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Serum vascular cell adhesion molecule-1 predicts significant liver fibrosis in non-alcoholic fatty liver disease

Sander Lefere (UGent) , Frederique Van de Velde (UGent) , Lindsey Devisscher (UGent) , Marlies Bekaert (UGent) , Sarah Raevens (UGent) , Xavier Verhelst (UGent) , Yves Van Nieuwenhove (UGent) , Marleen Praet (UGent) , Anne Hoorens (UGent) , Christophe Van Steenkiste (UGent) , et al.
(2017) INTERNATIONAL JOURNAL OF OBESITY. 41(8). p.1207-1213
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Abstract
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is strongly associated with obesity, dyslipidemia and insulin resistance. NAFLD often presents as simple steatosis (NAFL) but can progress to non-alcoholic steatohepatitis (NASH) and fibrosis. Current non-invasive biomarkers are not tailored to identify significant (>= F2) fibrosis, although recent guidelines recommend a stringent follow-up of this patient population. We and others have reported on the role of pathological angiogenesis in the pathogenesis of NAFLD, highlighting pro-angiogenic factors as potential diagnostic markers. OBJECTIVE: To investigate the applicability of angiogenic and endothelial dysfunction markers as non-invasive diagnostic tools for NASH or NASH-associated fibrosis in obese patients. METHODS: In a prospective cross-sectional study, male patients undergoing bariatric surgery (n = 61) and control patients (n = 35) were recruited. Serum protein levels and visceral adipose tissue gene expression of endothelial dysfunction and angiogenic markers were analyzed by multiplex bead-based assay and quantitative RT-PCR, respectively. For validation, we recruited a second cohort of patients undergoing bariatric surgery (n = 40) and a cohort of NAFLD patients from our outpatient clinic (n = 30). RESULTS: We identified serum vascular cell adhesion molecule-1 (VCAM-1) as an independent predictor for >= F2 fibrosis (median 14.0 vs 8.7 ng ml(-1) in patients with and without significant fibrosis; P<0.0001) with an area under the receiver-operating characteristics (AUROC) curve of 0.80. The cutoff point of 13.2 ng ml(-1) showed a sensitivity of 80% and specificity of 83%. In line with these results, VCAM-1 visceral adipose tissue gene expression was also elevated in patients with fibrosis (P=0.030). In the bariatric surgery and clinical validation cohorts, VCAM-1 displayed similar AUROCs of 0.89 and 0.85, respectively. CONCLUSIONS: VCAM-1 levels are able to accurately predict significant (>= F2) fibrosis in NAFLD patients.
Keywords
ENDOTHELIAL GROWTH-FACTOR, INSULIN-RESISTANCE, PLASMA CYTOKERATIN-18, NONINVASIVE MARKERS, STEATOHEPATITIS, STEATOSIS, DYSFUNCTION, PROGRESSION, NAFLD, RISK

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Chicago
Lefere, Sander, Frederique Van de Velde, Lindsey Devisscher, Marlies Bekaert, Sarah Raevens, Xavier Verhelst, Yves Van Nieuwenhove, et al. 2017. “Serum Vascular Cell Adhesion Molecule-1 Predicts Significant Liver Fibrosis in Non-alcoholic Fatty Liver Disease.” International Journal of Obesity 41 (8): 1207–1213.
APA
Lefere, S., Van de Velde, F., Devisscher, L., Bekaert, M., Raevens, S., Verhelst, X., Van Nieuwenhove, Y., et al. (2017). Serum vascular cell adhesion molecule-1 predicts significant liver fibrosis in non-alcoholic fatty liver disease. INTERNATIONAL JOURNAL OF OBESITY, 41(8), 1207–1213.
Vancouver
1.
Lefere S, Van de Velde F, Devisscher L, Bekaert M, Raevens S, Verhelst X, et al. Serum vascular cell adhesion molecule-1 predicts significant liver fibrosis in non-alcoholic fatty liver disease. INTERNATIONAL JOURNAL OF OBESITY. 2017;41(8):1207–13.
MLA
Lefere, Sander, Frederique Van de Velde, Lindsey Devisscher, et al. “Serum Vascular Cell Adhesion Molecule-1 Predicts Significant Liver Fibrosis in Non-alcoholic Fatty Liver Disease.” INTERNATIONAL JOURNAL OF OBESITY 41.8 (2017): 1207–1213. Print.
@article{8529590,
  abstract     = {BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and is strongly associated with obesity, dyslipidemia and insulin resistance. NAFLD often presents as simple steatosis (NAFL) but can progress to non-alcoholic steatohepatitis (NASH) and fibrosis. Current non-invasive biomarkers are not tailored to identify significant ({\textrangle}= F2) fibrosis, although recent guidelines recommend a stringent follow-up of this patient population. We and others have reported on the role of pathological angiogenesis in the pathogenesis of NAFLD, highlighting pro-angiogenic factors as potential diagnostic markers. 
OBJECTIVE: To investigate the applicability of angiogenic and endothelial dysfunction markers as non-invasive diagnostic tools for NASH or NASH-associated fibrosis in obese patients. 
METHODS: In a prospective cross-sectional study, male patients undergoing bariatric surgery (n = 61) and control patients (n = 35) were recruited. Serum protein levels and visceral adipose tissue gene expression of endothelial dysfunction and angiogenic markers were analyzed by multiplex bead-based assay and quantitative RT-PCR, respectively. For validation, we recruited a second cohort of patients undergoing bariatric surgery (n = 40) and a cohort of NAFLD patients from our outpatient clinic (n = 30). 
RESULTS: We identified serum vascular cell adhesion molecule-1 (VCAM-1) as an independent predictor for {\textrangle}= F2 fibrosis (median 14.0 vs 8.7 ng ml(-1) in patients with and without significant fibrosis; P{\textlangle}0.0001) with an area under the receiver-operating characteristics (AUROC) curve of 0.80. The cutoff point of 13.2 ng ml(-1) showed a sensitivity of 80\% and specificity of 83\%. In line with these results, VCAM-1 visceral adipose tissue gene expression was also elevated in patients with fibrosis (P=0.030). In the bariatric surgery and clinical validation cohorts, VCAM-1 displayed similar AUROCs of 0.89 and 0.85, respectively. 
CONCLUSIONS: VCAM-1 levels are able to accurately predict significant ({\textrangle}= F2) fibrosis in NAFLD patients.},
  author       = {Lefere, Sander and Van de Velde, Frederique and Devisscher, Lindsey and Bekaert, Marlies and Raevens, Sarah and Verhelst, Xavier and Van Nieuwenhove, Yves and Praet, Marleen and Hoorens, Anne and Van Steenkiste, Christophe and Van Vlierberghe, Hans and Lapauw, Bruno and Geerts, Anja},
  issn         = {0307-0565},
  journal      = {INTERNATIONAL JOURNAL OF OBESITY},
  keyword      = {ENDOTHELIAL GROWTH-FACTOR,INSULIN-RESISTANCE,PLASMA CYTOKERATIN-18,NONINVASIVE MARKERS,STEATOHEPATITIS,STEATOSIS,DYSFUNCTION,PROGRESSION,NAFLD,RISK},
  language     = {eng},
  number       = {8},
  pages        = {1207--1213},
  title        = {Serum vascular cell adhesion molecule-1 predicts significant liver fibrosis in non-alcoholic fatty liver disease},
  url          = {http://dx.doi.org/10.1038/ijo.2017.102},
  volume       = {41},
  year         = {2017},
}

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