Potential conflict of interest: Nothing to report.
“Defragmenting” the noninvasive diagnosis of nonalcoholic steatohepatitis: Hopes from cytokeratin-18†
Article first published online: 11 MAY 2009
Copyright © 2009 American Association for the Study of Liver Diseases
Volume 50, Issue 3, pages 990–991, September 2009
How to Cite
Yilmaz, Y. (2009), “Defragmenting” the noninvasive diagnosis of nonalcoholic steatohepatitis: Hopes from cytokeratin-18. Hepatology, 50: 990–991. doi: 10.1002/hep.23065
- Issue published online: 27 AUG 2009
- Article first published online: 11 MAY 2009
- Accepted manuscript online: 11 MAY 2009 12:00AM EST
To the Editor:
The multicenter study by Feldstein and colleagues1 on the usefulness of caspase-generated cytokeratin-18 (CK-18) fragments in the noninvasive diagnosis of nonalcoholic steatohepatitis (NASH) is definitely interesting. The authors convincingly demonstrated that elevated levels of CK-18 fragments, which serve as markers of hepatocyte apoptosis, are a strong and independent biochemical correlate of NASH, as well as of the presence of liver fibrosis. These results confirm and expand our original observation that CK-18 fragments might serve to noninvasively distinguish steatohepatitis in the setting of nonalcoholic fatty liver disease.2 Altogether, these findings hold great promise to downgrade the role of invasive liver biopsy as the only reliable way of diagnosing NASH and monitoring disease progression.
Of note, the authors have also provided evidence that the addition of routinely available laboratory tests did not significantly improve the sensitivity and specificity of CK-18 fragments to diagnose NASH.1 It is possible, however, that the addition of biomarkers that cover different pathophysiological facets of steatohepatitis (beside hepatocyte apoptosis) may further improve the diagnostic ability of CK-18 fragments. In this regard, it would be interesting to analyze the predictive value of CK-18 fragments in relation to biomarkers associated with the metabolic facets of NASH, i.e., novel biochemical markers of the metabolic syndrome that have been proven to be valuable tools to identify patients with NASH, such as soluble RAGE (receptor for advanced glycation end-products)3 and pentraxin 3.4 The promise for the future is not only to further validate the clinical usefulness of existing biomarker panels for NASH incorporating measurements of CK-18 fragments,5 but also to develop novel combinations of different enzyme-linked immunosorbent assay–based assays with improved sensitivity and specificity that may definitely reduce the need for liver biopsies.
Yusuf Yilmaz M.D.*, * Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey.