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Liver Fibrosis
€1.00
Liver fibrosis is the final common pathway for almost all causes of chronic liver injury. Liver fibrosis is now known to be a dynamic process having significant potential for resolution. Therefore, fibrosis prediction is an essential part of the assessment and management of patients with chronic liver disease. As such, there is strong demand for reliable liver biomarkers that provide insight into disease etiology, diagnosis, therapy, and prognosis in lieu of more invasive approaches such as liver biopsy.
Most commonly, fibrosis biomarkers are classified in one of two classes.
Class I fibrosis biomarkers are pathophysiological derived from extracellular matrix (ECM) turnover and/or from changes of fibrogenic cell types, in particular, HSCs (Ito-Cells) and their transdifferentiated counterpart. They should reflect the activity of the fibrogenic and/or fibrolytic process and, thus remodeling of ECM. These biomarkers do not indicate the extent of connective tissue deposition, i.e., the stage of fibrotic transition of the organ. Frequently, they are costly laboratory tests and are the result of translation of fibrogenic mechanisms into clinical application. Thus, their selection is driven by hypothesis.
Class II fibrosis biomarkers mostly estimate the degree of fibrosis (extent of ECM deposition). In general, they comprise common clinical-chemical tests (e.g., enzymes, proteins, and coagulation factors), which do not necessarily reflect ECM metabolism or fibrogenic cell changes. Their pathobiochemical relation with fibrogenesis is indirect, if at all. Thus, their selection is not driven by hypothesis, but empiric. The markers are standard laboratory tests and are integrated into multiparametric panels.
In general, both types of serum biomarkers follow different pathophysiological concepts. Class I markers inform about “what is going on” (i.e., grade of fibrogenic activity); class II markers indicate “where fibrosis is” (i.e., stage of fibrosis).
Most commonly, fibrosis biomarkers are classified in one of two classes.
Class I fibrosis biomarkers are pathophysiological derived from extracellular matrix (ECM) turnover and/or from changes of fibrogenic cell types, in particular, HSCs (Ito-Cells) and their transdifferentiated counterpart. They should reflect the activity of the fibrogenic and/or fibrolytic process and, thus remodeling of ECM. These biomarkers do not indicate the extent of connective tissue deposition, i.e., the stage of fibrotic transition of the organ. Frequently, they are costly laboratory tests and are the result of translation of fibrogenic mechanisms into clinical application. Thus, their selection is driven by hypothesis.
Class II fibrosis biomarkers mostly estimate the degree of fibrosis (extent of ECM deposition). In general, they comprise common clinical-chemical tests (e.g., enzymes, proteins, and coagulation factors), which do not necessarily reflect ECM metabolism or fibrogenic cell changes. Their pathobiochemical relation with fibrogenesis is indirect, if at all. Thus, their selection is not driven by hypothesis, but empiric. The markers are standard laboratory tests and are integrated into multiparametric panels.
In general, both types of serum biomarkers follow different pathophysiological concepts. Class I markers inform about “what is going on” (i.e., grade of fibrogenic activity); class II markers indicate “where fibrosis is” (i.e., stage of fibrosis).
