title: Novel biomarkers predict liver fibrosis in hepatitis C patients: alpha 2 macroglobulin, vitamin D binding protein and apolipoprotein AI.
abstract: BACKGROUND
  The gold standard of assessing liver fibrosis is liver biopsy, which is invasive and not without risk. Therefore, searching for noninvasive serologic biomarkers for liver fibrosis is an importantly clinical issue.
  
  
  METHODS
  A total of 16 healthy volunteers and 45 patients with chronic hepatitis C virus (HCV) were enrolled (F0: n = 16, F1: n = 7, F2: n = 17, F3: n = 8 and F4: n = 13, according to the METAVIR classification). Three serum samples of each fibrotic stage were analyzed by two-dimension difference gel electrophoresis (2D-DIGE). The differential proteins were identified by the cooperation of MALDI-TOF/TOF and MASCOT; then western blotting and Bio-Plex Suspension Array were used to quantify the protein levels.
  
  
  RESULTS
  Three prominent candidate biomarkers were identified: alpha 2 macroglobulin (A2M) is up regulated; vitamin D binding protein (VDBP) and apolipoprotein AI (ApoAI) are down regulated. The serum concentration of A2M was significantly different among normal, mild (F1/F2) and advanced fibrosis (F3/F4) (p < 0.01). The protein levels of VDBP and ApoAI were significantly higher in normal/mild fibrosis, when compared to those in advanced fibrosis (both p < 0.01).
  
  
  CONCLUSIONS
  This study not only reveals three putative biomarkers of liver fibrosis (A2M, VDBP and ApoAI) but also proves the differential expressions of those markers in different stages of fibrosis. We expect that combination of these novel biomarkers could be applied clinically to predict the stage of liver fibrosis without the need of liver biopsy.
authors.affiliation: Division of Gastroenterology, Buddhist Tzu Chi General Hospital, Taipei branch, Taiwan.
authors.forename: Ai-Sheng
authors.initials: AS
authors.lastname: Ho
authors.forename: Chun-Chia
authors.initials: CC
authors.lastname: Cheng
authors.forename: Shui-Cheng
authors.initials: SC
authors.lastname: Lee
authors.forename: Meng-Lun
authors.initials: ML
authors.lastname: Liu
authors.forename: Jing-Ying
authors.initials: JY
authors.lastname: Lee
authors.forename: Wen-Ming
authors.initials: WM
authors.lastname: Wang
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Wang
mesh_terms: D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D015153:Blotting, Western; D015180:Electrophoresis, Gel, Two-Dimensional; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology*; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D014809:Vitamin D-Binding Protein / Q000097:blood*; D000511:alpha-Macroglobulins / Q000032:analysis*
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D014809:Vitamin D-Binding Protein; D000511:alpha-Macroglobulins