Abundance of Immunologically Active Alanine Aminotransferase in Sera of Liver Cirrhosis and Hepatocellular Carcinoma Patients

Kim, Hyun Jeong; Oh, Sang Wook; Kim, Dong Joon; Choi, Eui Yul

doi:10.1373/clinchem.2008.102996

Cited by 16 publications

(18 citation statements)

References 14 publications

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“…Elevated concentrations of these aminotransferases in patients with HCC may result from ischemic necrosis of hepatocytes immediately adjacent to one or more tumor masses, HCC-associated steatohepatitis, or ongoing chronic hepatitis B or C infection [25]. The absence of aminotransferase concentrations from current staging systems may be due to the inability of conventional assays to measure total ALT, only the fraction that is enzymatically active [26]. Alternatively, elevated aminotransferase levels may reflect tumor-induced liver damage or the ability of a patient's liver to withstand the rigors of chemotherapy rather than locoregional treatment.…”

Section: Discussionmentioning

confidence: 99%

Relationship between baseline hepatic status and outcome, and effect of sorafenib on liver function: SHARP trial subanalyses

Raoul¹,

Bruix²,

Greten³

et al. 2012

Journal of Hepatology

111

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Section: Discussionmentioning

confidence: 99%

Relationship between baseline hepatic status and outcome, and effect of sorafenib on liver function: SHARP trial subanalyses

Raoul¹,

Bruix²,

Greten³

et al. 2012

Journal of Hepatology

111

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“…Elevation that is present before pregnancy (an often unknown fact) may indicate an underlying hepatic disease that requires further evaluation and/or treatment. Elevation of liver-associated enzymes that develops during pregnancy is usually considered to be an important finding and traditionally has been felt to be due to one of several severe conditions that can affect the mother and/or her baby, including those related to preecclampsia [including acute fatty liver of pregnancy and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome], hyperemesis gravidarum, and intrahepatic cholestasis of pregnancy (1 ). In one study, this occurred in 3% of all pregnancies (2 ).…”

Section: Authors' Disclosures or Potential Conflicts Of Interest: No mentioning

confidence: 99%

Fluctuating Serum Aspartate Aminotransferase Activity in a Complicated Pregnancy

et al. 2015

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A 29-year-old para 0 gravida 2 woman with a history of infertility and spontaneous abortion presented to her local hospital at 9 weeks gestation with severe nausea and vomiting. Symptoms persisted for 10 weeks, leading to the diagnosis of hyperemesis gravidarum and treatment with intravenous fluids (3 times/week) and Zofran. At 8 weeks gestation, laboratory tests were unremarkable with the exception of increased aspartate aminotransferase (AST) 5 measured at a regional reference laboratory [105 U/L; reference interval (RI), 10 -40 U/L]. AST continued to be monitored at the same laboratory, peaking at 132 U/L (9 weeks gestation) and gradually declining to 38 U/L by 19 weeks gestation. By 20 weeks gestation, the symptoms of hyperemesis gravidarum resolved. At 32 weeks gestation the patient returned to the hospital with significant right upper quadrant (RUQ) pain. Serum AST, measured this time at the local hospital laboratory, was markedly increased [336 U/L (RI, 14 -36 U/L)], whereas alanine aminotransferase (ALT; EC 2.6.1.2), ␥-glutamyltransferase, alkaline phosphatase, and bile acids were within reference intervals. RUQ ultrasound findings were unremarkable. Symptoms persisted 1 week later (33 weeks gestation) and the AST activity measured at the local hospital laboratory remained increased (311 U/L). However, a paired sample evaluated at the regional reference laboratory indicated that AST activity was within the reference interval (17 U/L). All other laboratory values were consistent between the regional reference laboratory and the local hospital laboratory (data not shown). For the next 3 weeks (33-36 weeks gestation) AST was monitored at the regional reference laboratory and the AST results were within reference intervals (16 U/L, 15 U/L, and 25 U/L). By 36 weeks gestation the RUQ pain was continuous and the patient's liver enzymes were closely monitored at the local hospital laboratory, where AST activity was again increased (312 U/L, 309 U/L, and 294 U/L). A second RUQ ultrasound was performed and was unremarkable. At this time, bile acids were mildly increased [17 mol/L (RI, Ͻ10 mol/L)], but other liver and pancreatic enzymes tested were within reference intervals. All things considered, the physician and the patient agreed on an elective cesarean delivery at 37 weeks gestation. Following an uneventful delivery, serum AST remained increased; hepatitis serology was negative. Additional ultrasound imaging results of the gall bladder, pancreas, and liver were normal. CASE RESOLUTIONThe physician engaged the laboratory directors to identify the cause of the fluctuating AST. On further review it was determined that the local hospital and regional reference laboratories used different instruments/reagents that were differentially supplemented with pyridoxal 5' phosphate (P5P) (Fig. 1). Also revealing, serum samples analyzed at 2 different national reference laboratories, both using Roche Cobas c501/502 chemistry analyzers, reported discordant results (Fig. 1). The national reference laboratory reporting a lo...

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“…ALT is thought as one of the more sensitive marker of liver injury and disease progression [56-58]. However, ALT enzymatic activity may not always reflect the degree of hepatic damage as about 26% patients have persistently normal ALT levels but have a histological score greater than A1F1 [59]. Serum AST levels are most important predictor of histological activity than ALT [60-62].…”

Section: Indirect Serum Fibrosis Markersmentioning

confidence: 99%

A brief review on molecular, genetic and imaging techniques for HCV fibrosis evaluation

Ahmad

Ijaz

Gull

et al. 2011

Virol J

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BackgroundChronic HCV is one of the major causes of morbidity and mortality in the present day world. The assessment of disease progression not only provides useful information for diagnosis and therapeutic supervision judgment but also for monitoring disease. Different invasive and non invasive methods are applied to diagnose the disease from initial to end stage (mild fibrosis to cirrhosis). Although, liver biopsy is still considered as gold standard to identify liver histological stages, an assessment of the disease development based on non-invasive clinical findings is also emerging and this may replace the need of biopsy in near future. This review gives brief insight on non-invasive methods currently available for predicting liver fibrosis in HCV with their current pros and cons to make easier for a clinician to choose better marker to assess liver fibrosis in HCV infected patients.MethodsMore than 200 studies regarding invasive and noninvasive markers available for HCV liver disease diagnosis were thoroughly reviewed. We examined year wise results of these markers based on their sensitivity, specificity, PPV, NPV and AUROCs.ResultsWe found that in all non-invasive serum markers for HCV, FibroTest, Forn's Index, Fibrometer and HepaScore have high five-year predictive value but with low AUROCs (0.60~0.85) and are not comparable to liver biopsy (AUROC = 0.97). Even though from its beginning, Fibroscan is proved to be best with high AUROCs (> 0.90) in all studies, no single noninvasive marker is able to differentiate all fibrosis stages from end stage cirrhosis. Meanwhile, specific genetic markers may not only discriminate fibrotic and cirrhotic liver but also differentiate individual fibrosis stages.ConclusionsThere is a need of marker which accurately determines the stage based on simplest routine laboratory test. Genetic marker in combination of imaging technique may be the better non invasive diagnostic method in future.

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Abundance of Immunologically Active Alanine Aminotransferase in Sera of Liver Cirrhosis and Hepatocellular Carcinoma Patients

Cited by 16 publications

References 14 publications

Relationship between baseline hepatic status and outcome, and effect of sorafenib on liver function: SHARP trial subanalyses

Relationship between baseline hepatic status and outcome, and effect of sorafenib on liver function: SHARP trial subanalyses

Fluctuating Serum Aspartate Aminotransferase Activity in a Complicated Pregnancy

A brief review on molecular, genetic and imaging techniques for HCV fibrosis evaluation

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