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Editorial
. 2021 Jan 1;116(1):77-79.
doi: 10.14309/ajg.0000000000001042.

Keratin-18: Diagnostic, Prognostic, and Theragnostic for Alcohol-Associated Hepatitis

Craig J McClain  1   2   3   4 , Vatsalya Vatsalya  1   3 , Mack C Mitchell  5
Affiliations
Editorial

Keratin-18: Diagnostic, Prognostic, and Theragnostic for Alcohol-Associated Hepatitis

Craig J McClain et al. Am J Gastroenterol. .

Abstract

It is still sometimes difficult to differentiate alcohol-associated hepatitis (AH) from other liver problems. In this edition of AJG, Atkinson et al. showed that keratin-18 (intermediate filament protein) is a promising biomarker for predicting histological severity of AH, defining the type of hepatocyte death (necrosis vs apoptosis), predicting 90-day mortality, and predicting the response to corticosteroid therapy in severe AH. The authors conclude that K18 is diagnostic, prognostic, and may be a theragnostic marker for prednisolone therapy and note that "serum K18 estimation should be adopted into routine clinical practice." We agree.

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Figures

Figure 1.
Figure 1.
Liver injury (AST, ALT) and liver cell death (K18) markers in healthy controls (HC); alcohol use disorder (AUD) patients without and with liver injury (AUD-L); moderate AH (MAH), severe AH (SAH) and non-alcoholic steatohepatitis (NASH). 1a. Alanine aminotransferase (ALT) levels. 1b. Aspartate aminotransferase (AST) levels. 1c. K18M65 levels. Black dotted line represents the upper limit of normal for each test. In figure 1c, the red dotted line (2000 IU/L) represents the level above which patients are classified as having definite AH based on Bissonnette criteria (8). Data are presented as mean ± standard deviation.
Figure 2.
Figure 2.
Necrotic and apoptotic type of cell death in AH can be quantified by M65 (necrotic) or M30 (apoptotic-caspase cleaved) keratin ELISA.
See this image and copyright information in PMC

Comment on

References

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