Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Higher increase degree of FGF21 post long-term interdisciplinary weight loss therapy preserves the free fat mass and rest metabolic rate in adolescents with obesity

ABSTRACT Objective Fibroblast growth factor 21 (FGF21) is among the activators that can stimulate thermogenesis in the white adipose tissue and brown adipose tissue. People with obesity have elevated blood levels of FGF21, but also develop resistance to its action, impairing its beneficial role. Inversely, clinical treatments to weight loss has been pointed out as an important therapy for increasing and recovering sensitivity to FGF21. The aim was to analyse the effect of long-term weight loss interdisciplinary intervention on FGF21 and body composition. Subjects and methods Eighty-six post-pubertal obese adolescents (14-19 years-old), were submitted to 20 weeks of weight loss therapy (clinical, nutritional, psychological and physical exercise support). Anthropometric measures, body composition and rest metabolic rate (RMR) by bioelectrical impedance, and serum FGF21 sample by ELISA were evaluated. The adolescents were grouped according to FGF21 individual delta variations after therapy: Higher Increase (HI); lower increase (LI); lower decrease (LD); higher decrease (HD). Results All groups present weight loss. Only in FGF21 ≥ 76,5 pg/mL variation the free-fat-mass and rest metabolic rate were preserved and to others group these variables were significantly reduced. Conclusion High increase in FGF21 can contribute to preservation of FFM and RMR after weight loss therapy, could have important implications for energy balance regulation. Future studies are necessary to continue determining the role of magnitude effects of FGF21 levels in obesity to improve clinical practice, especially in paediatrics population.

Fasting insulin and alanine amino transferase, but not FGF21, were independent parameters related with irisin increment after intensive aerobic exercising

Abstract Background Irisin is a protein cleaved from fibronectin type III domain-containing protein 5 and has been implicated in the beneficial effects of exercise. However, it is unknown which factors contribute to irisin increment after intensive exercising in humans. This study aimed to assess independent factors related with serum irisin after 2 weeks of supervised physical activity in young sedentary healthy women. Design and Methods We developed a comparative, interventional, longitudinal, and prospective study at a third-level specialty health center. Between March 2010 and August 2011, 82 sedentary young adult women, without chronic diseases or regular medical treatments, were recruited. A total of 38 women fulfilled selection criteria, and irisin concentrations were quantified before and after the intervention. Independent factors related with irisin increment were evaluated according to mild to moderate and vigorous intensity of physical activity. A supervised treadmill exercise test following the Bruce’s protocol was conducted from Monday to Friday during 2 weeks. In addition, anthropometric measurements were taken, and fibroblast growth factor 21 (FGF21), glucose, insulin, and liver transaminases were measured. Results Intensity of exercising was directly related to irisin (p = 0.02) and FGF21 (p = 0.01) serum levels. However, an independent and significant relationship between FGF21 and irisin was not confirmed. A novel association was found between alanine aminotransferase (ALT) and irisin, showing a positive and significant correlation (r = 0.37, p = 0.02). The association was particularly strong with higher intensity of aerobic exercising (r = 0.64, p = 0.01). Linear regression model adjusted for glucose and body mass index confirmed an independent association between ALT and irisin and also between insulin and irisin (adjusted R² = 0.12, p = 0.04). Such association increased after grouping in moderate to vigorous physical activity intensity (adjusted R² = 0.46, F = 4.7, p = 0.03). Conclusions Serum irisin and FGF21 levels significantly increased after 2 weeks of supervised physical activity. However, only fasting insulin and ALT, but not FGF21, were independent parameters explaining irisin increment, mainly after moderate to vigorous exercising.

Is FGF-23 an early indicator of atherosclerosis and cardiac dysfunction in patients with gestational diabetes?

ABSTRACT Objective: Fibroblast growth factor 23 (FGF-23) is a phosphorus-regulating hormone and plays a role in the pathogenesis of myocardial hypertrophy. The aim of this study was to evaluate the association of FGF-23 levels with echocardiographic parameters and insulin resistance (IR) in patients with gestational diabetes. Subjects and methods: Fifty-four pregnant patients with gestational diabetes mellitus (GDM) (age, 31.12 ± 5.72 years) and 33 healthy pregnant women (age, 29.51 ± 4.92 years) were involved in the study. Fasting insulin, fasting plasma glucose (FPG), lipid profile, oral glucose tolerance test (OGTT), FGF23, echocardiographic parameters, and carotid artery intima-media thickness (CIMT) were evaluated in the two groups. Results: The two groups were not significantly different in age, sex, body mass index, lipid profile, or blood pressure. Insulin, homeostatic model assessment-insulin resistance (HOMA-IR), FGF-23 levels, CIMT, left ventricular (LV) mass, LV mass index and myocardial performance index (MPI) were significantly higher in the GDM group. HOMA-IR was positively correlated with FGF-23, and insulin was positively correlated with FGF-23. Additionally, FGF-23 was positively correlated with CIMT, LV mass index, and MPI. Conclusion: Our findings suggest that monitoring serum FGF-23 may be useful as a non-invasive indicator of subclinical atherosclerosis in patients with GDM.

Serum Fibroblast Growth Factor 21 and New-Onset Metabolic Syndrome: KoGES-ARIRANG Study

PURPOSE: Fibroblast growth factor 21 (FGF21) is a crucial metabolic regulator, with multiple favorable effects on glucose homeostasis and lipid metabolism. Since serum FGF21 level has been implicated as a potential marker for the early identification of metabolic syndrome (MetS), we investigated the association between serum FGF21 level and the development of MetS in a population-based prospective study. MATERIALS AND METHODS: We conducted a prospective study of 221 randomly sampled adults without MetS from a general population-based cohort study who were examined from 2005–2008 (baseline) and from 2008–2011 (follow-up). Baseline serum FGF21 levels were analyzed using enzyme-linked immunosorbent assay. RESULTS: During the average 2.8-year follow-up period, 82 participants (36.6%) developed new-onset MetS. Serum FGF21 levels were significantly higher in patients with new-onset MetS than in those without MetS (209.56±226.80 vs. 110.09±81.10, p < 0.01). In multivariate adjusted models, the odds for MetS development were greater in patients with serum FGF21 levels in the highest quartile, compared to those in the lowest quartile (3.84, 95% confidence interval: 1.59–9.28). CONCLUSION: Serum FGF21 level was an independent predictor for new-onset MetS in a population-based prospective study.

Is fibroblast growth factor 23 a new cardiovascular risk marker in gestational diabetes?

ABSTRACT Objective This study was designed to compare the serum levels of fibroblast growth factor 23 (FGF23) among patients with gestational diabetes mellitus (GDM) and healthy pregnant women, and to evaluate the association between hormonal and metabolic parameters. Subjects and methods A total of 82 pregnant women were consecutively enrolled in the study. Of these, 46 were diagnosed as having GDM; the remaining 36 healthy pregnant women served as controls in a cross-sectional study design. The womens' ages ranged from 22 to 38 years and gestational ages, from 24 to 28 weeks. Serum samples were analyzed for FGF23 levels using an enzyme-linked immunosorbent assay. Results Serum FGF23 levels were increased in patients with GDM compared with controls (median, 65.3 for patients with GDM vs. 36.6 ng/mL for healthy controls; p = 0.019). Mean fasting glucose (105.6 ± 7.4 vs. 70.2 ± 7.2 mg/dL, p < 0.001), HbA1c (5.6 ± 0.5 vs. 4.9 ± 0.5%, p < 0.001), insulin (median, 11.1 vs. 8.7 µIU/mL, p = 0.006) and HOMA-IR (3.0 (1.8) vs 1.4 (0.6), p < 0.001) levels were significantly higher in patients with GDM than in controls. Serum FGF23 level was positively correlated with body mass index (r2 = 0.346, p < 0.05), FPG (r2 = 0.264, p < 0.05), insulin (r2 = 0.388, p < 0.05), HOMA-IR (r2 = 0.384, p < 0.05). Conclusion Serum FGF23 levels were higher in women with GDM compared with controls. The present findings suggest that FGF23 could be a useful marker of cardiovascular disease in GDM.

Lamivudine, Entecavir, or Tenofovir Treatment of Hepatitis B Infection: Effects on Calcium, Phosphate, FGF23 and Indicators of Bone Metabolism

ABSTRACT Background. Patients with chronic hepatitis B virus (HBV) are often treated with nucleoside/nucleotide antiviral agents and metabolic bone toxicity is a possible concern. Objective. To determine the relationships between fibroblast growth factor 23 (FGF23), a phosphaturic hormone, bone mineral density (BMD), and bone biochemical abnormalities in these patients. Material and methods. This is a cross-sectional observational study comparing HBV-infected subjects treated for at least one year with tenofovir (TDF), lamuvidine (LVD), entacavir (ETV), or not treated (CON). Patients with abnormalities in either calcium (Ca), phosphate (PO4), intact parathyroid hormone (iPTH) or FGF23 were further evaluated with BMD by DXA. Results. No difference in liver enzymes or renal function seen among groups, but hypophosphatemia was seen in all groups with the highest incidence with TDF treatment (14%). FGF 23 levels were found to be elevated in 11.1% of TDF patients, 2.77% amongst controls. No elevations were found in the LVD or ETV groups. Among a subset of subjects (FGF23, PO4, and/or Ca abnormalities) who underwent further evaluation, 67% had insufficient 25-OH vitamin D, and 30% had elevated 24 h urinary Ca or PO4 excretion. No patients with FGF23 abnormalities had urine abnormalities. 40% had low DXA Z-score (<-2) at spine or hip but there was no difference between control and antiviral treatment groups and the mean FRAX score was 2.33% for major osteoporotic fractures and 0.29% for hip fracture. Conclusion. Abnormalities in bone metabolism, particularly involving vitamin D insufficiency, in HBV-treated subjects were observed with a small increased likelihood in TDF treated patients.

Glycemic control and adipokines after periodontal therapy in patients with Type 2 diabetes and chronic periodontitis

Abstract: The mechanism by which chronic periodontitis (CP) affects type 2 diabetes (T2DM) remains unclear. Therefore, the aim of this study is to evaluate the effects of periodontal therapy (PT) on the glycemic control and adipokines of patients with T2DM and CP with the purpose of elucidating the possible mechanisms by which CP influences T2DM. Forty-four patients with T2DM and CP were randomly divided into two groups according to whether they underwent PT. Periodontal status, blood glucose, and the levels of serum tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), adiponectin (APN), and fibroblast growth factor-21 (FGF-21) were measured at baseline and after 3 months. The results revealed that the probing depth (PD) and attachment loss (AL) were significantly improved, the serum levels of TNF-α and IL-6 were significantly decreased, and APN and FGF-21 exhibited substantial increases in the intervention group after 3 months (p < 0.05), whereas no significant changes were observed in the control group. The glycated hemoglobin (HbA1c) levels in both groups decreased significantly after 3 months compared with baseline (p < 0.05), but the intervention group exhibited a significantly greater change (p < 0.05). In conclusion, PT may relieve periodontal inflammation, which causes a reduction of insulin-antagonizing adipokines and an increase in insulin-sensitizing adipokines, thereby eliciting an improvement in glycemic control.

Association between Serum Fibroblast Growth Factor 21 and Coronary Artery Disease in Patients with Type 2 Diabetes

The aim of this study was to evaluate the association of plasma fibroblast growth factor (FGF)-21 with angiographically significant coronary artery disease (CAD) in patients with type 2 diabetes mellitus. Serum FGF-21 was measured in 120 patients undergoing coronary angiography. Patients were divided into 4 groups based on the presence/absence of type 2 diabetes mellitus and of significant CAD. The atherosclerotic burden was obtained by two angiographic scores: Gensini score (GS) and Extent score (ES). FGF-21 levels were higher in type 2 diabetes mellitus than in non-diabetic patients (P = 0.014). FGF-21 levels were significantly correlated with GS (r = 0.358, P < 0.001) and ES (r = 0.324, P < 0.001) in univariate analysis with all patients. After adjusting for several confounding factors, both GS and ES were associated with FGF-21 in all patients (r = 0.271, P = 0.014; r = 0.217, P = 0.041, respectively). However, FGF-21 lost significant correlation with both GS and ES with type 2 diabetes mellitus in the final model. The patients with type 2 diabetes mellitus and CAD feature had elevated FGF-21 levels. Despite of a limited role in diabetic patients, FGF-21 levels are independently associated with angiographic severity and extent of CAD.

FGF-23: estado da arte / FGF-23: state of the art

Há aproximadamente 10 anos descobriuse um hormônio denominado FGF-23 (fator de crescimento de fibroblastos 23), um membro da família dos fatores de crescimento de fibroblastos, cujas funções atualmente conhecidas envolvem o metabolismo do fósforo (P) e a inibição da 1α hidroxilase, enzima responsável pela síntese de calcitriol. Tal descoberta possibilitou um novo entendimento sobre os mecanismos de controle do P, um elemento associado com mortalidade, especialmente na doença renal crônica (DRC). Nesta revisão descreveremos diversos aspectos deste hormônio, desde a sua descoberta, função, produção, mecanismo de ação, até os últimos estudos clínicos envolvendo o mesmo. Posteriormente, abordaremos as possíveis repercussões destes estudos na prática clínica.

Approximately 10 years ago, a member of the family of the fibroblast growth factors, the hormone FGF-23 (fibroblast growth factor 23) was discovered. Its currently known functions involve phosphorus (P) metabolism and inhibition of 1αhydroxylase, the enzyme responsible for the synthesis of calcitriol. That discovery led to a better understanding of the mechanisms of P control, an element associated with mortality, especially in chronic kidney disease. This study reviews several aspects of that hormone, such as its discovery, function, production, mechanism of action, and the most recent clinical studies about it. Afterwards, a discussion about the possible effects of those studies on clinical practice will be presented.

Osteomalacia hipofosfatémica secundaria a sarcoma de muslo: caso clínico / Hypophosphatemic osteomalacia secondary to a sarcoma: report of one case

Tumor induced osteomalacia is uncommon and is characterized by an isolated and not PTH dependent reduction in tubular phosphate reabsorption. This alteration is produced by phosphaturic factors, such as fibroblast growth factor-23 (FGF-23) that are secreted by tumors. We report a 41 years old female presenting with joint pain and progressive loss of muscle strength in the lower limbs. Initial laboratory assessment showed hypophosphatemia, elevated alkaline phosphatases, normal intact parathormone levels, low levels of 25 hydroxy vitamin D and an elevated 24 h phosphaturia. Bone mineral density showed spine and femoral neck osteopenia. A positron emission tomography (PET) revealed a right thigh tumor with lung metastases. Its biopsy disclosed a fibrosarcoma. FGF-23 levels, measured by ELISA were markedly elevated. The patient was discharged with palliative measures.

Basic fibrolast growth factor and vascular endothelial growth factor levels as pulmonary biomarkers of chronic obstructive pulmonary disease

There has been increasing interest in using pulmonary biomarkers to understand and monitor the inflammation in the respiratory tract of patients with chronic obstructive pulmonary disease [COPD]. The aim of this study is evaluating circulating basic fibroblast growth factor [bFGF] and vascular endothelial growth factor [VEGF] levels to determine the value of these growth factors as biomarkers of COPD and as indicators of severity of COPD in patients with chronic obstructive pulmonary disease in comparison to the inflammatory cytokines, C-reactive protein [CRP], tumor necrosis factor- alpha [TNF- alpha and interleukin-6 [IL-6]. Also, to determine if there is a correlation between circulating levels of VEGF and bFGF and pulmonary function [FEV1]. The study included 86 patients with chronic obstructive pulmonary disease [COPD], Besides 20 healthy, age matched males with normal pulmonary function were included as controls. The patients were divided into 5 stages according to lung function measured by spirometer [FEV1% predicted]. All patients were subjected to determination of FEV1 and determination of circulating bFGF, VEGF. TNF- alpha CRP and IL-6. The results showed that the concentration of circulating bFGF, VEGF, TNF- alpha, CRP and IL-6 were significantly higher in patients with CORD in comparison to the control group and their levels increased according to the stage of disease. There was a negative correlation between the blood levels of VEGF and bFGF with FEV1 in the different stages of COPD [p<0.05]. Also, there was a strong positive correlation between VEGF and bFGF [p<0.05]. In conclusion, bFGF and VEGF could play an important role in the pathogenesis of COPD and could be considered as a reliable and early biomarker in the diagnosis of COPD

Chronic lymphocytic leukemia: clinicoprognostic value of syndecan-1 level and its ligand basic fibroblast growth factor and CD38 expression

The clinical course of B-cell chronic lymphocytic leukemia is variable. While some patients have indolent disease, others require aggressive treatment within a short time after diagnosis. So, it is important to develop sensitive stratification parameters to identify patients with poor prognosis. In this study, we measured CD38 expression in B-CLL cells and serum levels of syndccan-1 [sCD138] and its ligand basic fibroblast growth factor [bFGF] and determined if they were involved in the prognosis of the patients. We measured the expression of CD38 in 40 newly diagnosed B-CLL cases by immunohistochemical method and serum levels of syndecan-1 and bFGF by ELISA technique. CD38 expressed more in advanced stages of CLL cases [p=0.04]. Also, its expression revealed statistically significant negative correlation with the response to treatment [p=0.0002]. Syndecan-1 and bFGF levels were significantly higher in B-CLL patients than in controls. There were no significant differences in sCD138 and bFGF levels in CD38+ cases compared to CD38[+] cases [p=0.087 and 0.190 respectively]. There was no statistically significant difference in sCD138 level in B I / B II stages compared to C III / C IV stages [p= 0.238], While bFGF level was significantly higher in C III / CIV cases compared to B I / B II cases [p=0.004]. As regard response to treatment, there was statististically significant low sCD138 and high bFGF levels in cases that showed progressive disease [p=0.002 and 0.026 respectively]. CD38 expression and serum levels of sCD138 and bFGF seem to provide additional prognostic information in B-CLL cases to identify which patients may benefit from an early or more aggressive

Role of vascular endothelial growth factor [VEGF], VEGF/platelets ratio and basic fibroblast growth factor [BFGF] in diagnosis of hepatocellular carcinoma

Pre-therapeutic serum levels of the angiogenic factors VEGF and bFGF were detected in sera of HCC patients, and were compared with the routinely used tumor marker used for diagnosis and follow up of HCC as AFP to evaluate the role of these angiogenic factors in diagnosis of HCC patients. The relation between the serum levels of VEGF, and bFGF and the clinical characteristics of HCC was also elucidated. This study was conducted on 50 patients with hepatocellular carcinoma. Diagnosis was confirmed by fine needle biopsy [FNB]. The study also included 9 patients with hepatitis C, 9 with hepatitis B, and 9 patients with cirrhosis, 11 healthy age and sex matching volunteers were included as controls. HCV patients were diagnosed by positive hepatitis C antibodies. HBV patients were diagnosed by positive hepatitis B surface antigens, while the cirrhotic patients by ultrasonography and positive bilharzial antibodies. All patients and control serum samples were tested for; vascular endothelial growth factor [VEGF], basic fibroblast growth factor [bFGF], alpha-fetoprotein [AFP]. Serum VEGF, bFGF and AFP levels were significantly elevated in HCC group. According to tumor size, only AFP showed statistically significant elevation [p 0.048]. bFGF was statistically significantly higher in cases with ascites than in those without ascites [p 0.003]. AFP and bFGF were statistically significantly higher in cases with edema than in those without edema [p 0.03 and 0.05, respectively]. Only AFP showed statistically significant elevation with portal vein thrombosis [p 0.03] and stage of the disease [p 0.002]. On measuring the sensitivity and specificity of the different tumor markers in HCC, VEGF showed the highest sensitivity [98%]. while AFP showed the highest specificity [100%]. The best diagnostic accuracy for double combinations was obtained with [AFP and VEGF], [AFP and VEGF/PLT ratio], [VEGF/PLT ratio and VEGF] and [bFGF and VEGF]. The best triple combination was detected between the combination. [VFGF. bFGF and VEGF/PLT ratio] and with the combination [AFP, bFGF.and VEGF] with diagnostic accuracy of 81.1%, and 80.7% . respectively. Elevated serum VEGF and bFGF levels were encountered n I-ICC compared to control groups. and serum VEGF has a higher sensitivity than other markers for the diagnosis of HCC Combined VEGF with AFP. bFGF. or VEGF/PLT ratio or with bFGF and VEGF/PLT ratio may he used to increase the overall diagnostic accuracy in HCC

Study of the plasma level of the angiogenic peptide "basic fibroblast growth factor" [bFGF] in breast ductal carcinoma

Angiogenesis is essential for the growing tumor delivering blood born nutrients to the tumor cells that promote their survival, proliferation and then their metastatic potential. In the present study, plasma levels of the angiogenic peptide, basic fibroblast growth factor [bFGF] was measured in twenty-five females, fourteen of them with primary breast ductal carcinoma, and in eleven normal female subjects of comparable age and socioeconomic status as the patients. A significant increase in bFGF was found in cancer group than controls. Basic FGF plasma levels in cancer patients were correlated with age, menopausal state, tumor size, pathological stage, grade, number of lymph nodes involved, estrogen and progesterone receptors and the extent of angiogenesis as measured by counting microvessel density using F VIII immunohistochemical staining. Vascular endothelial growth factor [VEGF], which is another angiogenic growth factor, has been evaluated in breast tissue and was found to be increased in malignant tissue than normal breast tissue. VEGF was also measured in the plasma of control subjects and some patients having the highest values of bFGF. There was a relative increase in the plasma VEGF levels in patients than controls. There was a positive correlation between VEGF in the plasma and tissues and between them and the plasma bFGF levels in the studied patients. There was a signifiant increase in the plasma level of bFGF and older patient's age, smaller tumor size and pathologic stage as well as estrogen receptors positivity. These findings confirm that the plasma bFGF could be an important regulator of human breast cancer growth and that patients with high levels of bFGF had better prognosis

Basic fibroblast growth factor: a marker predicting the severity of joint destruction in juvenile rheumatoid arthritis

To investigate whether serum basic fibroblast growth factor [bFGF], as a representative of angiogenesis, is to be considered a useful marker for predicting joint destruction in juvenile rheumatoid arthritis [JRA]. bFGF was measured by ELISA in 30 serum samples and 8 joint fluid samples obtained from JRA patients. Patients were evaluated at baseline and 12 months later. A] Clinically with the overall articular severity score. B] Laboratory tests including ESR, complete blood count and rheumatoid factor. C] Radiologically using modified Larsen index, mal-alignment and van Rossum's scores. A group of 20 healthy children and another of 10 patients with other collagen vascular diseases were also studied for comparison. Serum bFGF was significantly higher in JRA patients than those with other collagen vascular diseases and the controls with 90% sensitivity and 100% specificity at a cut-off level of 0.203 pg/ml [control mean + 3SD]. Polyarticular JRA patients had a significant higher rate of positive bFGF than those with systemic onset or pauciarticular types. Synovial fluid bFGF levels were significantly higher than the corresponding serum values. Serum bFGF correlated positively with disease activity markers and the articular severity score. Radiological evaluation revealed higher rate of seropositive bFGF in patients with severe joint destruction than in those with mild form of joint affection. Moreover, patients whose serum bFGF levels were >0.231 pg/ml showed deterioration of the clinical and radiological scores of joints when reevaluated after one year. Serum bFGF concentration helps to assess the degree of joint involvement and is a useful prognostic marker for predicting the severity of joint destruction in JRA patients

Circulating angiogenic factors in patients with chronic liver diseases

Platelet-derived endothelial cell growth Factor [PD-ECGF], basic fibroblast growth factor [b-FGF], gangliosides [Gs] and nitric oxide [NO] are angiogenic factors expressed in various cancer tissues as well as non malignant tissues. Little is known about the role of these factors in patients with chronic liver diseases such as chronic hepatitis [CH], cirrhosis, and hepatocellular carcinoma [HCC] with cirrhosis. The levels of these factors were determined in 28 patients with chronic hepatitis, 43 with cirrhosis and 29 patients with HCC. The study also included 18 normal individuals who are comparable to patients in age as a control group. The study revealed that the levels of these angiogenic factors are significantly increased in patients with HCC in comparison with either patients with hepatitis or liver cirrhosis. Moreover, both Gs and NO are also increased in patients with cirrhosis in comparison with controls. In HCC the levels of angiogenic factors reflected tumor burden where they were significantly increased in higher burden. These angiogenic factors are derived from HCC cells as well as inflammatory cells. In cirrhosis the elevation of these factors might be related to the extent of inflammation and angiogenesis in the cirrhotic liver. These factors showed significant positive correlations with liver enzymes in HCC. Assessment of the angiogenic factors in patients with chronic liver diseases would help to follow progression of liver affection. The expression of PD-ECGF in HCC would predict its chemosensitivity