title: Increase of fucosylated alpha-fetoprotein fraction at the onset of autoimmune hepatitis and acute liver failure.
abstract: OBJECTIVE
  Increased serum α-fetoprotein (AFP) has been associated with a good prognosis following acute liver failure (ALF), but the levels of the fucosylated fraction of AFP (Lens culinaris agglutinin-reactive fraction of AFP [AFP-L3]) following acute liver injury remain unknown. The aim of the present study was to investigate the clinical significance of AFP and AFP-L3 in patients with acute liver injury.
  
  
  METHODS
  We investigated the serum levels of AFP and highly sensitive AFP-L3% in 27 patients with acute-onset autoimmune hepatitis (AIH), 28 patients with acute hepatitis (AH) and 22 patients with ALF at the onset using a highly sensitive immunoassay (micro-total analysis system).
  
  
  RESULTS
  The serum AFP levels were increased in patients with AIH, AH and ALF, but the levels did not significantly differ among them. However, the mean AFP-L3% level was significantly higher in patients with AIH than in patients with AH (P = 0.0039). Moreover, significantly more patients with AIH demonstrated AFP-L3 positivity (≥10%) when compared with patients with AH (P = 0.014). Although the percentage of AFP-L3 positivity increased with AFP levels, at low serum AFP levels (<10 ng/mL), significantly more patients with AIH demonstrated AFP-L3 positivity than did patients with AH (P = 0.024) or ALF (P = 0.038).
  
  
  CONCLUSIONS
  We demonstrated for the first time that highly sensitive AFP-L3% levels were increased at the onset of AIH. The mechanism underlying the increase in AFP-L3 remains to be elucidated, but this finding may reflect an alteration of the glycosylation such as hyperfucosylation, which can influence the modifications of self-antigens in hepatocytes.
authors.affiliation: Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamagiwa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tamura
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takamura
authors.forename: Takuya
authors.initials: T
authors.lastname: Genda
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: Toru
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tomoteru
authors.initials: T
authors.lastname: Kamimura
authors.forename: Toru
authors.initials: T
authors.lastname: Takahashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Minoru
authors.initials: M
authors.lastname: Nomoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi
keywords: Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein; acute liver failure; alpha-fetoprotein; autoimmune hepatitis