title: Vitamin D deficiency: correlation to interleukin-17, interleukin-23 and PIIINP in hepatitis C virus genotype 4.
abstract: OBJECTIVE
  To assess vitamin D (Vit D) abnormalities in hepatitis C infected patients and their relationship with interleukin (IL)-17, IL-23 and N-terminal propeptide of type III pro-collagen (PIIINP) as immune response mediators.
  
  
  METHODS
  The study was conducted on 50 Egyptian patients (36 male, 14 female) with hepatitis C virus (HCV) infection, who visited the Hepatology Outpatient Clinic in the Endemic Disease Hospital at Cairo University. Patients were compared with 25 age- and sex-matched healthy individuals. Inclusion criteria were based on a history of liver disease with HCV genotype 4 (HCV-4) infection (as new patients or under follow-up). Based on ultrasonography, patients were classified into four subgroups; 14 with bright hepatomegaly; 11 with perihepatic fibrosis; 11 with hepatic cirrhosis; and 14 with cirrhosis and hepatocellular carcinoma (HCC). Total Vit D (i.e., 25-OH-Vit D) and active Vit D [i.e., 1,25-(OH)₂-Vit D] assays were carried out using commercial kits. IL-17, IL-23 and PIIINP levels were assayed using enzyme linked immunosorbent assay kits, while HCV virus was measured by quantitative and qualitative polymerase chain reaction.
  
  
  RESULTS
  Levels of Vit D and its active form were significantly lower in advanced liver disease (hepatic cirrhosis and/or carcinoma) patients, compared to those with bright hepatomegaly and perihepatic fibrosis. IL-17, IL-23 and PIIINP levels were markedly increased in HCV patients and correlated with the progression of hepatic damage. The decrease in Vit D and active Vit D was concomitant with an increase in viral load, as well as levels of IL-17, IL-23 and PIIINP among all subgroups of HCV-infected patients, compared to normal healthy controls. A significant negative correlation was evident between active Vit D and each of IL-17, IL-23 and PIIINP (r = -0.679, -0.801 and -0.920 at P < 0.001, respectively). HCV-infected men and women showed no differences with respect to Vit D levels. The viral load was negatively correlated with Vit D and active Vit D (r = -0.084 and -0.846 at P < 0.001, respectively), and positively correlated with IL-17, IL-23 and PIIINP (r = 0.951, 0.922 and 0.94 at P < 0.001, respectively). Whether the deficiency in Vit D was related to HCV-induced chronic liver disease or was a predisposing factor for a higher viral load remains to be elucidated.
  
  
  CONCLUSIONS
  The negative correlations between Vit D and IL-17, IL-23 and PIIINP highlight their involvement in the immune response in patients with HCV-4-related liver diseases in Egypt.
authors.affiliation: Department of Biochemistry, Faculty of Pharmacy, Misr International University, Cairo 1, Egypt. mona.schaalan@miuegypt.edu.eg
authors.forename: Mona F
authors.initials: MF
authors.lastname: Schaalan
authors.forename: Waleed A
authors.initials: WA
authors.lastname: Mohamed
authors.forename: Hesham H
authors.initials: HH
authors.lastname: Amin
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004534:Egypt; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics*; D006801:Humans; D007107:Immune System; D020381:Interleukin-17 / Q000097:blood*; D053759:Interleukin-23 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000096:biosynthesis*; D016133:Polymerase Chain Reaction / Q000379:methods; D011347:Procollagen / Q000096:biosynthesis*; D014463:Ultrasonography / Q000379:methods; D014807:Vitamin D / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000378:metabolism / Q000628:therapy*
chemical_list: D020381:Interleukin-17; D053759:Interleukin-23; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D014807:Vitamin D