title: Liver function as assessed by breath tests in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Little is known on hepatic function in patients with hepatocellular carcinoma (HCC). Metabolic changes were explored in HCC patients before/after nonsurgical therapy.
  
  
  METHODS
  HCV-related Child-Pugh A cirrhotic patients with (n = 37) or without HCC (n = 14) and healthy controls (n = 23) were enrolled. Subjects underwent breath testing with (13)C-methacetin or (13)C-ketoisocaproate for exploring microsomal and mitochondrial function, respectively. HCC patients repeated the tests 1-2, 30, and 180 d after radiofrequency ablation (n = 27, RFA) or transarterial chemoembolization (n = 10, TACE).
  
  
  RESULTS
  At baseline, cirrhotic patients showed decreased methacetin demethylation capacity compared with controls (8.1 +/- 2.1 versus 13.7 +/- 1.3% cum. dose exhaled at 60 min, M +/- CI, P < 0.001) and minor changes in ketoisocaproate decarboxylation. HCC patients had methacetin demethylation comparable to cirrhotic subjects, but a significantly lower ketoisocaproate decarboxylation (8.5 +/- 1.0 versus 11.6 +/- 1.9% cum. dose exhaled at 60 min, P < 0.001). Methacetin metabolism was significantly decreased following TACE (-28%, P < 0.05) but not RFA. Ketoisocaproate decarboxylation was unaffected by TACE but decreased after RFA (-27%, P < 0.05). A recovery was noticed with ketoisocaproate as a probe after 1 and 6 mo (P < 0.003). HCC recurrence was associated with early decrease of ketoisocaproate decarboxylation.
  
  
  CONCLUSIONS
  Liver mitochondrial function is decreased in cirrhotic patients with HCC suggesting a possible tumor-induced suppressant effect. RFA but not TACE appears to spare residual (microsomal) liver mass, but induces such a transient stunning effect on mitochondrial function. Improved mitochondrial function after 1 and 6 mo from RFA may represent an additional parameter of treatment efficacy. Breath test assessing liver function may have potential applications in HCC management.
authors.affiliation: Clinica Medica A Murri, Department of Internal Medicine and Public Medicine, University of Bari Medical School, Bari, Italy. v.palmieri@semeiotica.uniba.it
authors.forename: Vincenzo O
authors.initials: VO
authors.lastname: Palmieri
authors.forename: Ignazio
authors.initials: I
authors.lastname: Grattagliano
authors.forename: Francesco
authors.initials: F
authors.lastname: Minerva
authors.forename: Silvana
authors.initials: S
authors.lastname: Pollice
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Palasciano
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
mesh_terms: D000081:Acetamides / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001944:Breath Tests / Q000379:methods*; D002247:Carbon Isotopes; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007651:Keto Acids / Q000378:metabolism; D008099:Liver / Q000378:metabolism / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008930:Mitochondria, Liver / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000081:Acetamides; D002247:Carbon Isotopes; D007651:Keto Acids; C035495:methacetin; C013082:alpha-ketoisocaproic acid