title: Clinical use of hyaluronic acid as a predictor of fibrosis change in hepatitis C.
abstract: OBJECTIVE
  Hyaluronic acid (HA) is a glycosaminoglycan synthesized by hepatic stellate cells that has been shown to correlate with liver fibrosis in chronic hepatitis C (HCV) patients. However, its use in monitoring fibrosis over time has not been established. The aim of the present study was to assess the serial relationships between HA and liver fibrosis before and after treatment.
  
  
  METHODS
  Seventy-six previously untreated chronic HCV patients received interferon-based therapy over 48 weeks. Serum HA levels were measured and liver biopsies were obtained at baseline, and 24 weeks post-treatment. Histological fibrosis was assessed by using the Knodell and METAVIR scoring systems.
  
  
  RESULTS
  Knodell fibrosis was evaluated in 76 patients; METAVIR fibrosis in 72 patients. Following treatment, patients were grouped into those with increased fibrosis (Knodell = 17; METAVIR = 16), no change (Knodell = 50; METAVIR = 45), or decreased fibrosis (Knodell = 9; METAVIR = 11), relative to baseline. Moderate correlations between HA and fibrosis scores were found before treatment (Knodell R = 0.45; METAVIR R = 0.40) and post-treatment (Knodell R = 0.45; METAVIR R = 0.61). However, changes in HA correlated poorly with changes in fibrosis scores over the study period (Knodell R = 0.11; METAVIR R = 0.06). There was poor qualitative agreement between the direction of HA change and the direction of change in fibrosis scores (Knodell kappa = 0.04; METAVIR kappa = 0.08). The sustained virological response group (n = 18) had a significantly decreased mean HA compared with non-responders (-27.9 vs 21.7 micro g/L; P = 0.009), but pretreatment HA did not predict a response.
  
  
  CONCLUSIONS
  Serum HA showed a modest association with hepatic fibrosis, and remains a useful non-invasive marker. However, serum HA alone has limited value in predicting histological changes over a treatment period.
authors.affiliation: Division of Gastroenterology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Keyur
authors.initials: K
authors.lastname: Patel
authors.forename: Adrianne
authors.initials: A
authors.lastname: Lajoie
authors.forename: Shanon
authors.initials: S
authors.lastname: Heaton
authors.forename: Stephen
authors.initials: S
authors.lastname: Pianko
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Behling
authors.forename: David
authors.initials: D
authors.lastname: Bylund
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Pockros
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Blatt
authors.forename: Andrew
authors.initials: A
authors.lastname: Conrad
authors.forename: John G
authors.initials: JG
authors.lastname: McHutchison
mesh_terms: D000276:Adjuvants, Immunologic / Q000097:blood*; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D006526:Hepatitis C / Q000097:blood* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors
chemical_list: D000276:Adjuvants, Immunologic; D015415:Biomarkers; D012367:RNA, Viral; D006820:Hyaluronic Acid; D000410:Alanine Transaminase