Biomarkers Aid Transplant Patients

A new biomarker may be able to predict which hepatitis C (HVC) patients who underwent liver transplants are likely to develop hepatic fibrosis, according to two studies in the October 2005 issue of Liver Transplantation.

HVC is the leading cause of liver transplants, and recurrence of the disease following transplant is a serious problem. Up to 20% of HCV patients are estimated to develop fibrosis or cirrhosis within two years of undergoing a transplant. Antiviral therapy might be useful for those patients likely to develop fibrosis, if they could somehow be identified. Hepatic stellate cells (HSC) normally store vitamin A in the liver, but in HCV patients these cells produce collagen and other proteins that result in fibrosis. Researchers have tried to determine if HSC activation could help predict which patients would later develop fibrosis by using laboratory analysis of alpha smooth muscle actin (alpha-SMA), a reliable marker for HSC activation.

One study of 26 HCV patients who underwent transplant was conducted by researchers at the Mayo Clinic (Rochester, MN, USA). Their findings showed that HSC activation of one particular type of cell (mesenchymal cells) was highly reliable in predicting the development of fibrosis. "Staining early post-liver-transplant biopsies for alpha-SMA may help identify patients with hepatitis C at risk for severe recurrence who may benefit from early anti-HCV or anti-fibrotic therapy,” concluded the authors.

Another study of 46 such patients by researchers at the University of North Carolina (Chapel Hill, USA) revealed that HSC activation was significantly higher in the four-month biopsies for those who developed advanced fibrosis within two years. The authors noted that alpha-SMA "is an attractive biomarker because it is determined from the organ of interest and there is biological plausibility for why increased stellate cell activity would lead to advanced fibrosis.”





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Mayo Clinic
U. of North Carolina