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Lin et al. Hepatoma Res 2018;4:48 I http://dx.doi.org/10.20517/2394-5079.2018.19 Page 3 of 6
of type III procollagen, hyaluronic acid (HA). They concluded that YKL-40 might be a useful non-invasive
serum marker to evaluate the efficacy of IFN therapies in patients with HCV-associated liver disease.
CHI3L1 PREDICTS RESPONSE TO ANTIVIRAL THERAPY IN CHRONIC HBV PATIENTS
[13]
Wang et al. compared serum CHI3L1 levels with liver tissue collagen proportionate area (CPA) and liver
stiffness measurement (LSM) in a cohort of 131 CHB patients before treatment and after receiving entecavir-
based antiviral therapy for 78 weeks. Before treatment, correlation analysis revealed positive correlations
between CHI3L1 levels and the CPA (r = 0.351, P < 0.001) and between CHI3L1 and LSM (r = 0.412, P < 0.001).
After 78 weeks of treatment, serum CHI3L1 levels decreased compared with baseline (87.8 vs. 69.6 ng/mL,
P < 0.001). Furthermore, the changes in CHI3L1 are correlated with changes in CPA (r = 0.366, P < 0.001)
and the changes in LSM (r = 0.438, P < 0.001) before and after antiviral treatments. They concluded that
CHI3L1 is a useful non-invasive marker for the assessment of liver fibrosis in CHB patients before treatment
and a potential useful marker for monitoring the change in liver fibrosis during therapy. More interestingly,
in many cases, CHI3L1 concentrations decreased after 78 weeks of antiviral therapies, whereas histological
stages based on biopsy did not change. However, upon closer examination of the histological images, they
found that many samples exhibited improvement in fibrosis as demonstrated by thinning of the septa and
reduction in the numbers of the septa. However, the Ishak histological stage remains the same based on the
classification standards (personal communication).
CHI3L1 PREDICTS FIBROSIS PROGRESSION RATE (FIBROSIS UNIT/YEAR) IN CHRONIC HCV
PATIENTS
Kamal et al. conducted serial liver biopsies in a 10-year longitudinal cohort study consisting of patients
[7]
with HCV alone or HCV and schistosomiasis. Two liver biopsies were performed for patients at the time
of acute HCV infection and at the end of the follow-up to calculate the fibrosis progression rate/year. In
addition, CHI3L1 serum concentrations were measured yearly and at the end of the follow-up. The serum
CHI3L1 change rate (difference between baseline and follow-up values) was compared with the fibrosis
progression rate/year. Kamal et al. reported that the CHI3L1 change rate had a very high linear correlation
[7]
with the fibrosis progression rate/year (r = 0.892, P < 0.001). Furthermore, the CHI3L1 increase rate increases
from years 4 to 8 compared with years 1 to 4 for HCV mono-infected patients, and the increase was noted
at year 2 instead of at year 4 in HCV and schistosomiasis co-infected patients. Using data from the table
of Kamal et al. , we generated a scatter plot of CHI3L1 concentration and the fibrosis progression rate per
[7]
year (increase in histological stages per year) [Figure 1]. As noted, no fibrosis progression is noted when the
CHI3L1 concentration is 53 ng/mL. As the CH3L1 concentration increases, the speed of fibrosis progression
increases. When the CHI3L1 concentration is 110 ng/mL, the speed of fibrosis progression is at 0.8 histological
stages per year [Figure 1].
CHI3L1 PREDICTS RAPID FIBROSIS PROGRESSION AFTER LIVER TRANSPLANTATION FOR
HCV PATIENTS
Pungpapong et al. obtained serum and liver biopsy samples from 46 liver transplantation (LT) recipients
[14]
at two time points: time point 1, means of 5 ± 2 (biopsy 1) months; time point 2, means of 39 ± 6 (biopsy 2)
months post-LT. Rapid fibrosis progression (RFP) was defined as an increase in the fibrosis score ≥ 2 from
biopsy 1 to biopsy 2 (a mean interval of 33 ± 6 months). They analyzed the ability of parameters, including
serum CHI3L1 and hyaluronic acid (HA), histological assessment, and hepatic stellate cell activity (HSCA)
at biopsy 1, to predict RFP. They found that serum HA and YKL-40 performed significantly better than
conventional parameters and HSCA in predicting RFP post-LT. Furthermore, CHI3L1 (cutoff ≥ 200 μg/L)
exhibited 96% accuracy and performed better than serum HA (cutoff ≥ 90 μg/L) in predicting RFP at biopsy
1 with 80% accuracy.