Increased Severity due to Aflatoxin in Viral Cause of Hepatocellular Carcinoma: A Case Control Study

Nudrat Zeba, Mahvish Jabeen, Ali Raza, Muhammad Siddique Rajput, Sadia Tabassum, Razia Asif, Allah Bux Ghanghro, Arslan Ahmer

Abstract

The objective of our study was to assess the presence of aflatoxin in Hepatocellular Carcinoma patients and their severity. This case control study was conducted in the Asian Institute of Medical Sciences (AIMS) Hyderabad and Nuclear Institute of Medicine and Radiotherapy (NIMRA) Jamshoro for the period of 02 years from March 2018 to February 2020. The calculated sample size was 218 subjects, 109 patients were diagnosed with cases of HCC (76 male and 33 female), and 109 were included as control. Control was selected from the relatives of the patients who were Viral Hepatitis-Negative. Non-probability convenience sampling was used. Majority of the cases and controls were for 40 to 49 years of age. Serum α-fetoprotein (AFP) was significantly high in 80 (73.4%) cases who were culture positive with (p=0.013). There is no association between the AG ratio and mycological culture media-positive cases. A strong correlation is observed between Viral Hepatitis infection and the development of hepatocellular carcinoma (HCC) in Pakistan. The toxin produced by fungi has worse outcomes in patients with liver compromise especially hepatocellular carcinoma. The poor prognosis was observed in HCC and Liver Cirrhosis patients, especially in low-income countries where health services are poor. Therefore, preventive strategies need to be applied to control these toxins. Proper handling and cooking of common food and good hygiene, especially for high-risk patients, can help prevent and controlling the spread of these toxins.

 

Keywords: hepatocellular carcinoma, aflatoxins, hepatitis B, hepatitis C, Pakistan.

 

https://doi.org/10.55463/issn.1674-2974.50.2.4


Full Text:

PDF


References


XUAN W., SONG D., YAN Y., YANG M., and SUN Y. A Potential Role for Mitochondrial DNA in the Activation of Oxidative Stress and Inflammation in Liver Disease. Oxidative Medicine and Cellular Longevity, 2020, 2020: 5835910. https://doi.org/10.1155/2020/5835910

KIMANYAI M. E., ROUTLEDGE M. N., MPOLYA E., EZEKIEL C. N., SHIRIMA C. P., and GONG Y. Y. Estimating the risk of aflatoxin-induced liver cancer in Tanzania based on biomarker data. PLoS ONE, 2021, 16(3): 1-11. https://doi.org/10.1371/journal.pone.0247281

RANJITH R., SHETHY N., PRASHANTH Y. M., and SHET D. Characteristics of Hepatocellular Carcinoma: A retrospective study. PARIPEX – Indian Journal of Research, 2019, 8(12): 1. https://doi.org/10.36106/paripex

AXLEY P., AHMED Z., RAVI S., and SINGAL A. K. Hepatitis C Virus and hepatocellular carcinoma. Journal of Clinical and Translational Hepatology, 2018, 6(1): 79. https://doi.org/10.14218/JCTH.2017.00067

SAYINER M., GOLABI P., and YOUNOSSA Z. M. Disease Burden of Hepatocellular Carcinoma: A Global Perspective. Digestive Disease and Sciences, 2019, 64(4): 910-917. https://doi.org/10.1007/s10620-019-05537-2

REUNGOAT E., GRIGOROV B., ZOULIM F., and PÉCHEUR E. I. Molecular crosstalk between the hepatitis C virus and the extracellular matrix in liver fibrogenesis and early carcinogenesis. Cancers, 2021, 13(9): 2270. https://doi.org/10.3390/cancers13092270

TORNESELLO M. L., ANNUNZIATA C., TORNESELLO A. L., BUONAGURO L., and BUONAGURO F. M. Human oncoviruses and p53 tumor suppressor pathway deregulation at the origin of human cancers. Cancers, 2018, 10(7): 213. https://doi.org/10.3390/cancers10070213

ANSTEE Q. M., REEVES H. L., KOTSILITI E., GOVAERE O., and HEIKENWALDER M. From NASH to HCC: current concepts and future challenges. Nature Reviews Gastroenterology & Hepatology, 2019, 16(7): 411-28. https://doi.org/10.1038/s41575-019-0145-7

MAGNUSSEN A., & PARSI M. A. Aflatoxins, hepatocellular carcinoma and public health. World Journal of Gastroenterology, 2013, 19(10): 1508–1512. https://doi.org/10.3748/wjg.v19.i10.1508

PLAZ-TORRES M. C., BODINI G., FURNARI M., MARABOTTO E., ZENTILIN P., STRAZZABOSCO M., and GIANNINI E. G. Surveillance for hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: universal or selective. Cancers, 2020, 12(6): 1422. https://doi.org/10.3390/cancers12061422

KHAN A., AFZAL S., YAQOOB A., FATIMA R., HAQ MU., JUNAID K., and NADIR A. Epidemiology of viral hepatitis B and C in Punjab, Pakistan: a multicenter cross-sectional study, 2017-18. F1000Research, 2019, 8(2065): 2065. https://doi.org/10.12688/f1000research.20174.1

MAK L. Y., WONG D. K., POLLICINO T., RAIMONDO G., HOLLINGER F. B., and YUEN M. F. Occult hepatitis B infection and hepatocellular carcinoma: Epidemiology, virology, hepatocarcinogenesis and clinical significance. Journal of Hepatology, 2020, 73(4): 952-964. https://doi.org/10.1016/j.jhep.2020.05.042

PETRICK J. L., FLORIO A. A., ZNAOR A., RUGGIERI D., LAVERSANNE M., ALVAREZ C. S., FERLAY J., VALERY P. C., BRAY F., and MCGLYNN K. A. International trends in hepatocellular carcinoma incidence, 1978–2012. International Journal of Cancer, 2020, 147(2): 317-330. https://doi.org/10.1002/ijc.32723

AKHTAR S., NSAIR J. A., and HINDE A. The prevalence of hepatitis C virus infection in β-thalassemia patients in Pakistan: a systematic review and meta-analysis. BMC Public Health, 2020, 20: 1-9. https://doi.org/10.1186/s12889-020-8414-5

HAMID A. S., TESFAMARIAM I. G., ZHANG Y., and ZHANG Z. G. Aflatoxin B1-induced hepatocellular carcinoma in developing countries: Geographical distribution, mechanism of action and prevention. Oncology Letters, 2013, 5(4): 1087-1092. https://doi.org/10.3892/ol.2013.1169

MAGNUSSEN A., & PARSI M. A. Aflatoxins, hepatocellular carcinoma and public health. World Journal of Gastroenterology, 2013, 19(10): 1508. https://doi.org/10.3748/wjg.v19.i10.1508

ZHU Q., MA Y., LIANG J., WEI Z., LI M., ZHANG Y., LIU M., HE H., QU C., CAI J., WANG X., ZENG Y., and JIAO Y. AHR mediates the Aflatoxin B1 toxicity associated with hepatocellular carcinoma. Signal Transduction and Targeted Therapy, 2021, 6(1): 1-2. https://doi.org/10.1038/s41392-021-00713-1

LOPEZ-VALDES S., & MEDINILLA-CRUZ M. The relationship of aflatoxin b1 and hepatocellular carcinoma: a mini review. Journal of Liver Research, Disorders & Therapy, 2017, 3(6): 00073. https://doi.org/10.15406/jlrdt.2017.03.00073

PARKASH O., & HAMID S. Next big threat for Pakistan hepatocellular carcinoma (HCC). Journal of Pakistan Medical Association, 2016, 66(6): 27339578. https://pubmed.ncbi.nlm.nih.gov/27339578/

MOAZ I. M., ABDALLAH A. R., YOUSEF M. F., and EZZAT S. Main insights of genome wide association studies into HCV-related HCC. Egyptian Liver Journal, 2020, 10(1): 1-8. https://https://doi.org/10.1186/s43066-019-0013-8

SHIHA G., MOUSA N., SOLIMAN R., N. N. H. MIKHAIL N., ADEL ELBASIONY M., and KHATTAB M. Incidence of HCC in chronic hepatitis C patients with advanced hepatic fibrosis who achieved SVR following DAAs: A prospective study. Journal of Viral Hepatitis, 2020, 27(7): 671-679. https://doi.org/10.1111/jvh.13276

OZAKYOL A. Global epidemiology of hepatocellular carcinoma (HCC epidemiology). Journal of Gastrointestinal Cancer, 2017, 48(3): 238-240. https://doi.org/10.1007/s12029-017-9959-0

NASIR U., NAEEM I., ASIF M., ISMAIL A., GONG Y. Y., ROUTLEDGE M. N., AMJAD A., FAZAL A., and ISMAIL Z. Assessment of aflatoxins exposure through urinary biomarker approach and the evaluation of the impacts of aflatoxins exposure on the selected health parameters of the children of Multan city of Pakistan. Food Control, 2021, 123: 107863. https://doi.org/10.1016/j.foodcont.2021.107863

FARAG R. M., AL AYOBI D., ALSALEH K. A., SEROUR E. A., KWON H., and EL-ANSARY A. Relationship between Aflatoxin B1 Exposure and Etiology of Liver Disease in Saudi Arabian Patients. Preprints Life Science Microbiology, 2016, 59: 51. https://doi.org/10.20944/preprints201612.0142.v1

JASIRWAN C. O. M., FAHIRA A., SIREGAR L., and LOHO I. The alpha-fetoprotein serum is still reliable as a biomarker for the surveillance of hepatocellular carcinoma in Indonesia. BMC Gastroenterology, 2020, 20: 215. https://doi.org/10.1186/s12876-020-01365-1


Refbacks

  • There are currently no refbacks.