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2017
Zekri, A. R. N., H. Salama, E. medhat, S. Hamdy, Z. K. Hassan, Y. M. Bakr, A. S. E. D. - Youssef, D. Saleh, R. Saeed, and D. Omran, "Potential Diagnostic and Prognostic Value of Lymphocytic Mitochondrial DNA Deletion in Relation to Folic Acid Status in HCV-Related Hepatocellular Carcinoma", Asian Pacific journal of cancer prevention : APJCP, vol. 18, issue 9, pp. 2451-2457, 2017 09 27. Abstract

Objective: We assessed the possibility of using mitochondrial (mt) DNA deletion as a molecular biomarker for
disease progression in HCV-related hepatocellular carcinoma (HCC) and to identify its association with folic acid status.
Methods: Serum folic acid and lymphocytic mtDNA deletions were assessed in 90 patients; 50 with HCC, 20 with
liver cirrhosis (LC), and 20 with chronic hepatitis C (CHC) compared to 10 healthy control subjects. The diagnostic
accuracy of mtDNA deletions frequency was evaluated using receiver-operating characteristic (ROC) curve analysis
Survival analysis was performed using the Kaplan-Meier method. Differences in the survival rates were compared
using log-rank test. Result: Our data revealed a significant elevation of mtDNA deletions frequency in the HCC
group compared to the other groups (P-value <0.01). Also, our data showed a significant correlation between folate
deficiency and high frequency of mtDNA deletions in patients with HCV-related HCC when compared to the other
groups (r= -0.094 and P-value <0.05). Moreover, the size of the hepatic focal lesion in the HCC patients was positively
correlated with mtDNA deletions (r= 0.09 and P-value <0.01). The median survival time for the HCC patients with
high frequency of mtDNA deletions (ΔCt ≥3.9; 5.7+ 0.6 months) was significantly shorter than those with low mtDNA
deletions frequency (ΔCt < 3.9; 11.9+ 0.04 months, P-value <0.01). Conclusion: Our data provided an evidence that
lymphocytic mtDNA deletion could be used as non-invasive biomarker for disease progression and patients’ survival in
HCV-related HCC. Also, our findings implied a causal relationship between the folate deficiency and the high mtDNA
deletions frequency among Egyptian patients with HCV related HCC.

2016
Zekri, A. - R. N., A. S. E. - D. Youssef, Y. M. Bakr, R. M. Gabr, O. S. Ahmed, M. H. Elberry, A. M. Mayla, M. Abouelhoda, and A. A. Bahnassy, "Early detection of hepatocellular carcinoma co-occurring with hepatitis C virus infection: A mathematical model.", World journal of gastroenterology, vol. 22, issue 16, pp. 4168-82, 2016 Apr 28. Abstract

AIM: To develop a mathematical model for the early detection of hepatocellular carcinoma (HCC) with a panel of serum proteins in combination with α-fetoprotein (AFP).

METHODS: Serum levels of interleukin (IL)-8, soluble intercellular adhesion molecule-1 (sICAM-1), soluble tumor necrosis factor receptor II (sTNF-RII), proteasome, and β-catenin were measured in 479 subjects categorized into four groups: (1) HCC concurrent with hepatitis C virus (HCV) infection (n = 192); (2) HCV related liver cirrhosis (LC) (n = 96); (3) Chronic hepatitis C (CHC) (n = 96); and (4) Healthy controls (n = 95). The R package and different modules for binary and multi-class classifiers based on generalized linear models were used to model the data. Predictive power was used to evaluate the performance of the model. Receiver operating characteristic curve analysis over pairs of groups was used to identify the best cutoffs differentiating the different groups.

RESULTS: We revealed mathematical models, based on a binary classifier, made up of a unique panel of serum proteins that improved the individual performance of AFP in discriminating HCC patients from patients with chronic liver disease either with or without cirrhosis. We discriminated the HCC group from the cirrhotic liver group using a mathematical model (-11.3 + 7.38 × Prot + 0.00108 × sICAM + 0.2574 × β-catenin + 0.01597 × AFP) with a cutoff of 0.6552, which achieved 98.8% specificity and 89.1% sensitivity. For the discrimination of the HCC group from the CHC group, we used a mathematical model [-10.40 + 1.416 × proteasome + 0.002024 × IL + 0.004096 × sICAM-1 + (4.251 × 10(-4)) × sTNF + 0.02567 × β-catenin + 0.02442 × AFP] with a cutoff 0.744 and achieved 96.8% specificity and 89.7% sensitivity. Additionally, we derived an algorithm, based on a binary classifier, for resolving the multi-class classification problem by using three successive mathematical model predictions of liver disease status.

CONCLUSION: Our proposed mathematical model may be a useful method for the early detection of different statuses of liver disease co-occurring with HCV infection.

2015
Zekri, A. - R. N., Y. M. Bakr, M. M. Ezzat, M. S. E. Zakaria, and T. M. Elbaz, "Circulating Levels of Adipocytokines as Potential Biomarkers for Early Detection of Colorectal Carcinoma in Egyptian Patients.", Asian Pacific journal of cancer prevention : APJCP, vol. 16, issue 16, pp. 6923-8, 2015. Abstract

BACKGROUND: Early detection of various kinds of cancers nowadays is needed including colorectal cancer due to the highly significant effects in improving cancer treatment. The aim of this study was to evaluate the potential value of adiponectin, visfatin and resistin as early biomarkers for colorectal cancer patients.

MATERIALS AND METHODS: Serum levels of adiponectin, visfatin and resistin were measured by a sandwich-enzyme-linked (ELISA) assay technique in 114 serum samples comprising 34 patients with colorectal cancer (CRC), 27 with colonic polyps (CP), 24 with inflammatory bowel disease (IBD) and 29 healthy controls .The diagnostic accuracy of each serum marker was evaluated using receiver-operating characteristic (ROC) curve analysis.

RESULTS: The mean concentration of adiponectin was significantly higher in CRC and CP groups than IBD and control groups (P-value <0.05). Also the mean concentration of serum resistin was significantly elevated in the IBD and control groups compared to CRC and CP groups (P-value = 0.014). However, no significant difference was noted in patients of the CRC and CP groups. On the other hand, the mean concentration of visfatin was significantly elevated in CRC and control groups compared to CP and IBD groups (P-value = 0.03). ROC analysis curves for the studied markers revealed that between CRC and IBD groups serum level of adiponectin had a sensitivity of 76.7% and a specificity of 76% at a cut off value of 3940, +LR being 3.2 and -LR 0.31 with AUC 0.852, while serum level of adiponectin between CP and IBD had a sensitivity of 77.8% and a specificity of 75% at a cut off value of 3300, with +LR=3.11 and -LR = 0.3 with AUC 0.852. On the other hand the serum level of visfatin between CRC and CP groups had a sensitivity of 65.5% and a specificity of 66.7 at a cut off value of 2.4, +LR being 1.67 and -LR 0.52 with AUC 0.698. Also the serum level of resistin had a sensitivity of 62.5% and a specificity of 70.3% at a cut off value of 24500, with +LR=2.1 and -LR = 0.53 with AUC 0.685 between control and other groups. On the other hand by comparing control vs CP groups resistin had a sensitivity of 81.8% and a specificity of 70.8% at a cut off value of 17700, with +LR=2.8 and -LR = 0.26 with AUC 0.763 while visfatin had a sensitivity of 68.2% and a specificity of 70.8% at a cut off value of 2.7, with +LR=2.34 and -LR = 0.0.45 with AUC 0.812.

CONCLUSIONS: These findings support potential roles of adiponectin, visfatin and resistin in early detection of CRC and discrimination of different groups of CRC, CP or IBD patients from normal healthy individuals.

Zekri, A. - R., A. S. E. - D. Youssef, Y. M. Bakr, R. M. Gabr, M. N. E. - D. El-Rouby, I. Hammad, E. A. E. - M. Ahmed, H. A. E. - H. Marzouk, M. M. Nabil, H. A. E. - H. Hamed, et al., "Serum biomarkers for early detection of hepatocellular carcinoma associated with HCV infection in egyptian patients.", Asian Pacific journal of cancer prevention : APJCP, vol. 16, issue 3, pp. 1281-7, 2015. Abstract

BACKGROUND: Early detection of hepatocellular carcinoma using serological markers with better sensitivity and specificity than alpha fetoprotein (AFP) is needed.

AIMS: The aim of this study was to evaluate the diagnostic value of serum sICAM-1, β-catenin, IL-8, proteasome and sTNFR-II in early detection of HCC.

MATERIALS AND METHODS: Serum levels of IL-8, sICAM-1, sTNFR-II, proteasome and β-catenin were measured by ELISA assay in 479 serum samples from 192 patients with HCC, 96 patients with liver cirrhosis (LC), 96 patients with chronic hepatitis C (CHC) and 95 healthy controls.

RESULTS: Serum levels of proteasome, sICAM-1, β-catenin and αFP were significantly elevated in HCC group compared to other groups (P-value<0.001), where serum level of IL-8 was significantly elevated in the LC and HCC groups compared to CHC and control groups (P-value <0.001), while no significant difference was noticed in patients with HCC and LC (P-value=0.09). Serum level of sTNFR- II was significantly elevated in patients with LC compared to HCC, CHC and control groups (P-value <0.001); also it was significantly higher in HCC compared to CHC and control groups (P-value <0.001). ROC curve analysis of the studied markers between HCC and other groups revealed that the serum level of proteasome had sensitivity of 75.9% and specificity of 73.4% at a cut-off value of 0.32 μg/ml with AUC 0.803 sICAM-1 at cut off value of 778ng/ml, the sensitivity was 75.8% and the specificity was 71.8% with AUC 0.776. β-catenin had sensitivity and specificity of 70% and 68.6% respectively at a cut off value of 8.75ng/ml with an AUC of 0.729. sTNFR-II showed sensitivity of 86.3% and specificity of 51.8% at a cut off value of 6239.5pg/ml with an AUC of 0.722. IL-8 had sensitivity of 70.4% and specificity of 52.3% at a cut off value of 51.5pg/ml with AUC 0.631.

CONCLUSIONS: Our data supported the role of proteasome, sICAM-1, sTNFR-II and β-catenin in early detection of HCC. Also, using this panel of serological markers in combination with αFP may offer improved diagnostic performance over αFP alone in the early detection of HCC.