title: Angiotensin-converting enzyme for noninvasive assessment of liver fibrosis in autoimmune hepatitis.
abstract: OBJECTIVE
  There are no validated noninvasive markers of liver fibrosis in autoimmune hepatitis (AIH). An activated renin-angiotensin system (RAS) and its key element angiotensin-converting enzyme (ACE) have been implicated in the pathogenesis of hepatic fibrogenesis. We aimed to study the assumed role of activated RAS in the fibrogenic process and whether the serum concentration of ACE can predict different fibrosis stages in AIH.
  
  
  METHODS
  Serum samples of 73 consecutive patients who were diagnosed with AIH were analysed for ACE concentration. All patients underwent a liver biopsy.
  
  
  RESULTS
  Serum ACE levels increased significantly for each fibrosis score. The median ACE was 45 U/l in patients with fibrosis score I, 54 U/l in patients with fibrosis score II, 68 U/l in patients with fibrosis score III and 87 U/l in patients with fibrosis score IV. For significant fibrosis (≤F2), a 56 U/l cut-off value of ACE had 95.5% sensitivity and 74.5% specificity, and receiver-operating characteristic curves showed an area under the curve (AUC) of 0.89. For advanced fibrosis (≤F3), a 64 U/l cut-off level of ACE had 85.2% sensitivity and 94.8% specificity, and AUC was 0.91. For cirrhosis, a 68 U/l cut-off level of ACE had 100% sensitivity and 84.4% specificity, and AUC was 0.95.
  
  
  CONCLUSIONS
  Our results suggest that activated RAS may sustain hepatic fibrogenesis in AIH. Measurement of serum ACE offers an easy, accurate and inexpensive noninvasive method that differentiates significant from nonsignificant liver fibrosis in AIH. Blockade of RAS may exert beneficial effects on fibrosis progression in AIH.
authors: aDepartment of Gastroenterology, Hacettepe University Medical Faculty bDepartment of Gastroenterology, Demetevler Oncology Hospital cDepartment of Biochemistry dDepartment of Gastroenterology, Numune Education and Research Hospital eDepartment of Gastroenterology, Gazi University, Ankara fDepartment of Gastroenterology, Çanakkale State Hospital, Canakkale gDepartment of Gastroenterology, Gulhane Military Medicine Academy, Istanbul, Turkey hDepartment of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors: Cumali
authors: C
authors: Efe
authors: Mustafa
authors: M
authors: Cengiz
authors: Evrim
authors: E
authors: Kahramanoğlu-Aksoy
authors: Bülent
authors: B
authors: Yilmaz
authors: Burak
authors: B
authors: Özşeker
authors: Yavuz
authors: Y
authors: Beyazt
authors: Alpaslan
authors: A
authors: Tanoğlu
authors: Tugrul
authors: T
authors: Purnak
authors: Taylan
authors: T
authors: Kav
authors: Turan
authors: T
authors: Turhan
authors: Seren
authors: S
authors: Ozenirler
authors: Ersan
authors: E
authors: Ozaslan
authors: Staffan
authors: S
authors: Wahlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000201:enzymology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000201:enzymology* / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood*; D012372:ROC Curve; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007703:Peptidyl-Dipeptidase A