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.