methods for the early diagnosis of HCC. At present, α-fetoprotein (AFP) is the most practical serum biomarker for HCC diagnosis. However, the diagnostic accuracy of HCC with serum AFP exhibits both sensitivity and specificity far below satisfaction, especially with small sizes of HCC. As a result, the discovery of new biomarkers and/or their combination to enhance both the sensitivity and specificity for laboratory diagnosis of HCC is a crucial goal. With the development of new technology and advances in research, a number of new and specific biomarkers of HCC have been discovered. These biomarkers and their applications for the diagnosis, treatment monitoring and prognosis prediction of HCC, are reviewed in this article.

Association between serum α-L-fucosidase and non-alcoholic fatty liver disease: Cross-sectional study

AIM: To explore the association between serum α-L-fucosidase (AFU) and non-alcoholic fatty liver disease (NAFLD).

METHODS: A total of 16473 individuals (9456 men and 7017 women) were included in the current study, who presented for a health examination at the First Affiliated Hospital of Zhejiang University School of Medicine in 2014. The baseline characteristics of the cohort were compared by NAFLD status. Linear regression analysis and stepwise multiple regression analysis were applied to assess the risk factors for NAFLD. Receiver operating characteristic curve was used to determine the sensitivity and specificity of AFU in the diagnosis of NAFLD.

RESULTS: The prevalence rates of NAFLD and metabolic syndrome (MetS) were 38.0% and 25.4%, respectively. The NAFLD group had significantly higher AFU levels than the non-NAFLD group (28.7 ± 7.9 U/L vs 26.0 ± 7.3 U/L, P < 0.001) and the prevalence rate of NAFLD increased with progressively higher serum AFU levels. AFU was positively correlated with MetS and its five components: central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, and elevated blood pressure and fasting glucose. Stepwise multiple logistic regression analysis showed that AFU was associated with an increased risk of NAFLD (OR = 1.009, 95%CI: 1.003-1.014, P < 0.001). The best cut-off value of AFU for the diagnosis of NAFLD was 27.5 U/L. The area under the curve (diagnostic efficacy index) was 0.606. The sensitivity and specificity were 54.6% and 61.8%, respectively.

CONCLUSION: AFU level is significantly associated with NAFLD, and elevated AFU level is an independent risk factor for NAFLD.

Serum protein biomarkers relevant to hepatocellular carcinoma and their detection

Hepatocellular carcinoma (HCC) is one of the most recurrent and lethal cancers worldwide. The low survival rate of this particular strain of carcinoma is largely due to the late stages at which it is diagnosed. Tumorigenesis of hepatocellular carcinoma is most frequently detected through ultrasonography, magnetic resonance imaging and computerized tomography scans, however, these methods are poor for detection of early tumor development. This review presents alternative hepatocellular carcinoma detection techniques through the use of protein and enzyme/isozyme biomarkers. The detection methods used to determine the serum levels of α-fetoprotein (AFP), glypican-3 (GPC3), Golgi protein 73 (GP73), α-L-fucosidase (AFU), des-γ-carboxyprothrombin (DCP), γ-glutamyl transferase (GGT) and squamous cell carcinoma antigen (SCCA) are presented and each marker's respective validity in the diagnosis of hepatocellular carcinoma is evaluated.

Role of biomarkers in the prediction and diagnosis of hepatocellular carcinoma

The prevalence of hepatocellular carcinoma (HCC) has progressively increased in recent years and is now the fifth and the second most common cancer in the World and in Egypt, respectively. Much work has focused in the development of assays for detecting hepatic carcinogensis before the observance of hepatic focal lesions. Particular attention has been directed towards HCC-specific biomarkers for use in the early diagnosis of HCC and in the confirmation of radiological studies. Although a number of biomarkers have been identified, none have been considered reliable indicators of early HCC lesions. This review presents a few of the most relevant HCC biomarkers and suggests improvements to the accuracy of diagnostic assays through their combined use. Furthermore, we present an algorithm for the biomarker-based diagnosis of HCC and highlight its important role in the early prediction of HCC.

Diagnostic accuracy of serum squamous cell carcinoma antigen and squamous cell carcinoma antigen-immunoglobulin M for hepatocellular carcinoma: A meta-analysis

A number of individual studies have evaluated the diagnostic efficiency of serum squamous cell carcinoma antigen (SCCA) and SCCA-immunoglobulin (IgM) for diagnosing hepatocellular carcinoma (HCC), but the results have been conflicting. The aim of this study was to determine the diagnostic accuracy of serum SCCA and SCCA-IgM for HCC. A systematic review of related studies was conducted and relevant data on the accuracy of serum SCCA and SCCA-IgM in the diagnosis of HCC were pooled using random-effects models. Summary receiver operating characteristic curve (SROC) analysis was used to summarize the overall test performance. A total of 12 studies were included in our meta-analysis. The summary estimates for serum SCCA and SCCA-IgM for HCC diagnosis in the included studies were as follows: Sensitivity = 0.59 (95% CI: 0.56-0.62) vs. 0.60 (95% CI: 0.56-0.63); specificity = 0.76 (95% CI: 0.73-0.79) vs. 0.70 (95% CI: 0.67-0.73); diagnostic odds ratio (DOR) = 6.68 (95% CI: 3.71-12.03) vs. 7.32 (95% CI: 3.31-16.15); and area under the SROC curve = 0.7826 vs. 0.7955. Therefore, SCCA and SCCA-IgM exhibited moderate diagnostic accuracy for HCC. Due to the design limitations, the results of published studies should be interpreted with caution. In addition, well-designed studies including larger sample sizes should be conducted to rigorously evaluate the diagnostic value of SCCA and SCCA-IgM.

Evaluation of the diagnostic value of alpha-l-fucosidase, alpha-fetoprotein and thymidine kinase 1 with ROC and logistic regression for hepatocellular carcinoma

The purpose of this study was to evaluate the diagnostic efficiency for hepatocellular carcinoma (HCC) with the combined analysis of alpha-l-fucosidase (AFU), alpha-fetoprotein (AFP) and thymidine kinase 1 (TK1). Serum levels of AFU, AFP and TK1 were measured in: 116 patients with HCC, 109 patients with benign hepatic diseases, and 104 normal subjects. The diagnostic value was analyzed using the logistic regression equation and receiver operating characteristic curves (ROC). Statistical distribution of the three tested tumor markers in every group was non-normally distributed (Kolmogorov-Sminov test, Z = 0.156-0.517, P < 0.001). The serum levels of AFP and TK1 in patients with HCC were significantly higher than those in patients with benign hepatic diseases (Mann-Whitney U test, Z = -8.570 to -5.943, all P < 0.001). However, there was no statistically significant difference of AFU between these two groups (Mann-Whitney U test, Z = -1.820, P = 0.069). The levels of AFU were significantly higher in patients with benign hepatic diseases than in normal subjects (Mann-Whitney U test, Z = -7.984, P < 0.001). Receiver operating characteristic curves (ROC) in patients with HCC versus those without HCC indicated the optimal cut-off value was 40.80 U/L for AFU, 10.86 μg/L for AFP and 1.92 pmol/L for TK1, respectively. The area under ROC curve (AUC) was 0.718 for AFU, 0.832 for AFP, 0.773 for TK1 and 0.900 for the combination of the three tumor markers. The combination resulted in a higher Youden index and a sensitivity of 85.3%. The combined detection of serum AFU, AFP and TK1 could play a complementary role in the diagnosis of HCC, and could significantly improve the sensitivity for the diagnosis of HCC.

Low alpha-fetoprotein HCC and the role of GGTP

BACKGROUND

HCC patients are heterogeneous in terms of both tumor and liver factors. Alpha-fetoprotein (AFP) is an important prognostic tumor marker for those patients with elevated AFP levels.

AIMS

To examine the differences in HCC patients with high or low AFP levels in blood and evaluate the prognostic parameters in low AFP patients.

METHODS

A cohort of 2,440 HCC patients from 11 Italian medical centers was studied. AFP-positive patients were compared to AFP-negative ones, and the blood and tumor parameters of AFP-negative patients were examined.

RESULTS

Low blood AFP levels were found in 58% of the total cohort, in 64% of patients with small HCCs, and in 51% of patients with large HCCs. In patients with large tumors, platelet and gamma glutamyl transpeptidase (GGTP) levels, tumor multifocality and portal vein thrombosis (PVT) incidence were all greater than in patients with small tumors, regardless of AFP status. Patients with higher AFP levels had worse survival rates than those with low AFP in each tumor size group. In patients with small tumors, the elevated AFP was associated with significantly increased PVT and worse survival. In patients with large tumors, the elevated AFP was associated with significantly higher GGTP, ALKP, and bilirubin levels, as well as with increased PVT and multifocality, and worse survival. Low-AFP patients with high GGTP levels had worse survival than patients with low GGTP levels.

CONCLUSION

Patients with low AFP were the majority in this cohort, and patients with elevated GGTP had worse prognosis than those with low GGTP. GGTP may be a useful tumor and prognosis marker in low-AFP patients. AFP-negative patients are important to identify due to their enhanced survival.

A review on the diagnosis and treatment of hepatocellular carcinoma with a focus on the role of Wnts and the dickkopf family of Wnt inhibitors

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide. There are multiple etiologic factors including viral and environmental influences that can lead to HCC. Successful screening for early HCC is challenging due to the lack of well characterized and specific biomarkers. However, achieving successful screening is critically important as early diagnosis can potentially provide curative opportunities. Once HCC is advanced, there are multiple therapeutic venues, but most eventually fail, therefore developing new targeted therapies may provide greater chance for effective therapies. Along these lines, the Wnt pathway has been identified as contributing to the development and progression of HCC. Wnts can modify HCC growth and invasive ability. A key factor in the Wnt pathway is the dickkopf (DKK) family of Wnt inhibitors. DKKs have also been shown to modulate HCC progression. Additionally, several studies have suggested that DKK expression in tissue and serum has diagnostic and prognostic value.

Diagnostic value of alpha-L-fucosidase for hepatocellular carcinoma: a meta-analysis

Alpha-fetoprotein (AFP) is the primary marker for detecting hepatocellular carcinoma (HCC) and has been used widely in the clinic, but AFP is a biomarker characterized by poor sensitivity and specificity. Alpha-L-fucosidase (AFU) has been proposed as a tumor marker for diagnosis of HCC in many studies. However, conclusions of its diagnostic value are inconsistent. The current review aimed to evaluate the diagnostic value of AFU for HCC. After systematic review of 12 related studies, sensitivity, specificity, and diagnostic odds ratio (DOR) were pooled using random-effect models. Summary receiver operating characteristic (sROC) curve analysis was used to summarize the overall test performance. The pooled sensitivity for AFU was 0.72 (95% confidence interval (CI) 0.69-0.76), while the pooled specificity was 0.78 (95% CI 0.74-0.81). DOR was 10.26 (95% CI 5.99-17.59), and the area under the curve (AUC) was 0.8125. AFU had great value for the diagnosis of HCC as a serum marker.

Serum GP73 is complementary to AFP and GGT-II for the diagnosis of hepatocellular carcinoma

Golgi protein 73 (GP73) is a resident Golgi type II transmembrane protein that has been reported to markedly increase in chronic liver disease, particularly in hepatocellular carcinoma (HCC). However, it remains unclear as to whether serum GP73 represents a reliable serum marker for the diagnosis of HCC. The aim of the present study was to evaluate the diagnostic value of serum GP73 in patients with HCC and to determine the diagnostic accuracy of measuring serum GP73 in combination with α-fetoprotein (AFP) and γ-glutamyl transferase isoenzyme II (GGT-II) in HCC. Serum GP73 was detected using a time-resolved fluorescence immunological assay (TRFIA) and enzyme-linked immunosorbent assay (ELISA) in 79 HCC cases, including 16 liver cirrhosis, 30 chronic hepatitis and 28 healthy individuals. The correlation between serum GP73 and tumor size and HCC grading was analyzed and the complementary diagnostic value of serum GP73, AFP and GGT-II was evaluated. TRFIA was established for the detection of serum GP73 and was sensitive and reproducible. The expression levels of serum GP73 were markedly higher in the patients with HCC when compared with those of the individuals with liver cirrhosis and chronic hepatitis or the healthy individuals. According to the receiver operating characteristic (ROC) curve, diagnostic sensitivity and specificity for HCC with a cut-off value of 78.1 ng/l were 73.4 and 79.0%, respectively. However, no correlation was identified among serum GP73 and tumor size or grading, and no correlations were identified among serum GP73, AFP and GGT-II. The diagnostic sensitivities for HCC, as detected by TRFIA of GP73, AFP and GGT-II, were 73.4, 55.6 and 68.4%, respectively, and the specificities were 80.0, 86.7 and 97.1%, respectively. The combined determination of these markers increased the diagnostic sensitivity to 96.3% for HCC. TRFIA functions as a sensitive and replicable assay for the detection of serum GP73. The levels of serum GP73 were significantly higher in the HCC group when compared with the individuals with benign liver diseases. Serum GP73 may serve as a potential independent diagnostic candidate for HCC and the combined determination of serum GP73, AFP and GGT-II may increase the diagnostic efficiency of HCC.