الفهرس 
Amino AcidsOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma is considered the fifth in frequency among all types of cancers worldwide and the third cause of cancer death. It is usually asymptomatic in the early stages and tends to be invasive. Therefore, most patients are presented with an incurable disease at the time of detection which makes early diagnosis of HCC critical for a good prognosis.
In Egypt, the incidence rate of HCC has increased sharply in the last decade. This could be due to HBV, HCV epidemic infection. Furthermore, improvements in diagnostic tools and health care led to increased survival rate among cirrhotic patients allowing time for some of them to develop HCC.
The prognosis of HCC has improved dramatically with the identification of high-risk populations and the advancement of diagnostic imaging and treatment. For further improvement of the prognosis of HCC, it is necessary to assess not only cancer progression, but also hepatic functional reserve. Hepatic functional reserve is recognized as a factor affecting survival in the treatment of HCC.
To date, the Child-Pugh classification system has been the most widely used system for assessing hepatic functional reserve in chronic liver disease and in patients undergoing treatment for HCC. In the Child-Pugh classification, the serum albumin level is used to achieve accurate assessment of the status of protein metabolism.
Serum albumin is a protein that is synthesized and secreted by hepatocytes, and is used as an index of hepatic synthetic capacity for protein. This parameter is particularly important for evaluating the severity and prognosis of cirrhosis. However, to date, no attention has been given
to the status of amino acid (AA) metabolism in chronic liver disease and HCC. Protein malnutrition of HCC patients is a result of amino acid imbalance. So accurate assess of protein metabolism in HCC patients with a background of chronic liver disease needs not only determining the serum albumin level but also the status of amino acid metabolism.
The Fischer ratio is the molar ratio of branched chain amino acids (leucine, valine, isoleucine) to aromatic amino acids (phenylalanine, tyrosine), and is important for assessing hepatic metabolism and hepatic functional reserve, as well as for judging the severity of liver damage.
The BTR (branched tyrosine ratio) is a simpler method and can be a substitute for the Fischer ratio. Furthermore, it is reported that patients with a low BTR, even patients in Child-Pugh class A, have already begun to demonstrate a potential decrease in hepatic functional reserve. Additionally, in the event of malnutrition, BTR declines before the serum albumin declines; therefore, determining BTR is useful for the early detection of potential hypoalbuminemia.
All patients and control groups were subjected to the following:
1. Full history taking.
2. Complete clinical examination.
3. Abdominal ultrasonography and or CT.
4. Laboratory investigations including: complete blood picture, Liver function tests, Viral markers (HBsAg, HCV-Ab), Estimation of serum AFP.
4. Measurement of plasma amino acids using Ultra performance liquid chromatography (UPLC) - electrospray ionization (ESI)-mass spectrometry (MS).
The results from the current study show the following:
The mean age of HCC patients in this study was 56.19 ±7.81 years. and HCC was more predominant in males than females. The ratio was approximately (6:1).
Concerning hematological tests, platelet count, prothrombin concentration (%) and hemoglobin were significantly lower in HCC and cirrhotic patients compared to control group.
Regarding the liver biochemical profile: ALT, AST, and ALP were significantly higher in HCC and HCV patients compared to control.
There was a significantly higher levels of AFP and T-bill in HCC patients compared to the HCV patients and control group.
There was a significantly lower levels of Alb and Total protein in HCC patients compared to the HCV patients and control group.
Regarding the amino acids profile:
There were a statistically significant difference between HCC and control group with a statistically significant increase of Met, Tyr, Orn, Cit, Gly, Phe, Ala, Glu, Pro, and Arg. And decrease of Val, Asp, Leu/Ileu, BTR and Fischer ratio in HCC compared to Control group
A statistically significant difference between CLD and control group with a statistically significant increase of Met, Tyr, Cit, Gly, Pro, Arg. And decrease of Orn, Val, Asp, Leu/Ileu, BTR and Fischer ratio in CLD compared to control group. No statistically significant difference regarding Phe, Ala and Glu
A statistically significant difference between HCC and CLD group with a statistically significant increase of Met, Tyr, Orn, Cit, Gly, Phe, Ala
and Glu. And decrease of Val, Asp, Leu/Ileu, Arg, BTR and Fischer ratio in HCC compared to CLD.
There was statistically significant correlation between BTR and Platelets, AST, Alb, Bilirubin and AFP. Also there was a statistically significant differences in BTR among Child-Pugh A, B and C (Child-Pugh A 1.509 ± 0.324, Child-Pugh B 1.303± 0.774 and Child-Pugh C 0.8357±0.194) among patients in HCC group.
Conclusion
Cancer cells are hyper mutable and may result in amino acid changes in certain protein sequences. Thus, the PFAA profile is considered valuable for diagnosis and for nutritional care in cancer patients.