Potential of Apolipoprotein A1 (ApoA1) for Detecting Liver Cirrhosis and Hepatocellular Carcinoma

Abstract

Objective: Liver cirrhosis and hepatocellular carcinoma (HCC) are chronic liver diseases that can cause serious health problems. Meanwhile, the methods used to detect liver cirrhosis and HCC are limited. Apolipoprotein A1 (ApoA1) is a protein that makes up high-density lipoprotein (HDL), which plays a role in liver cirrhosis and HCC, and can be used as a biomarker. This study aims to determine the ability of ApoA1 to detect and differentiate liver cirrhosis and hepatocellular carcinoma. Methods: This cross-sectional study was conducted on 47 patients with liver cirrhosis and HCC at Margono Soekarjo Regional General Hospital, Purwokerto, Indonesia. This study also involved 33 healthy participants from blood donors at the Blood Transfusion Unit, Indonesian Red Cross, Banyumas. Serum ApoA1 levels were analyzed by ELISA method. Receiver Operating Characteristics (ROC) were used to evaluate the diagnostic power of ApoA1 and differentiate between cirrhotic, HCC, and healthy patients. Multivariate binary logistic regression test to determine the most influential variables on the incidence of cirrhosis, HCC, and health. Results: ApoA1 was able to differentiate cirrhosis from HCC, cirrhosis from healthy and HCC from healthy, with sensitivity 56.7%, 86.7%, 70.6%, specificity 70.6%, 93.9%, 84.9%, respectively, and AUC 68.5%, 92.6%, 75.0%. AFP (p = 0.002, OR 1.004) and bilirubin (p = 0.021, OR 1.259) were variables that contributed to cirrhosis -HCC. Age (p = 0.011, OR 0.766) and AST (p = 0.003, OR 0.834) are variables that play a role in health -cirrhosis. ALT (p = 0.024, OR 0.965) and PT (p = 0.004, OR 0.253) are variables that play a role in healthy -HCC. Conclusion: ApoA1 was best for detecting healthy from cirrhosis, followed by healthy from HCC and cirrhosis from HCC. ApoA1 is not the primary variable determining the incidence of cirrhosis -HCC, healthy -HCC, and healthy -HCC.

Prevalence of Hepatocellular Carcinoma in Hepatitis B Population within Southeast Asia: A Systematic Review and Meta-Analysis of 39,050 Participants

“…The high rate of hepatitis B infection in Southeast Asia and its accompanying comorbidities and consequences can be blamed for the high burden of HCC in HBV cases there. The results of this study agree with those of earlier studies [77][78][79][80].…”

Single-cell RNA sequencing reveals cell subpopulations in the tumor microenvironment contributing to hepatocellular carcinoma

“…Previous studies have shown that elevated levels of APOA1 are associated with liver injury (Gumilas et al, 2022). In the present study, APOA1 was not only most highly expressed in the APOA1 + HCC subpopulation, but was also highly expressed in other malignant HCC cells; therefore, it may be a potential biomarker for HCC.…”

APOA1 mRNA and serum APOA1 protein as diagnostic and prognostic biomarkers in gastric cancer

“…The deficiency or reduction of APOA1 can result in the accumulation of cholesterol in tissues, and cancer cells often show increased cholesterol synthesis, possibly due to the high cellular demand for cholesterol to support rapid proliferation and cell membrane synthesis, thereby promoting tumor growth. Gumilas et al ( 29 ) highlighted the potential mechanistic role of APOA1 in liver cirrhosis and hepatocellular carcinoma (HCC), stating that the primary biological function of APOA1 is to facilitate reverse cholesterol transport, transporting excess cholesterol from peripheral tissues to the liver for metabolism. Additionally, APOA1 possesses various biological properties such as anti-inflammatory, antioxidant, and immune-modulatory effects.…”