Evaluation of Serum Fibrosis Markers CTGF and IL-17 Versus Liver Biopsy for Detection of Hepatic Fibrosis in Egyptian Patients with Chronic Hepatitis C

Abstract

Hepatitis C virus (HCV) infection is a worldwide disease. HCV infection and its complications represent major public health problem in Egypt, where 10%-15% (about 9 million) of the general population is infected (Frank et al., 2000). Liver biopsy has been considered the gold standard and an indispensable reference method for therapeutic decisions regarding CHC, as treatment indication is based on histological findings including inflammatory grading and fibrosis staging. However, liver biopsy is associated with problems that sometimes limit its applicability as diagnostic procedure (Aselah et al., 2007, Soriano et al., 2007). These limitations have prompted the search for new approaches and have led to the development of several non-invasive tools for assessing the liver condition, such as serum markers of hepatic inflammation and fibrosis. In the current study we have chosen two biochemical markers which were IL-17 and CTGF. Connective tissue growth factor (CTGF), a member of the CCN family, is known as a multifunctional growth factor that plays important roles in extracellular matrix production, cartilage regeneration, angiogenesis, cell adhesion, migration and proliferation (Perbal, 2004). The CTGF level in blood is considered to reflect fibrosis in a variety of organs, because CTGF expression, induced by transforming growth factor beta (TGF-β) in inflammatory lesions, causes fibrogenesis in tissues, with production of extracellular matrix (Rachfal and Brigstock, 2003). Also there is Interleukin 17 (IL-17), which is best described asIL-17A, is believed to play an important role in regulating monocyte and neutrophil recruitment during inflammatory conditions (Kolls and Linden, 2004). Interleukin 17 as a family functions as a pro-inflammatory cytokine that responds to the invasion of the immune system by extracellular pathogens and induces destruction of the invasive pathogen (Miossec et al., 2009). This study was conducted on 58 patients having hepatitis C virus infection either with history of bilharziasis or without and 30 normal healthy controls. Serum sample were collected for detection of serum fibrosis markers CTGF and IL-17 using ELISA. Liver biopsies were obtained from some patients for evaluation of the expression levels of serum fibrosis markers CTGF and IL-17 by quantitative Real Time PCR and for histological examination and quantification of liver fibrosis and inflammation by Metavir scoring system.