Assessment of serum hydroxyproline and osteopontin as noninvasive markers of hepatic fibrosis in Egyptian patients with chronic hepatitis C virus infection

Background: Hepatitis C virus [HCV] infection is a progressive disease that may result in chronic hepatitis, cirrhosis and hepatocellular carcinoma [HCC]. Liver fibrosis is an essential factor that must be considered in the management of patients with HCV. Although liver biopsy represents the gold standard for evaluating the presence, type and stage of liver fibrosis, this technique remains a costly and invasive procedure. Therefore, several diagnostic methods for determining liver fibrosis, such as the detection of serum biomarkers, have been used

Objective: To evaluate the use of serum hydroxyproline [HYP] and osteopontin [OPN] as non invasive direct markers to assess the degree of hepatic fibrosis in Egyptian patients with chronic HCV infection in comparison to indirect markers such as aspartate aminotransferase platelet ratio index [APRI] and to determine the most diagnostically accurate non invasive marker of hepatic fibrosis, hoping to replace liver biopsy in the next few years

Methodology: This study was carried out on 48 patients with chronic HCV infection who had undergone liver biopsy and scored as mild fibrosis [F1], moderate fibrosis [F2], sever fibrosis [F3] and liver cirrhosis [F4] based on Metavir scoring system, and 12 age and sex matched controls. The serum levels of HYP and OPN were measured by enzyme linked immunosorbent assay [ELISA]

Results: There was a highly significant increase in HYP, OPN and APRI in all patients groups in comparison to control group and their increase was significantly associated with the degree of hepatic fibrosis. Furthermore, HYP, OPN and APRI values showed highly significant increase in significant hepatic fibrosis [F2-F4] in comparison to mild fibrosis [F1], and in hepatic cirrhosis [F4] in comparison to hepatic fibrosis [F1-F3]. There was a highly significant positive correlation between serum HYP level, OPN and APRI. The receiver operating characteristic [ROC] curve analysis revealed that OPN has the highest area under the curve [AUC] value for discriminating fibrosis stages, followed by HYP and lastly APRI

Conclusion: This study demonstrated that OPN was the most diagnostically accurate marker for assessing the severity of hepatic fibrosis and served as a prognostic index towards the progression of hepatic fibrosis to cirrhosis in patients with chronic HCV infection, followed by HYP and lastly APRI. These findings indicated that OPN and HYP could be used as non invasive markers of hepatic fibrosis and cirrhosis which would help to reduce the need for liver biopsy in chronic HCV infection

Assessment of the dynamic immunological interaction between the lactating mothers and their infected nursing infants

Human breast milk is an unique, natural source of nutrition for the human infants which protects them from infections and assists in the development of the infants' intestinal mucosa, gut micro flora and own defenses

The immunomodulatory function of breast milk is thought to be mediated by both cellular and biochemical components, including milk fat globules, immune competent cells, soluble proteins like immunoglobulin [Ig]-A, cytokines and antimicrobial peptides, and bioactive substances like hormones and growth factors. To investigate the effect of active infection in the nursing infants on some immunologic factors [leukocytes, lactoferrin and cathelicidin] in breast milk of their healthy lactating mothers which could be used as a diagnostic tool for assessment of the health status of nursing infants and to ensure the protective role of breast milk. Breast milk from healthy mothers of 15 infants, up to 3 months of age, who were hospitalized with fever, was sampled during active illness and recovery. Another milk samples were taken from mothers of 15 healthy infants of the same ages who served as controls. The total number of leukocytes in all milk samples was counted by Flow Cytometry and the milk levels of lactoferr in and cathelicidin were measured by ELISA. Total CD45[+] leukocytes count, lactoferr in and cathelicidin levels were statistically significantly higher in breast milk of healthy mothers nursing infected infants than that in controls [P-value < 0.001]

These high results of leukocytes, lactoferr in and cathelicidin showed highly statistically significant decrease in the second milk samples were taken from mothers after recovery of infection in their nursing infants when compared to those which were taken during infection [P-value < 0.001]

The correlation between total no. of CD 45 [+] Leukocytes, lactoferr in and cathelicidin levels in SI and in S2, and bet//veen them in SI and the clinical data of the patients showed no statistical significance. Our findings support the dynamic immunological connection between lactating mothers and their nursing infants, especially during active infection that alters the milk to help protect the babies