Serum Prohepcidin and Iron Indices in Chronic Hepatitis C Patients: Impact on Early Virologic Response to Pegylated-Interferon / Ribavirin Therapy
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Background/Aim: Prohepcidin is the precursor of hepcidin which is the key regulator of iron metabolism. It is mainly synthesized in the liver and was claimed to affect the response to therapy in patients with chronic hepatitis C (CHC).The aim of this study was to assess s. prohepcidin and iron indices [iron, ferritin and total iron binding capacity (TIBC)] in patients with CHC and to emphasize their impact on early virologic response (EVR) to combined pegylated interferon (PEG-1PN) /ribavirin (RBV) therapy. Subjects & Methods: The cases group comprised 70 adults (56 males and 14 females) with CHC (positive HCV-Ab and HCV-RNA-PCR) whose serum levels of prohepcidin and iron indices; namely s. iron, s. ferritin and TIBC were assessed before initiation of PEG-1FN/RBV therapy (beside the routine investigations including histopathological examination of liver biopsy applying the METAVIR score). Quantitative HCV-RNA-PCR was done again after the 12th week of therapy to assess EVR. Twenty healthy subjects were taken as the control group. Results: S. prohepcidin was non-significantly (P> 0.05) higher while s. ferritin and s. iron were non-significantly lower in CHC patients (cases group) than in healthy controls (167+98 0 124157 ng/ml, 1361 92 0 1501119 ng/ml and 57125 0 64125 ug/dl, respectively). TIBC was similar in both cases and control groups (229187 0 232151 ug/dl). Cases with higher METAVIR fibrosis stages (F) had lower s. prohepcidin levels (but statistically non significant with p> 0.05) and s. prohepcidin did not show significant differences in different METAVIR necroinflammatory grades (A). S. iron showed a statistically significant positive correlation with both the METAVIR grade and stage (p= 0.002 & 0.037 respectively), while s. ferritin and TIBC did not. In early responders, s. prohepcidin, s. iron and s. ferritin as well as HCV-RNA-load were nonsignificantly lower than in non-responders. At cut off value = 179 ng/ml; s. prohepcidin was 54% sensitive and 69% specific for prediction of EVR in the studied cases. In conclusion: S. prohepcidin is relatively increased in CHC patients and higher rates of EVR to combined PEG-oN/RBV therapy would be predicted in patients with lower serum -prohepcidin, -iron and -ferritin levels.