Review Article
Abstract
The majority of HCC patients are not amenable to curative therapy as they are detected at late stages. Therefore, this study was conducted to evaluate the clinical implications of TNF-α level and its correlation with the activity of GGT and LDH in monitoring the progression of HCV-chronic liver disease. Forty-eight patients suffering from HCV-chronic liver disease were categorized into 24(50%) cases with HCC, 14(29.2%) cases with LC and 10(20.8%) cases with CH. Twenty-five healthy individuals (HI) served as control group. Sera of all individuals were examined for TNF-α, LDH, GGT, AFP and all values were correlated with other laboratory investigations. The results showed that serum levels of TNF-α, LDH, AFP were elevated significantly in HCC patients compared to LC and CH but the difference between LC and CH was elevated significantly only (p<0.0001) in TNF-α. Significant association was recorded between LDH and TNF-α, GGT, AFP, ALT and AST. Linear regression for TNF-α, LDH and AFP showed significant prediction in progressive HCV-chronic liver disease. Therefore, LDH and TNF-α could be used as independent predictors for evaluating the progression of chronic inflammation leading to cancer development.
Keywords: Tumor necrosis Factor-α (TNF-α), Lactate Dehydrogenase (LDH), Gamma Glutamyle Transferase (GGT), Alpha Fetoprotein (AFP), HCV-chronic liver diseases
Introduction
Hepatocellular carcinoma (HCC) ranks as the 5th most common malignant cancer and the 3rd most frequent cause of cancer leading death worldwide [1-3]. HCC is an environmentally related cancer, with both viral and chemical carcinogens involved in multi stage process [4]. However, the reasons for viral persistence and transformation from acute to chronic infection are not clear, but it is known that both viral and host characteristics can influence the outcome of the infection [5]. The host response to hepatitis viruses involves various components of the immune system, including T-lymphocyte immune-regulatory cytokines [6,7]. TNF-α, a monocyte/macrophage-derived cytokine, is known to possess antineoplastic, anti-viral, and potent immunomodulatory activities [8]. It has been reported that TNF-α is involved in the pathogenesis of a diversity of liver diseases including viral hepatitis and HCC [9]. The majority of HCC patients are not amenable to curative therapy as they are detected at late stages [4]
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Figure 1: Role of tryptophan and its metabolites in various disciplines.
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