enzymatic cycling method to detect LPA used in their study is very different from the enzyme-linked immunosorbent assay (ELISA)-based method used in our study. With regard to our data on LPA levels in healthy donors, we effectively detected serum levels 10-fold those detected in plasma. Nevertheless, the values of undiluted human serum samples are perfectly in line with the values reported in the datasheet provided by the manufacturer of the LPA assay kit (Echelon Biosciences) that we used in our study. Moreover, increased LPA concentrations have previously been reported in the serum of patients with HCC. 7 In addition, the cholestatic pruritus mentioned by Ikeda et al. occurs in patients with cholestatic disorders, which are quite different from HCC and therefore not comparable. Finally, we investigated 60 patients with HCC and 50 with liver cirrhosis, whereas the number of patients investigated by Ikeda et al. in their letter (21 with HCC and 15 with chronic hepatitis C) is too limited to draw reliable conclusions. In conclusion, we do not see a conflict between our data and those presented in the letter, and we also stand by our hypothesis, supported by other reports in the literature.ANTONIO MAZZOCCA, RESEARCH ASSOCIATE GIANLUIGI GIANNELLI, ASSOCIATE PROFESSOR