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Macía C, Loureiro J, Campos-Varela I, Abdulkader I, Otero E, Varo E, Tomé S, Gonzalez-Quintela A. Time-Course Changes of Serum Keratin Concentrations after Liver Transplantation: Contrasting Results of Keratin-18 and Keratin-19 Fragments. Case Reports Hepatol 2020; 2020:8895435. [PMID: 33335785 DOI: 10.1155/2020/8895435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
Objective Under normal conditions, adult hepatocytes express only keratin-8 (K8) and keratin-18 (K18), whereas cholangiocytes also express K19. In this study, we delineate the pattern of normal time-course changes in serum K19 and K18 levels after liver transplantation. Patients and Methods. Serum levels of the K19 fragment CYFRA 21-1 and the K18 fragments tissue polypeptide specific antigen (TPS) and M30 (a neoepitope that is generated after caspase cleavage during apoptosis) were measured at baseline and at regular intervals (up to 6 months) after liver transplantation in 11 adult patients. Results There was a gradual decrease in serum K19 concentrations from baseline values after transplantation, following a time-course pattern similar to that of serum bilirubin. In contrast, serum concentrations of K18 fragments increased markedly shortly after transplantation and gradually decreased thereafter, following a time-course pattern similar to that of serum transaminases. The increase in TPS tended to occur earlier than that in M30, suggesting an initial predominance of hepatocyte necrosis followed by a predominance of apoptosis in the first days after transplantation. Five patients presented posttransplant complications (acute rejection in three cases and HCV recurrence in two cases). An early increase in serum K19 concentrations was observed in all cases. An increase in serum concentrations of K18 fragments (M30 and TPS) was observed in the two cases with HCV recurrence and was more variable in the three cases with acute rejection. Conclusions Serum concentrations of K19 and K18 fragments follow a dissimilar pattern of time-course changes after liver transplantation. The diagnostic value of variations in these normal patterns should be addressed in future studies.
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Li C, Liu S, Lu L, Dong Q, Xuan S, Xin Y. Association between Serum Cytokeratin-18 Neoepitope M30 (CK-18 M30) Levels and Chronic Hepatitis B: A Meta-Analysis. Hepat Mon 2018; 18. [DOI: 10.5812/hepatmon.64152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Li J, Verhaar AP, Pan Q, de Knegt RJ, Peppelenbosch MP. Serum levels of caspase-cleaved cytokeratin 18 (CK18-Asp396) predict severity of liver disease in chronic hepatitis B. Clin Exp Gastroenterol 2017; 10:203-209. [PMID: 28860836 PMCID: PMC5560566 DOI: 10.2147/ceg.s135526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and aim Caspase-cleaved cytokeratin 18 (CK18-Asp396) is a potential clinically useful biomarker in liver disease as it is released from hepatocytes during apoptosis. In this study, we investigated serum CK18-Asp396 levels in chronic hepatitis B (CHB). Patients and methods Overall, 163 patients with CHB were included. Serum CK18-Asp396 levels were determined by enzyme-linked immunosorbent assay (ELISA), and results were related to steatosis grade, histological activity index, inflammation score, and METAVIR fibrosis grade as well as to viral load, serum levels of liver enzymes, and albumin. Receiver operating characteristic analysis was used to evaluate the diagnostic performance of serum CK18-Asp396 levels for assessing disease activity. Results A higher level of serum CK 18 concentrations was found in patients with significant inflammation vs no significant inflammation (378.5 [interquartile range {IQR}: 173.2–629.6] vs 137.3 [87.5–197.7], P < 0.05; approximately threefold increase) and in patients with significant fibrosis vs no significant fibrosis (177.8 [IQR: 120.8–519.1] vs 142.7 [IQR: 88.8–214.4], P < 0.05; 1.25-fold increase). There was no differential CK 18 level by degree of steatosis. CK 18 was an independent predictor of significant inflammation with an 82% specificity and a 94% negative predictive value. We found the strongest correlation of CK 18 with alanine aminotransferase and aspartate aminotransferase (both r = 0.52; P < 0.001), but less with albumin (r = −0.24; P < 0.05) and viral load (log) (r = 0.19; P < 0.05). Conclusion CHB appears to be accompanied by continuous high levels of hepatocyte apoptosis as judged from serum CK 18, suggesting that elimination of the infected compartment constitutes a defensive strategy against disease. Accordingly, CK 18 works as an independent predictor of significant inflammation with a high specificity.
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Affiliation(s)
- Juan Li
- Erasmus MC Cancer Institute, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Auke P Verhaar
- Erasmus MC Cancer Institute, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Qiuwei Pan
- Erasmus MC Cancer Institute, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert Jacobus de Knegt
- Erasmus MC Cancer Institute, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maikel P Peppelenbosch
- Erasmus MC Cancer Institute, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
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Mueller S, Nahon P, Rausch V, Peccerella T, Silva I, Yagmur E, Straub BK, Lackner C, Seitz HK, Rufat P, Sutton A, Bantel H, Longerich T. Caspase-cleaved keratin-18 fragments increase during alcohol withdrawal and predict liver-related death in patients with alcoholic liver disease. Hepatology 2017; 66:96-107. [PMID: 28170108 DOI: 10.1002/hep.29099] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED Noninvasive assessment of disease activity in patients with nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) is still unsettled, but essential for the evaluation of disease progression. We here studied the association of total (M65) and caspase-cleaved (M30) serum keratin-18 fragments (n = 204) with histological parameters (n = 106) in heavy drinkers primarily admitted for alcohol withdrawal before and after alcohol detoxification. An age-, sex-, and fibrosis-stage matched NAFLD cohort (n = 30) was used for comparison. The prognostic value of M30 and M65 levels were assessed in an additional prospectively followed-up cohort of 230 patients with alcoholic cirrhosis (AC) using competing risk analyses. Among the histological parameters, both M30/65 correlated significantly and better than any other serum marker with apoptosis and liver damage, such as ballooning (r = 0.65; P < 0.001), followed by lobular inflammation (0.48; P < 0.001), steatosis (0.46; P < 0.001), but less with fibrosis (0.24; P < 0.001). Area under the receiver operating characteristics curves to detect ballooning, steatosis, or steatohepatitis (SH) were slightly better for M30 (P < 0.005). Optimal M30 cut-off values for mild and severe ballooning were 330 and 420 U/L, and 290 and 330 U/L for SH grades 1 and 2. No significant differences of M30/65 were found between the matched NAFLD and ALD cohort. In contrast to aspartate-amino-transferase and M65, M30 levels increased significantly from 391 to 518 U/L during alcohol detoxification. Moreover, levels of M30 and M65 predicted non-hepatocellular carcinoma liver-related mortality in patients with AC during a mean observation interval of 67.2 months. CONCLUSION Our data suggest M30 as highly specific marker of liver apoptosis both in ALD and NAFLD. In addition, hepatocellular apoptosis, as determined by M30 levels, occurs during alcohol withdrawal, and survival data point toward a novel underestimated role of apoptosis in patients with ALD. (Hepatology 2017;66:96-107).
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Affiliation(s)
- Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206, Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris, France
| | - Vanessa Rausch
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Tessa Peccerella
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Ines Silva
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr. Stein and colleagues, Mönchengladbach, Germany
| | - Beate K Straub
- Institute for Pathology, Universities of Mainz and Heidelberg, Germany
| | - Carolin Lackner
- Institute for Pathology, Medical University Graz, Graz, Austria
| | - Helmut K Seitz
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Pierre Rufat
- APHP, Biostatistics, Pitié-Salepêtrière Hospital, Paris, France
| | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027, Paris, France.,APHP, Biochemistry Unit, Jean Verdier Hospital, Bondy, France.,INSERM U1148, and Paris 13 University, Bobigny, France
| | - Heike Bantel
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thomas Longerich
- Institute of Pathology, RWTH-University Hospital Aachen, Aachen, Germany
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Balkan A, Yılmaz N, Balkan Y, Koruk I, Örkmez M, Aydınlı M, Koruk M. Relationship between liver injury and serum cytokeratin 18 levels in asymptomatic hepatitis B virus carriers and in patients with chronic hepatitis B infection. Arab J Gastroenterol 2017; 18:98-103. [PMID: 28579343 DOI: 10.1016/j.ajg.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/24/2017] [Accepted: 05/14/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Apoptosis represents a well-known mechanism of cell death involved in most chronic liver injuries. Our aim was to investigate the serum fragment level of cytokeratin 18 (CK18), M30, in asymptomatic hepatitis B virus (HBV) carriers and patients with chronic hepatitis B (CHB) and to evaluate the relationship between serum M30 levels and the severity of hepatic injury. PATIENTS AND METHODS Asymptomatic HBV carriers (n=169), patients with CHB (n=100), and healthy control subjects (n=43) were enrolled in the study. Serum CK18 (M30) levels were analysed in all subjects. Liver biopsy for histopathological assessment was performed in asymptomatic HBV carriers and in patients with CHB infection. RESULTS Serum CK18 (M30) levels were significantly higher in asymptomatic HBV carriers (198.77±77.62U/L) than in healthy control subjects (146.92±40.18U/L). Patients with CHB (283.02±147.45U/L) had significantly higher CK18 (M30) levels than asymptomatic HBV carriers (p=0.001). The diagnostic efficacy of CK18 (M30) levels in distinguishing patients with HBeAg-negative CHB from asymptomatic HBV carriers was found to be moderate (c-statistics: 0.695), and the diagnostic cut-off value of CK18 (M30) was 262U/L (specificity: 85%, sensitivity: 48%, positive likelihood ratio: 3.35, and negative likelihood ratio: 0.60). There was a positive correlation between serum CK18 (M30) levels and histological activity index scores in asymptomatic HBV carriers and patients with CHB. CONCLUSIONS Serum CK18 (M30) levels may be a valuable indicator in distinguishing asymptomatic HBV carriers from patients with HBeAg-negative CHB when considered together with ALT and HBV-DNA levels.
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Cao ZJ, Li J, Wang Y, Bao R, Liu YH, Xiang XG, Lin LY, Ye FX, Lu J, Xie Q, Bao SS, Wang H. Serum hepatocyte apoptosis biomarker predicts the presence of significant histological lesion in chronic hepatitis B virus infection. Dig Liver Dis 2016; 48:1463-1470. [PMID: 27575659 DOI: 10.1016/j.dld.2016.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/03/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatocyte death, either apoptosis or necrosis, is closely associated with hepatic inflammation and fibrosis. AIMS To investigate the potential values of hepatocytes death biomarker, M30 (apoptosis) and M65 (total death) in predicting histological lesions in chronic hepatitis B virus (HBV) infection. METHODS Total 201 treatment-naïve patients were prospectively recruited. Liver biopsies were performed prior to antiviral treatments for treatments starting evaluation. Sera were collected on the day of liver biopsy for biomarker measurements. Sera from 200 age-matched healthy volunteers served as healthy controls (HCs). RESULTS Significant histological lesions (SHL, i.e. significant inflammation and/or significant fibrosis) were confirmed in 150 (74.63%) patients. There were significantly higher serum M30 and M65 in patients with SHL than those without SHL (p<0.001) or than HCs (p<0.001). Serum M30, but not M65, independently predicted SHL [odds ratio:3.4 (95% CI, 1.8-6.2) per increase of 50U/L, p<0.001] after adjusting other potential confounding factors. A novel model based on M30 provided good diagnostic performance in predicting SHL [AUC, 0.87 (0.81-0.92)]. Cut-off value of >0 to confirm or ≤-0.5 to exclude SHL has ∼12% misclassification rate. CONCLUSION Hepatocyte apoptosis biomarker, M30 is a promising non-invasive alternative to liver biopsy in chronic HBV infection upon treatment evaluation.
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Affiliation(s)
- Zhu-Jun Cao
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jing Li
- Department of Infectious Diseases, Huai-An Fourth People's Hospital, Jiangsu 223002, China
| | - Yun Wang
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Rebecca Bao
- Discipline of Anatomy and Histology, School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Yu-Han Liu
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xiao-Gang Xiang
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Lan-Yi Lin
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Fu-Xiang Ye
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jie Lu
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qing Xie
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Shi-San Bao
- Discipline of Pathology, School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Hui Wang
- Department of Infectious Diseases, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
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Yilmaz B, Aktas B, Altinbas A, Ginis Z, Ozturk G, Ekiz F, Kilincalp S, Deveci M, Simsek Z, Coban S, Basar O, Yuksel O. The Role of M30 in Predicting the Severity of Liver Fibrosis and Inflammation in Chronic Hepatitis B Patients. Hepat Mon 2016; 16:e35640. [PMID: 27822256 PMCID: PMC5088916 DOI: 10.5812/hepatmon.35640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 06/12/2016] [Accepted: 07/10/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver biopsy is an invasive procedure that is currently still necessary for predicting underlying hepatic injury related to chronic viral hepatitis B (CVHB). To date, none of the studied non-invasive methods have been able to replace liver biopsy. An apoptotic serum marker, M30, which has been reported to indicate ongoing liver fibrosis, has been popular in recent years. OBJECTIVES We aimed to investigate the possible role of M30 in predicting CVHB-associated hepatic injury and its severity. METHODS Forty-eight patients undergoing liver biopsy for evaluation of the severity of CVHB-related liver injury and 40 healthy controls were included in this cross-sectional study. M30 levels were determined for all CVHB patients and controls, and other laboratory parameters and demographic features were obtained from our hospital's database. RESULTS The mean ages of patients and controls were 39.7 and 45.7 years, respectively, and 35% of the controls and 52% of the patients were male. In contrast to lower platelet counts, transaminase and M30 levels were both higher in the patient group than in the controls. Among the investigated parameters, only transaminase increased as the fibrosis stage changed from mild to moderate; however, none of the laboratory parameters, including M30, differed as the histological activity index (HAI) score increased. CONCLUSIONS M30 levels were higher in CVHB patients compared to healthy controls. However, M30 levels were similar in the mild and moderate stages of fibrosis, so they did not indicate the severity of underlying fibrotic or inflammatory processes in CVHB patients.
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Affiliation(s)
- Baris Yilmaz
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
- Corresponding Author: Baris Yilmaz, Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey. Tel: +90-3125963085, Fax: +90-3123186690, E-mail:
| | - Bora Aktas
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Akif Altinbas
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Zeynep Ginis
- Department of Biochemistry, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Gulfer Ozturk
- Department of Biochemistry, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Fuat Ekiz
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Serta Kilincalp
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Murat Deveci
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Zahide Simsek
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Sahin Coban
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Omer Basar
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Osman Yuksel
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Yang ZH, Yang SX, Qin CZ, Chen YX. Clinical values of elevated serum cytokeratin-18 levels in hepatitis: a meta-analysis. Hepat Mon 2015; 15:e25328. [PMID: 26045704 PMCID: PMC4451272 DOI: 10.5812/hepatmon.15(5)2015.25328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND As an important intermediate filament protein within liver cells, cytokeratin-18 (CK-18) has been confirmed as a potential indicator in various hepatitis progressions. OBJECTIVES We sought to clarify the connection between serum CK-18 levels and hepatitis pathogenesis in the present meta-analysis. MATERIALS AND METHODS With the application of various computerized databases, including PubMed, Embase, Cochrane Library, Google Scholar, Web of Science, China BioMedicine (CBM), China National Knowledge Infrastructure (CNKI), published papers that assessed the relationship between serum CK-18 levels and hepatitis were obtained. The main key words used are "Hepatitis", "hepatitides", "Cytokeratin-18", "Keratin-18" and "CK-18". Statistical analysis was conducted using the STATA software (version 12.0). RESULTS Eight case-control studies published between 2010 and 2014 were confirmed eligible, according to our selection criteria. The results of the meta-analysis showed that serum levels of CK-18 in hepatitis patients were higher compared to healthy controls (standardized mean difference (SMD) = 3.71, 95%CI: 2.27-5.14, P < 0.001). Subgroup analysis by ethnicity and disease implicated that high serum CK-18 levels might be a risk factor for non-alcoholic steatohepatitis (NASH), chronic hepatitis C (CHC), and chronic hepatitis B (CHB) (all P < 0.05) among Asians (SMD = 2.89, 95%CI: 2.35-3.43, P < 0.001), Africans (SMD = 0.69, 95%CI: 0.12-1.26, P = 0.017), and Caucasians (SMD = 4.86, 95%CI: 1.82-7.89, P = 0.002). CONCLUSIONS Serum CK-18 levels in hepatitis patients were higher, compared with healthy controls. Our results revealed the clinical values of CK-18, in combination with other apoptosis markers, in identifying the development of hepatitis.
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Affiliation(s)
- Zhao Hui Yang
- Department of Infectious Diseases, People’s Hospital of Linyi City, Linyi, PR China
| | - Su Xian Yang
- Department of Infectious Diseases, People’s Hospital of Linyi City, Linyi, PR China
| | - Cheng Zhi Qin
- Department of Infectious Diseases, People’s Hospital of Linyi City, Linyi, PR China
| | - Yun Xiu Chen
- Department of Infectious Diseases, People’s Hospital of Linyi City, Linyi, PR China
- Corresponding Author: Yun Xiu Chen, Department of Infectious Diseases, People’s Hospital of Linyi City, PR China. Tel/Fax: +86-05398086739, E-mail:
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Bae CB, Kim SS, Ahn SJ, Cho HJ, Kim SR, Park SY, Song GW, Kim DJ, Hwang SG, Yang JM, Kim YB, Park YN, Shin SJ, Cho SW, Cheong JY. Caspase-cleaved fragments of cytokeratin-18 as a marker of inflammatory activity in chronic hepatitis B virus infection. J Clin Virol 2013; 58:641-6. [PMID: 24210327 DOI: 10.1016/j.jcv.2013.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/23/2013] [Accepted: 10/06/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The differential diagnosis between inactive carrier and active hepatitis is important in patients with chronic hepatitis B (CHB) virus infection. Serum cytokeratin (CK)-18 fragments (M30-antigen) are proposed as biomarkers of apoptosis. OBJECTIVES We investigated whether serum M30-antigen levels might help to characterize the various phases of CHB and predict the state of significant inflammation in patients with CHB. STUDY DESIGN A total of 339 CHB patients who underwent liver biopsy, were included. Serum M30-antigen levels were compared between inactive carriers (n=21), patients with HBeAg-negative hepatitis (n=95), HBeAg-positive hepatitis (n=141) and liver cirrhosis (n=82). RESULTS Serum M30-antigen levels were correlated significantly not only with AST (r=0.544, p<0.001) and ALT (r=0.315, p<0.001) and but also inflammatory grading score on liver biopsy (r=0.240, p<0.001). Serum M30-antigen level in HBeAg-negative CHB was significantly higher than that of inactive HBV carrier (399.78 U/L vs 148.90 U/L, p<0.001). Multivariate analysis showed that AST (p<0.001), albumin (p=0.009) and M30-antigen (p=0.020) were the independent predictors of significant inflammation. Combined serum M30-antigen level (>344 U/L) and AST (>78 IU/L) measurement provided the most accurate identification of significant inflammation, showing 38.2% sensitivity, 96.1% specificity, 91.0% positive predictive value and 56.1% negative predictive value. CONCLUSIONS Serum M30-antigen can be a predictive marker for distinguishing between inactive carrier and HBeAg-negative CHB. Serum M30 levels are associated with the presence of significant inflammation, especially in patients with normal or minimally elevated ALT in CHB patients.
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Affiliation(s)
- Chang Bum Bae
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea
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Abstract
Keratins, a major component of epithelial cell intermediate filaments, provide structural support to the cell and are important for the maintenance of structural integrity. Beyond its role of structural integrity in hepatocytes, keratin 18 (K18) is a known marker of apoptosis and has been proposed as an indicator of progression in chronic liver diseases such as nonalcoholic fatty liver disease (NAFLD). NAFLD is the most common cause of chronic liver disease in children and adolescents in the United States and throughout the world and comprises a wide spectrum of disease ranging from simple steatosis (fatty liver) to nonalcoholic steatohepatitis (NASH) and cirrhosis. While simple steatosis is typically benign in nature, NASH is a more serious condition that may progress to end-stage liver disease and liver failure. Currently, liver biopsy is considered the most reliable method of assessing the histological severity of disease and differentiating between simple steatosis and NASH. Because biopsy is invasive in nature, expensive, and subject to sampling error and/or variability in interpretation, it is not suitable as a screening test. Therefore, it is necessary to examine known mechanisms associated with the progression of liver disease, such as hepatocellular apoptosis, and identify potential biomarkers that could be used as a diagnostic tool in NASH. This review will focus on the role of apoptosis in pediatric liver disease and how K18, an early marker of apoptosis, can be utilized as a noninvasive biomarker to diagnose NASH.
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Affiliation(s)
- Yanci O Mannery
- Department of Pharmacology and Toxicology, University of Louisville Medical Center Louisville, KY 40202
| | - Craig J McClain
- Department of Pharmacology and Toxicology, University of Louisville Medical Center Louisville, KY 40202 ; Department of Medicine, University of Louisville Medical Center, Louisville, KY 40202 ; Robley Rex VAMC, Louisville, KY
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322 ; Children's Healthcare of Atlanta, Atlanta, GA 30322
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11
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Abstract
Experimental and clinical evidence suggests that cytokeratins (CK), among other physiological functions, are expressed in hepatocytes and can be released in the bloodstream after acute or chronic inflammatory liver injury. Interest in CK in viral and nonviral hepatitis has been rapidly increasing during the last years, especially as they have been proposed as circulating biomarkers of hepatocyte necrosis and apoptosis. In the present review, we sought to summarize and discuss the alterations in circulating CK levels in different form viral and nonviral hepatitis, as well as their potential relation with liver histology. Understanding the mechanisms of hepatitis impact on CK and vice versa is a promising area of research that will positively enhance our understanding of the complexity of acute and chronic inflammatory liver injury.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Marmara University, School of Medicine, Pendik, 34899 Istanbul, Turkey.
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