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Urinary biomarkers for early liver cancer detection


A human liver Image PHOTO: Sebastian Kaulitzki on getty image

*Condition responsible for 600,000 deaths annually as NIMR proffers solution to research funding
Worried by the incessant increase in liver cancer and finding a lasting solution to cancer cure, medical researchers have proved the potency of urinary biomarkers for early detection.

The critical difference in diagnostic algorithms of hepatocellular carcinoma (HCC), the most frequent liver cancer, accounting for 80 per cent-90 per cent of all primary liver cancers, are due not only to the skills and knowledge of pathologists, but also to the actual availability of such diagnostic facilities in most countries, particularly where liver cancer is more recurrent. Sadly, there are countries where only one surgical pathology laboratory is available.

According to the World Health Organisation (WHO), cancer accounts for 13 percent of all deaths registered globally and 70 percent of that figure occurs in middle and low income countries. In Nigeria, about 10,000 cancer deaths are recorded annually while 250,000 new cases are recorded yearly.


It had been established that early detection is germane for cancer cure but WHO indicates that the dearth of functional cancer plans is especially alarming in developing countries, which already account for more than two-thirds of the new cancer cases and deaths yearly.

Recent research has shown that urinary biomarkers can proffer an immediate answer to this challenge. These biomarkers are able to improve the diagnostics of liver cancer in the blood and tissue and would enable an improved early detection of cancers, and therapeutic monitoring in the various treatment strategies on the long run.

The new biomarkers are molecules that allow inferences on certain conditions or diseases by specific occurrence or concentration. They can provide indications on the risk for developing a disease, on the disease itself or on certain therapies.

According to the World Cancer Research Fund International, liver cancer is the sixth most common cancer in the world, with 782,000 new cases diagnosed in 2012.

An oncologist at Emory Winship Cancer Institute, Atlanta, Bassel El-Rayes lamented that liver cancer does not commonly have early warning signs. Symptoms of liver cancer often do not appear until it is in its later stages, where it is more difficult to treat.

Chronic hepatitis B virus (HBV) infection is the main cause of HCC, a form of liver cancer, prevalent in Africa. HCC is the most common cause of cancer death in adult males in Africa and the peak incidence of this cancer is between the ages of 30 and 50.

Professor of Translational Medicine, St. Mary’s Hospital Campus Imperial College London, Prof. Simon Taylor-Robinson, has said that urinary biomarkers differentiates hepatocellular carcinoma (HCC) from other chronic liver disease, adding that Hepatitis B and hepatitis C viruses are major causes of liver cancer.

“HBV infection which is responsible for about 80% of liver cancers acts directly by damaging cells and their DNA while Hepatitis C shows an indirect effect, mediated by cirrhosis,” he added.

Taylor-Robinson, who was the key note speaker at the National Institute of Medical Research (NIMR) 4th International Scientific conference, added that the disease is developed by higher exposure to aflatoxin-contaminated food, Hepatitis B and C, Human Immune Virus (HIV), Nash, and alcohol consumption.

Aflatoxins, according to the National Cancer Institute are a family of toxins produced by certain fungi that are found on agricultural crops such as maize (corn), peanuts, cottonseed, and tree nuts. The main fungi that produce aflatoxins are Aspergillus flavus and Aspergillus parasiticus, which are abundant in warm and humid regions of the world. Aflatoxin-producing fungi can contaminate crops in the field, at harvest, and during storage.

Delivering his research on ‘Urinary Biomakers of Liver Cancer’, he added that HCC is the 5th commonest cancer with records of 600,000 deaths annually.

“It is a primary solid liver tumour that affects even young people in Africa,” he added.

According to Taylor-Robinson’s Urinary (1) H MRS Study done in Nigeria with multivariate statistical analysis was able to differentiate patients with HCC from normal subjects and patients with cirrhosis.

Carnitine, acylcarnitine and creatine were identified as the most influential metabolite biomarkers, while creatinine, glycine, hippurate, TMAO and citrate were in reduced relative concentration.

These findings have identified candidate urinary HCC biomarkers which have potential to be developed as simple urinary screening test.

The Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) project on 13, 000 patients in Gambia, Senegal and Nigeria has demonstrated treatment of chronic hepatitis B is feasible and effective for reducing the incidence of HCC in resource-poor settings using urinary biomarkers and were able to develop a urinary diagnostic.

Partnering with Jos University Teaching Hospital during the study, PROLIFICA also developed urinary diagnostic and proved that HCC can be detected early and treated effectively.

On the efficiency of the urine dipstix for screening, even at local level, the report said urine is easier to collect on population screening and would allow validation of preliminary results.

Having discovered new markers, Taylor-Robinson said combination of NMR and MS has enabled identification of new biomarkers of HCC.

In Nigeria, frequent HBV and HCC screening and surveillance programmes for the general population are inefficient, and there is a lack of infrastructure to support channelling of screened patients into long-term treatment programmes.

Decrying the deficiency of medical research in Nigeria, Director General of National Institute for Medical Research (NIMR), Prof. Babatunde Lawal Salako said has called on private and public sector collaboration to support research.

The Nigerian Institute of Medical Research (NIMR) Yaba, Lagos state, Nigeria which was saddled with the responsibility of promoting National health and developments through medical research has been deprived of executing its mandates due to inadequate financing.

In his words: “Research is an endeavour that can only be done with good fund. If Nigeria can improve on research funding (private and government agencies), the scientific advancement will help to eliminate poverty and improve economic development, hence, improve the quality of life.”

Salako admitted that although the economic situation of the country had not been palatable recently, research remains a non negotiable factor to major breakthrough in Nigeria.

“In the midst of the economic downturn, government should prioritise research because it determines and improve the health care system of Nigeria, human development within the country and by extension economic prosperity.


“The present administration has promised to look into medical research and we look forward to that,” he added.

On other means of sourcing funds, Salako said NIMR is now thinking outside the box seeing clearly that government cannot do everything.

Public Health Communicator and Adjunct Lecturer of the Lagos state College of Health, Dr. Noimot Balogun has emphasised that more value-based communication that would speak to the population would ensure positive collaboration among different stakeholders in Nigeria.

“These form of collaboration entails more than getting financial support from public and private firms, it is more about delivering value as benefit to them,” she added.

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