Cytokeratin 18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is one of the types of fatty liver which occurs when exceeive fat is deposited in the liver due to causes other than excessive alcohol use, NAFLD is subdivided into non alcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH). In NAFLD, hepatic steatosis is present without evidence of significant inflammation, whereas in NASH, hepatic steatosis is associated with hepatic inflammation Aims To evaluate the role of CK-18 as a non invasive marker in diagnosis of NASH and its usefulness in correlation with disease severity in Egyptian patients. Patients and Methods 60 subjects were divided into 2 groups: group I: including 30 patients with NAFLD, group II: including 30 matched healthy controls Diagnosis of NASH and its discrimination from NAFL was done by fibroscan. CK-18 level in plasma was measured for all subjects using ELISA. Results CK-18 was significantly elevated in patients of group I in comparison to group II, with mean ± SD: 460 ± 279, 167 ± 56 and 149 ± 57, respectively, and P value: 0.001. with mean ±SD: 59.6± 28, when compared with control group (with 23±8) P value < 0.001. ROC curve between Cases and Control regard CK18 with Area Under the Curve (AUC): 0.925. Cutoff > 30 ug/l With Sensitivity: 86.67% & Specificity: 83.33%. Ck-18 was found to correlate with steatosis and fibrosis assessed by fibroscan with P value< 0.001. Conclusion Measurement of serum cytokeratin 18 fragment levels (CK18) correlate with the Fibroscan (Transient Elastograph) as a non invasive tests in diagnosis & prognosis of non alcoholic fatty liver diseases (NAFLD).

Impact of Pre-operative Aerobic Exercise on Cardiometabolic Health and Quality of Life in Patients Undergoing Bariatric Surgery

“…In contrast, CK18 had a robust lowering effect to our EX + SC treatment. CK18 is a biomarker of hepatocyte apoptosis that predicts and correlates to the development of hepatic inflammation, fibrosis, as well as non-alcoholic steatohepatitis ( Maher et al, 2015 ). EX + SC decreased CK18 by 23.6% compared to an 11.6% increase with SC.…”

“…Our findings are consistent with prior work showing that 7 days of treadmill walking at ∼85% of HR max caused a significant decrease in CK18 in obese adults with non-alcoholic fatty liver disease independent of weight loss ( Fealy et al, 2012 ). Lower CK18 may improve with EX + SC through decreased oxidative stress, hepatic triglyceride stores, or Mallory bodies ( Schweizer et al, 2006 ; Maher et al, 2015 ). Why SC in contrast had increased plasma CK18 is unclear given the metabolic control prior to testing.…”

Model for Non-Invasive Diagnosis of NAFLD Incorporating Caspase 3-Cleaved Cytokeratin-18: A Clinical, Serological, and Immunohistochemical Analysis

“…Several studies have demonstrated significantly increased serum levels of CK-18 fragment in NASH versus non-NASH patients (9, 14). CK-18 was also found to correspond with disease severity as assessed by NAS scoring system, with positive correlation reported between CK-18 and NAS score, ballooning, Mallory bodies formation, steatosis, and fibrosis (30), as well fibrosis score (31). Moreover, the apoptotic marker, M30 antigen, was also shown to distinguish steatohepatitis from simple hepatic steatosis as well as being substantially correlated with the degree of hepatic fibrosis in patients with NAFLD (32).…”

The cytokeratin 18, adiponectin and leptin levels in patients with non-alcoholic steatohepatitis and coronary heart disease

“…One of the most informative markers of the inflammation and liver fibrosis is the presence of the cytokeratin 18 (CK 18). CK 18 is a fragment of intermediate phylums of cells cytoskeleton, which is cut by the effector caspase 3 because of the process of apoptosis of hepatocytes [7][8][9][10][11] . This peptide is detected in the blood even before the morphological signs of apoptosis occur.…”

“…This peptide is detected in the blood even before the morphological signs of apoptosis occur. This allows to use CK-18 as a non-invasive biomarker of non-alcoholic steatohepatitis (NASH) [1][2][3][8][9][10][11] .…”