Evaluation of Albumin messenger Ribo Nuclear Acid (mRNA) by Polymerase Chain Reaction (PCR) in Comparison to Alpha Feto Protein (AFP) by Chemiluminescence in Liver Disease

Abstract

Hepatocellular Carcinoma (HCC) represents the fifth most common cancer in the world and the third most frequent cause of mortality among oncological patients. It is responsible for 500,000 deaths globally every year. It represents the most common primary malignant tumor of the liver;its incidence is increasing because of hepatitis B and C virus infections.Egypt has the highest prevalence of HCV in the world with 13.8% of the population infected and seven million with chronic HCV liver disease. Up to 90% of HCC cases in the Egyptian population were attributed to HCV. Diagnosis of HCC depends on clinical evaluation, laboratory diagnosis, imaging techniques and histopathological techniques. The patient may be completely asymptomatic with no physical signs other than those of cirrhosis. Therefore the laboratory markers of HCC are very important in early diagnosis for better prognosis. The conventional and the most commonly used marker for HCC is AFP which measure by chemiluminescence technique, but AFP it has low specificity and unsatisfactory sensitivity in the diagnosis of early HCC. Thus, there is need for supplementary markers for AFP to increase the sensitivity in early diagnosis of HCC as well as the specificity in differentiation between HCC and benign lesions. In this regards, our study aimed to evaluate the clinical utility of serum ALB mRNA as a non-invasive biomarker in diagnosis of HCC and to correlate its levels with serum levels of AFP, the routinely used serological test in diagnosis of HCC. The present study included 20 patients with HCC. The second group included 20 patients with chronic hepatitis C and liver cirrhosis.10 healthy individuals were serving as a normal control group. All studied subjects in this study were subjected to full history taking, thorough clinical examination, radiological investigations and routine laboratory investigations including liver function tests as serum ALT, AST, ALP, albumin, total bilirubin, AFP in addition to serum ALB mRNA. In this study,we found that the median value of ALB mRNA was significantly higher in HCC patients group when compared to chronic liver disease patients and normal control individuals. As regards AFP and ALB mRNA, data of the present study revealed that both markers were significantly higher in cirrhosis patients and in HCC patients when compared to healthy control group. Also there was a highly significant increase of both markers in HCC patients as compared to cirrhosis patients. The best cut-off point for AFP as predictor of HCC was 5.5 IU/mL (sensitivity 80%, specificity 90%). The best cut off point for ALB mRNA as predictor of HCC was 1.879 (sensitivity 90%, specificity 73.3%).Combination of AFP and ALB mRNA revealed best cut-off of AFP at 5.5 IU/mL and best cut off of ALB mRNA at 91.13 giving sensitivity of 100%, specificity of 100%. In conclusion ALB mRNA is a promising marker for diagnosis of HCC especially when combined with AFP as the diagnostic sensitivity was optimum so both markers can be used in the screening of HCC. Insummary,weconcludethat chemiluminescence immunoassay applications have become the most important research focus in detection of tumor markers. ThemeasurementofplasmacirculatingalbuminmRNAenabledsensitiveandearlydetectionofnon-invasivediagnosticmarkerforhepaticinjuryinliverfibrosisandHCCcomparedwiththatofplasmaALTactivityandserumAFPlevels. FurtherstudiesarerecommendedtoinvestigatetheclinicalutilityofALB mRNAasabiomarkerforassessingormanagingHCC.Largenumbersofsampleswithlong-termclinicaldataareurgentlyreq