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Serum type III procollagen aminopeptide for assessing liver damage in methotrexate-treated psoriatic patients
M J Boffa1, A Smith, R J Chalmers
1Dermatology Centre, University of Manchester School of Medicine, U.K.
Abstract:
This study was designed to establish whether measurement of a serological marker of fibrosis might reduce the need for liver biopsy in psoriatic patients receiving methotrexate (MTX). Levels of type III procollagen aminopeptide (PIIINP-O and PIIINP-B) and laminin P1 (LamP1-B) were measured in 147 serum samples taken at the time of liver biopsy in 87 patients receiving long-term MTX treatment for severe psoriasis. Biopsies were classified as: (1) normal, (2) steatosis, (3) inflammation, (4) fibrosis, or (5) cirrhosis. Groups 3-5 were considered to show clinically relevant abnormality. Compared with controls, PIIINP-O was significantly raised in the group of MTX-treated psoriatics (P < 0.001). Within this group, levels were significantly higher in patients with inflammation, fibrosis or cirrhosis compared with those with normal histology or steatosis alone (P < 0.0001). In contrast, PIIINP-B and LamP1-B did not distinguish between controls and MTX-treated patients or between histological groups. Forty-two patients had two or more biopsies with simultaneous PIIINP-O measurement. PIIINP-O levels at the time of the first biopsy were normal in six of the seven patients whose histology was initially normal and subsequently became abnormal. A single measurement of PIIINP-O thus did not predict which patients might develop abnormal histology following further MTX. In a group of 17 patients, PIIINP-O was measured 3-monthly for up to 6 years during MTX treatment. PIIINP-O was elevated at some time during follow-up in all three patients who developed abnormal histology but was consistently normal in eight of the 11 patients whose histology remained or became normal. Our findings indicate that PIIINP-O is of value in detecting liver damage and, particularly if measured serially, may reduce the need for liver biopsy in MTX-treated patients. Although the test does not detect all patients with fibrosis, it would appear that the risk of missing significant liver damage in patients with persistently normal PIIINP-O is low.
Insights
Type III procollagen aminopeptide (PIIINP-O) shows promise as a non-invasive marker for detecting liver damage in psoriasis patients on methotrexate. Serial measurements of PIIINP-O may reduce the need for liver biopsies in this population.
Area of Science:
- Hepatology
- Dermatology
- Clinical Chemistry
Background:
- Methotrexate (MTX) is a common treatment for severe psoriasis.
- Long-term MTX use can lead to liver damage, necessitating monitoring.
- Liver biopsy is the gold standard but is invasive.
Purpose of the Study:
- To evaluate serological markers for liver fibrosis in MTX-treated psoriasis patients.
- To determine if PIIINP-O can reduce the need for liver biopsy.
Main Methods:
- Measured serum levels of PIIINP-O, PIIINP-B, and LamP1-B in 87 MTX-treated psoriasis patients undergoing liver biopsy.
- Compared marker levels with histological findings (normal, steatosis, inflammation, fibrosis, cirrhosis).
- Assessed PIIINP-O's predictive value using serial measurements in some patients.
Main Results:
- PIIINP-O levels were significantly elevated in MTX-treated patients compared to controls.
- Higher PIIINP-O levels correlated with inflammation, fibrosis, and cirrhosis.
- PIIINP-B and LamP1-B did not differentiate histological groups.
- Serial PIIINP-O measurements showed potential in identifying patients with developing liver abnormalities.
Conclusions:
- PIIINP-O is a valuable serological marker for detecting liver damage in MTX-treated psoriasis patients.
- Serial PIIINP-O measurements may decrease the requirement for liver biopsies.
- The risk of missing significant liver damage in patients with persistently normal PIIINP-O appears low.