Serum and tissue levels of zinc, copper and metallothionein as prognostic factors in patients with HCV-related liver diseases

The relationship between chronic hepatitis and trace metals has not been understood clearly. Serum metal levels such as those of zinc and copper have been reported to be highly sensitive in the diagnosis of chronic liver diseases. Metallothioneins [MT] are family of low molecular weight cysteine rich proteins which are widely distributed in various species. They are thought to be involved in heavy metal detoxification, intracellular trace elements storage and scavenging free radicals. The aim of this work was to study the serum and liver tissue levels of zinc, copper and metallothionein in patients with chronic hepatitis, liver cirrhosis and HCC, and to clarify their role in the progression of liver disease. This study was carried out on 40 patients with chronic liver disease, divided into three groups: Group I: Included 15 patients with chronic hepatitis C, Group II: Included 10 patients with liver cirrhosis [histologically diagnosed cirrhosis from patients subjected to biopsy for grading of chronic hepatitis or diagnosis of suspicious nodule], and Group III: Included 15 patients with hepatocellular carcinoma. All patients were subjected to liver function tests, viral hepatitis markers, alpha-fetoprotein, abdominal ultrasonography, and estimation of zinc, copper and metallothionein in serum and liver tissue. The results of the present study revealed that serum and liver tissue levels of zinc were significantly lower in patients with HCC than patients with chronic hepatitis and cirrhosis. On the other hand, serum and tissue levels of copper and metallothionein were significantly higher in patients with HCC than patients with chronic hepatitis and cirrhosis. Also, the present study showed a positive correlation between serum and liver tissue levels of zinc, copper and metallothionein. So, monitoring the serum level of Zn, Cu and MT can limit the need for liver biopsy for detection of their tissue level. We can conclude that serum levels of zinc, copper and metallothionein may be useful as prognostic markers for chronic liver diseases especially with the development of HCC. Future studies are encouraged to evaluate potential therapeutic role of these findings to delay the progression of chronic liver disease in HCV patients

Prevalence of celiac disease in Egyptian children and adolescents with insulin dependent diabetes mellitus: a biochemical and histopathologic study

Diagnosis of atypical and silent celiac disease [CD] is important because of its serious complications. The association of insulin dependent diabetes mellitus [DDM] and CD has been reported worldwide. The aim of this study was to determine the prevalence and clinical, biochemical and histopathologic characteristics of CD among Egyptian children and adolescents with IDDM. A total of 116 children and adolescents with IDDM [62 males and 54 females, age rage 2-21 yrs] and 25 age and sex matched healthy children were screened for CD using anti-gliadin [AGA], anti-tissue transglutaminase [t-TG], anti-reticulin [AGA] and anti-endomysial [EmA] antibodies. Clinical data, hemoglobin Air, insulin requirements, hemoglobin concentration, mean red cell volume and serum ferritin levels were evaluated. Twenty six [22.4%] patients were positive for AGA and ITG antibodies, 14 of them were ARA positive. Ten of these patients were EmA positive and four were EmA negative. From the EmA negative patients three sera with IgA deficiency had high lgG class in AGA, anti-t-TG and ARA antibodies. All these 14 patients [EmA positive and negative] underwent intestinal biopsy. Thirteen had histological evidence of CD including the EmA negative patients with IgA deficiency, giving a prevalence of CD in diabetic children of 11.2% [13/116]. Compared with the other diabetic patients, those with CD had a significantly higher height SD scores with no statistical significant changes in any other parameters. The prevalence of CD in Egyptian IDDM children and adolescents was found to the high. Serologic markers for CD are useful for identifying asymptomatic IDDM children who should undergo a small intestinal biopsy