Clinical significance of anigogenic marker in Egyptian bladder cancer patients

Vascular Endothelial growth factor [VEGF] is a principle growth factor mediating angiogenesis. The high expression of VEOF within bladder tumors is associated with a poor prognosis. We determined tissue, plasma and urinary levels of VEGF in patients with bladder cancer to study their correlation with the classical clinicopathological factors and to assess its potential role in the evaluation of bladder cancer patients. Materials and VEGF was measured by enzymeimmunoassay in the tissue, plasma and urine of 100 bladder cancer patients and in corresponding 40 healthy volunteers. Tumor tissue samples were standardized to the protein content and urine samples were normalized for creatinine content. Tissue, plasma and urinary VEGF levels were significantly elevated in bladder cancer patients compared to healthy controls [p < 0.001]. The highest VEGF levels were noted in patients with invasive and poorly differentiated bladder cancer compared to those with superficial and well or moderately differentiated individuals followed by healthy controls. Similarly, we detected the same observation in patients with lymph node metastases signifying that VEGF increases with tumor progression. Also, VEGF levels for schistosomal bladder cancer patients were elevated compared to non-schistosomal patients [although they were insignificantly different] and healthy controls as they correlated significantly together suggesting that bilharziasis may participate in angiogenie switch. VEGF sensitivity was superior to urine cytology and combined sensitivity between them was the highest [100%] when urine cytology combined with plasma or urinary VEGE Tissue, plasma and urinary VEGF were significantly correlated together implying that the tumor is the source of plasma and urinary VEGF. Our study demonstrates that strongly expressed VEGF may be relevant for diagnosis of bladder cancer patients, and it is implicated in the pathogenesis of bladder cancer progression. Quantification of urinary VEGF may provide a novel noninvasive marker for the early detection of bladder cancer as well a therapy target

Role of non invasive biomarkers in the assessment of liver condition in chronic hepatitis C Egyptian patients and if they correlate with the severity of liver affection

Hepatitis C virus [HCV] is considered the most common etiology of chronic liver disease in Egypt. Anti-HCV-positive patients are more likely to have elevated liver enzymes, liver cirrhosis, portal hypertension and spleen enlargement. Schistosomal liver disease in Egypt is commonly associated with HCV infection. Concurrent infection results in much more severe liver affection than that seen in either disease alone. Chronic hepatitis C is a slowly progressive inflammatory disease that can lead to cirrhosis with all its complications. Thus, repeated assessment of liver condition is always required. Assessment of liver damage has been primarily done by liver function tests as well as by histological evaluation. Meanwhile, assessment of liver affection is mainly done by liver biopsy with histological analysis which always remains the "reference standard" used by physicians to assess the presence as well as the degree of liver fibrosis in patients with chronic liver diseases and also to determine the appropriate management. However, many physicians are cautious to perform liver biopsy because of the relative risks associated with this procedure, particularly in patients with coagulation abnormalities. Among the possible alternatives, imaging is informative mainly for cirrhosis but not for lesser stages of fibrosis. In addition, it is nonquantitative and thus cannot track progression. Unfortunately, there are few reliable noninvasive methods for detecting liver fibrosis and its progression. Thus, a noninvasive test detecting hepatic fibrosis has become a priority in the context of hepatitis C evaluation and treatment. Therefore, identifying hepatic biomarkers that correlate with the severity of the liver pathology is an important issue in the follow up of such cases. Few serum markers such as hyaluronic acid, ferritin, and soluble interleukin-2 receptor [sIL-2R] have been reported to be useful in detecting fibrosis in liver disease. The aim of this study is to clarify the diagnostic value of serum hyaluronic acid, ferritin, and soluble interleukin-2 receptor levels as non-invasive biomarkers in the assessment of the liver condition in chronic hepatitis C Egyptian patients with and without concurrent Bilharzial affection and moreover, to evaluate whether their serum levels correlate with the histological severity of the related liver injury. One hundred and twenty Egyptian subjects were included in this study. They were divided into three main groups. Group A [n=30] included patients with chronic hepatitis C and with liver fibrosis as assessed by abdominal ultrasonography, Group B [n = 60] included patients with chronic hepatitis C and with liver cirrhosis and/or history of antibilharzial treatment and positive rectal snips for bilharzial ova, and Group C [n = 30] included apparently normal age and sex-matched subjects taken as a control group. Group B was further subdivided into two subgroups according to liver cirrhosis staging as performed by abdominal ultrasonography, where Subgroup B1 [n = 30] included patients with early cirrhotic changes while Subgroup B2 [n = 30] included patients with advanced cirrhotic changes. Patients were diagnosed as having hepatitis C by detecting HCV antibodies using a third generation enzyme immunoassay, ELISA. Biochemical blood tests were carried out to evaluate liver functions in the form of serum transaminases [AST and ALT], alkaline phosphatase [ALP], gamma glutamate [GGT], total bilirubin, as well as serum albumin. In addition, serum hyaluronic acid, ferritin, as well as sIL-2R levels were measured by EL1SA. Our study detected impaired liver functions in all patient groups compared to the controls. Liver functions were also detected to be more impaired in each of subgroup B1 early cirrhosis as well as in B2 advanced cirrhosis patients compared to group A fibrosis patients and this was statistically significant. Meanwhile, our study also demonstrated statistically significant difference on comparing both subgroups B1 and B2 together showing more impairment in subgroup. B2 advanced cirrhosis patients. The above findings denote that as the liver condition progresses from fibrosis to early then to advanced cirrhosis, the liver enzymes as well as the bilirubin concentrations increase progressively and the serum albumin concentrations decrease progressively, thus indicating more deterioration in liver functions and more liver injury. Not only this, but also our study detected more deterioration in liver functions occurring in the presence of bilharzial infection concurrent with hepatitis C infection than without it. This was shown clearly from comparing group B patients, whether subgroup B1 or B2, with history of bilharziasis to group A patients without, denoting that concurrent bilharzial infection adds more to the liver affection. As regarding the hepatic biomarkers, namely, serum hyaluronic acid, ferritin, and sIL-2R, our study detected statistically increased serum levels in each of the patient groups compared to the controls. A progressive increase in their serum levels was detected as the liver condition progressively deteriorates. Meanwhile, more serum level elevations occurred with the presence of bilharzial infection concurrent with hepatitis C infection than without it. In addition, our study reported that in advanced cirrhosis subgroup B2 patients; there was a significant positive correlation detected between each of serum hyaluronic acid, ferritin, and sIL-2R and each of ALT and GGT serum levels. A positive correlation was also detected between serum hyaluronic acid and ALP. Meanwhile, a significant negative correlation was detected between each of the above three biomarkers and serum albumin level. In conclusion, our study reported that in chronic hepatitis C Egyptian patients, as the liver affection progresses, the liver functions deteriorate progressively, thus indicating more liver injury. Not only this, but also more deterioration in liver functions was detected in the presence of concurrent bilharzial infection than without it. As regarding the serum biomarkers: serum hyaluronic acid, ferritin, and sIL-2R, a progressive increase in their serum levels was detected as the liver condition progressively deteriorates. In addition, more elevations occurred in the presence of concurrent bilharzial infection. Moreover, our study detected that in advanced cirrhosis, these biomarkers correlate significantly with the liver functions denoting not only their diagnostic value as non-invasive biomarkers in the assessment of the liver condition, but also that their levels correlate with the histological severity of the related liver injury, and thus can be used in the prognostic follow up to assess the degree of liver pathological progression especially when liver biopsy is contraindicated, thus, protecting the patient from its hazards especially in cases of hepatic coagulopathy which is well known to occur in this category of patients