Table 1.
Direct serum biomarkers of fibrosis:
In hepatic fibrosis, there is excessive extracellular matrix deposition which occurs due to a homeostatic imbalance between matrix deposition and removal 47. Several biomarkers involved either in fibrogenesis or fibrolysis have been utilized in screening fibrosis. Tissue inhibitors of metalloproteinase (TIMPs), collagen-IV, matrix metalloproteinase (MMP)-2, hyaluronic acid, and prolyl hydroxylase have been explored in CFHBI 48-50. MicroRNAs (miRNAs) are short RNA molecules that modulate gene expression at the post-transcriptional level which are increased in chronic liver diseases and have also been investigated in CFHBI 24,51,52. However, these tests are expensive, not widely available for clinical settings, results can also be confounded by other fibrotic processes seen CF 53-55, and have not resulted in improved diagnostic accuracy compared to conventional markers outlined above56,57.
Biomarker conclusions:
Taken together, direct and indirect serum biomarkers have yet to show the ability to predict the progression to aCFLD. Normal liver indices are very sensitive (i.e. exclude aCFLD) but specificity and predictability remain poor. Clinically, intraindividual changes over time are likely more significant and should be followed closely rather adhering to strict cut-offs for any individual marker.