Hyaluronic acid as a potential marker for assessment of fibrosis regression after direct acting antiviral drugs in chronic hepatitis C patients

Abstract

Introduction:Fibrosis is an inevitable complication of chronic hepatitis C virus (HCV) infection. Direct acting antivirals (DAAs) radically treated HCV and were suggested to ameliorate fibrosis. Silymarin (a natural herbal remedy) was proposed to further decrease hepatic inflammation and fibrosis. Consequently, serial monitoring of liver fibrosis status by different biomarkers is needed. Aim of the study: To assess hyaluronic acid (HA) as a potential marker of fibrosis regression after DAAs in chronic HCV patients; in addition, to evaluate silymarin as an agent that, beside DAAs, could further improve fibrosis. Material and methods: Two groups were included (150 patients each). Group 1 received DAAs only, while group 2 received DAAs followed by silymarin. Hyaluronic acid and FIB4 score were assessed at baseline before treatment and 1 year after inclusion in the study. Results: We found that DAA therapy alone or in combination with silymarin resulted in a significant reduction in serum HA level. However, the latter case showed a statistically significantly greater reduction (p = 0.034). Mean ±SD of serum HA level was 211.8 ±179.9 and 143.3 ±123.9 µg/l before and one year after inclusion respectively in group 1 (p = 0.001) and also, its level decreased significantly in group 2 from 188.3 ±211.8 µg/l before receiving DAAs to 126.4 ±136.9 µg/l at one year after inclusion (p = 0.001). There was no significant difference between the 2 studied groups as regards FIB-4 at 1 year after inclusion (p = 0.103). Conclusions: Hyaluronic acid might be a sensitive marker for monitoring fibrosis regression in treated chronic HCV patients. Adding silymarin to treatment protocols could ameliorate the fibrosis status.

Host Subcellular Organelles: Targets of Viral Manipulation

“…Yet, this relationship requires further examination to understand the full extent and implications of ECM remodeling due to viral interactions. In the realm of therapeutics, while certain antiviral drugs have been observed to mitigate inflammation and fibrosis in contexts like HCV [60][61][62], the specifics of their impact on the ECM remain less clear. This highlights our ever-evolving comprehension of the intricate interaction between viruses and the ECM, emphasizing the necessity for continued research.…”

Noninvasive Fibrosis Assessment in Chronic Hepatitis C Infection: An Update

“…AUROC for both diagnosis of fibrosis and cirrhosis was about 0.90 for HA compared to 0.75 for procollagen III, N-terminal propeptide (PIIINP). 63 Rewisha et al 64 compared serum levels of HA and fibrosis-4 index (FIB-4) during a 1 year follow-up after DAA therapy and showed a significant decrease in serum levels of HA. However, the diagnosis was based on laboratory and imaging parameters not the serum levels of HA with any reference value.…”