Relationship of α-fetoprotein levels and development of hepatocellular carcinoma in hepatitis C patients with liver cirrhosis

Comprehensive analysis and validation of SNX7 as a novel biomarker for the diagnosis, prognosis, and prediction of chemotherapy and immunotherapy response in hepatocellular carcinoma

BACKGROUND

Studies have demonstrated that Sorting nexin 7 (SNX7) functions as an anti-apoptotic protein in liver tissue and plays a crucial role in the survival of hepatocytes during early embryonic development. However, its diagnostic and prognostic value as well as the predictive value of chemotherapy and immunotherapy have not been reported in hepatocellular carcinoma (HCC).

METHODS

SNX7 mRNA expression and its diagnostic efficacy were examined in GEO datasets, and the findings were further confirmed in TCGA, ICGC cohorts, and cell lines. The protein level of SNX7 was determined using CPTAC and HPA databases, and the results were validated through immunohistochemistry (IHC). Survival analyses were performed in TCGA and ICGC cohorts, and the results were subsequently validated via Kaplan-Meier Plotter. The response to chemotherapy and immunotherapy was predicted via GDSC dataset and TIDE algorithm, respectively. R packages were employed to explore the relationship between SNX7 expression and immune infiltration, m6A modification, as well as the functional enrichment of differentially expressed genes (DEGs).

RESULTS

The expression of SNX7 at both mRNA and protein levels was significantly upregulated in HCC tissues. SNX7 exhibited superior diagnostic efficacy compared to AFP alone for HCC detection, and combining it with AFP improved the diagnostic accuracy for HCC. High SNX7 was associated with unfavorable outcomes, including poor overall survival, disease-specific survival, progression-free survival, and advanced pathological stage, in patients with HCC, and SNX7 was identified as an independent risk factor for HCC. Moreover, elevated SNX7 expression was positively correlated with increased sensitivity to various chemotherapy drugs, including sorafenib, while it was associated with resistance to immunotherapy in HCC patients. Correlation analysis revealed a relationship between SNX7 and multiple m6A-related genes and various immune cells. Finally, enrichment analysis demonstrated strong associations of SNX7 with critical biological processes, such as cell cycle regulation, cellular senescence, cell adhesion, DNA replication, and mismatch repair pathway in HCC.

CONCLUSIONS

Our study highlights the association of SNX7 with the immune microenvironment and its potential influence on HCC progression. SNX7 emerges as a promising novel biomarker for the diagnosis, prognosis, and prediction of response to chemotherapy and immunotherapy in patients with HCC.

Efficacy of erzhu jiedu recipe on hepatitis B cirrhosis with hyperalphafetoproteinemia: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Hepatitis B cirrhosis with hyperalphafetoproteinemia is the intermediate stage of liver cirrhosis progressing to hepatocellular carcinoma (HCC), there is no effective way to treat precancerous lesions of liver in modern medicine. In recent decades, clinical and experimental evidence shows that Chinese medicine (CM) has a certain beneficial effect on Hepatitis B Cirrhosis. Therefore, this trial aims to evaluate the efficacy and safety of a CM erzhu jiedu recipe (EZJDR) for the treatment of Hepatitis B Cirrhosis with Hyperalphafetoproteinemia.

METHODS

We designed a randomized, double blind, placebo-controlled clinical trial. A total of 72 patients of Hepatitis B Cirrhosis with hyperalphafetoproteinemia were randomized in 2 parallel groups. Patients in the control group received placebo granules similar to the EZJDR. In the EZJDR group, patients received EZJDR twice a day, after meals, for 48 weeks. The primary efficacy measures were changes in serum alpha-fetoprotein (AFP) and alpha-fetoprotein alloplasm (AFP-L3); The secondary indicators of efficacy are changes in liver function indicators, HBV-DNA level; Liver stiffness measurement (LSM); Hepatic portal vein diameter; T lymphocyte subgroup indexes during treatment. All data will be recorded in case report forms and analyzed by Statistical Analysis System software. Adverse events will also be evaluated.

RESULTS

The results showed that EZJDR can significantly inhibit the levels of AFP and AFP-L3 in patients with hepatitis B cirrhosis and hyperalphafetoproteinemia and have good security.

ETHICS AND DISSEMINATION

The study protocol was approved by the Medical Ethics Committee of Shuguang Hospital, affiliated with University of Traditional Chinese Medicine, Shanghai (NO.2018-579-08-01).

TRIAL REGISTRATION

This trial was registered on Chinese Clinical Trial Center (NO.ChiCTR1800017165).

Serum inducible protein-10 chemokine as a biomarker for clearance of HCV with and without treatment in Egyptian patients

BACKGROUND AND AIMS

Assessment of the potential predictive value of serum inducible protein-10 chemokine (IP-10) in the clearance of HCV in Egyptian patients with and without treatment.

MATERIALS AND METHODS

Ninety Egyptian individuals were involved in the current study where, 20 patients (23%) were chronic HCV (positive HCV antibodies and positive HCV RNA without treatment, 20 (22%) were healthy individuals (negative for both HCV antibodies and HCV RNA, 20 (22%) were natural clearance (positive HCV antibodies and negative for HCV RNA without treatment), 20 (22%) were achieved SVR after treatment (responders group, HCV positive and negative for HCV RNA after treatment) and 10 (11%) were non responders (positive HCV antibodies and still positive HCV RNA after treatment). HCV RNA was quantitated by real time PCR and serum IP10 level was measured by commercial ELISA kit. All biochemical and hematological examinations included liver function, CBC and alphefeto protein were assessed.

RESULTS

The mean serum levels of IP-10 were significantly higher (p< 0.001) in CHC patients (345.4 ± 100) pg/ml compared with healthy control group (101.5 ± 31.4) and natural clearance group (103.2 ± 40.7). Also serum levels of IP-10 was significantly elevated in non-responders group (257.4 ± 52.5) compared with each of SVR group (103.5 ± 43.5) (p< 0.001) and healthy group (101.5 ± 31.4), (p< 0.001). Prediction of a clinical response based on a IP10 chemokine revealed high sensitivity (93%), specificity (96%), negative predictive value (96%), and area under curve is (1.00). Moreover, there is no correlation ((R= 0.05), P value p< 0.795) between serum level of IP-10 and HCV viral load.

CONCLUSION

IP10 is a useful non-invasive biomarker for viral clearance and might be used to apply patients according to the predictable treatment outcome. Accordingly, patients who are unlikely to respond to treatment would avoid unnecessary exposure to medication that is related with high morbidity.

Synthesis of xanthone derivatives and anti-hepatocellular carcinoma potency evaluation: induced apoptosis

Twenty-one xanthone derivatives (XDs) were synthesized by a microwave-assisted technique. Their in vitro inhibition potency against the growth of four cancer cell lines was evaluated. XD-1 ∼ [6,9,10-trihydroxy-3,3-dimethyl-5-(2-methylbut-3-en-2-yl)-3H,7H-pyrano[2,3-c]xanthen-7-one] was confirmed as the most active agent against HepG2 cell line growth with IC₅₀ of 18.6 ± 2.31 μM. Apoptosis analysis indicated different contributions of early/late apoptosis and necrosis to cell death for XD-1. XD-1 arrested HepG2 cells on the G0/G1 phase, as indicated by the decreased expressions of cyclin D and CDK2 and the increased expressions of p21. Western blot implied that XD-1 regulated p53/MDM2 to a better healthier state. Moreover, XD-1-induced cell apoptosis was mitochondrion-mediated, as evidenced by caspase activation and involved the PI3K/AKT/mTOR signaling pathway. All the evidence supports that XD-1 is a significant anti-cancer agent for HCC.

Twenty-one xanthone derivatives (XDs) were synthesized by a microwave-assisted technique.

Disease-free survival assessment by artificial neural networks for hepatocellular carcinoma patients after radiofrequency ablation

BACKGROUND/PURPOSE

Radiofrequency ablation (RFA) provides an effective treatment for patients who exhibit early hepatocellular carcinoma (HCC) stages or are waiting for liver transplantation. It is important to assess patients after RFA. The goal of this study was to build artificial neural network models with HCC-related variables to predict the 1-year and 2-year disease-free survival (DFS) of HCC patients receiving RFA treatments.

METHODS

This study was a retrospective study that tracked HCC patients who received computer tomography-guided percutaneous RFA between January 2009 and April 2012. The numbers of total patients with 1-year and 2-year DFS were 252 and 179, respectively. A total of 15 HCC clinical variables were collected for the construction of artificial neural network models for DFS prediction. Internal validation and validation conducted using simulated prospective data were performed.

RESULTS

The results showed that the model with 15 inputs showed better performance compared with the models including only significant features. Parameters for performance assessment of 1-year DFS prediction were as follows: accuracy 85.0% (70.0%), sensitivity 75.0% (63.3%), specificity 87.5% (71.8%), and area under the curve 0.84 (0.77) for internal validation (simulated prospective validation). For 2-year DFS prediction, the values of accuracy, sensitivity, specificity, and area under the curve were 67.9% (63.9%), 50.0% (56.3%), 85.7% (70.0%), and 0.75 (0.72), respectively, for internal validation (simulated prospective validation).

CONCLUSION

This study revealed that the proposed artificial neural network models constructed with 15 clinical HCC relevant features could achieve an acceptable prediction performance for DFS. Such models can support clinical physicians to deal with clinical decision-making processes on the prognosis of HCC patients receiving RFA treatments.

Latent transforming growth factor-beta binding protein-1 in circulating plasma as a novel biomarker for early detection of hepatocellular carcinoma

This study aimed to assess the diagnostic value of the latent transforming growth factor-beta binding protein-1 (LTBP-1) in distinguishing hepatocellular carcinoma (HCC) from patients with hepatitis or liver cirrhosis. The protein levels of LTBP-1 or AFP in circulating plasma were measured by enzyme-linked immunosorbent assay (ELISA) or chemiluminescence in four cohorts: HCC (n = 167), liver cirrhosis (n = 50), chronic hepatitis B (CHB, n = 50), and healthy individuals (n = 104). Receiver operating characteristics (ROC) curves and area under the curves (AUC) of the proteins were calculated. Results showed that plasma levels of LTBP-1 were significantly higher in HCC patients than those in other three groups. LTBP-1 showed a better diagnostic performance (AUC = 0.74, 95% CI: 0.67-0.80) in distinguishing HCC from the CHB or cirrhosis patients, compared to AFP (AUC = 0.59, 95% CI: 0.52-0.65). In the early-stage HCCs investigated, diagnostic performance of LTBP-1 (AUC = 0.77, 95% CI: 0.70-0.84) remained better than that of AFP (AUC = 0.61, 95% CI: 0.52-0.69). Combination of LTBP-1 and AFP showed increased diagnostic efficiency than any of the two proteins performed alone, for both all HCC (AUC = 0.78, 95% CI: 0.72-0.83) and early-stage HCC (AUC = 0.80, 95% CI: 0.74-0.87). These findings proposed that LTBP-1 may be a promising biomarker for distinguishing HCC from the CHB or liver cirrhosis patients, especially for the early-stage HCC.

Epigenetic biomarkers in liver cancer

Liver cancer (hepatocellular carcinoma or HCC) is a major cancer worldwide. Research in this field is needed to identify biomarkers that can be used for early detection of the disease as well as new approaches to its treatment. Epigenetic biomarkers provide an opportunity to understand liver cancer etiology and evaluate novel epigenetic inhibitors for treatment. Traditionally, liver cirrhosis, proteomic biomarkers, and the presence of hepatitis viruses have been used for the detection and diagnosis of liver cancer. Promising results from microRNA (miRNA) profiling and hypermethylation of selected genes have raised hopes of identifying new biomarkers. Some of these epigenetic biomarkers may be useful in risk assessment and for screening populations to identify who is likely to develop cancer. Challenges and opportunities in the field are discussed in this chapter.

Hepatocarcinogenesis in chronic hepatitis C patients achieving a sustained virological response to interferon: significance of lifelong periodic cancer screening for improving outcomes

BACKGROUND

Due to advances in interferon (IFN) therapy for chronic hepatitis C, most elderly patients, and even many of those with advanced hepatic fibrosis, now achieve a sustained virological response (SVR). However, carcinogenesis remains problematic in these patients. Hence, we aimed to elucidate risk factors for hepatocarcinogenesis in SVR patients and to present an appropriate follow-up protocol for improving outcomes.

METHODS

We retrospectively studied 562 consecutive SVR patients for a median observation period of 4.8 years.

RESULTS

Hepatocellular carcinoma was diagnosed in 31 patients (5.5%). Respective cumulative incidences were 3.1, 10.1, and 15.9% at 5, 10, and 15 years after completion of IFN therapy. The proportional hazards model identified moderate or advanced fibrosis stage, advanced age, habitual alcohol consumption, and alpha-fetoprotein elevation as determinants of carcinogenesis, with hazard ratios of 10.7 (p < 0.001), 4.1 (p < 0.01), 3.9 (p < 0.01), and 2.6 (p < 0.05), respectively. Carcinoma was diagnosed in 26% of patients more than 10 years after completion of IFN therapy. Unexpectedly, F2 fibrosis was detected in 42% of these patients. The 5-year survival rate was 93% in the patients who had received periodic cancer screening but only 60% in those who had not.

CONCLUSION

We recommend that SVR patients be observed at 6-month intervals, at a minimum, to facilitate diagnosis at an early stage, for as long as possible after completion of therapy even if not at an advanced stage of fibrosis.