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Des-gamma carboxyprothrombin

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Des-gamma carboxyprothrombin (DCP), also known as protein induced by vitamin K absence/antagonist-II (PIVKA-II), is an abnormal form of the coagulation protein, prothrombin. Normally, the prothrombin precursor undergoes post-translational carboxylation (addition of a carboxylic acid group) by gamma-glutamyl carboxylase in the liver prior to secretion into plasma. DCP/PIVKA-II may be detected in people with deficiency of vitamin K (due to poor nutrition or malabsorption) and in those taking warfarin or other medication that inhibits the action of vitamin K.

Diagnostic use

Hepatocellular carcinoma

A 1984 study first described the use of DCP as a marker of hepatocellular carcinoma (HCC); it was present in 91% of HCC patients, while not being detectable in other liver diseases. The DCP level did not change with the administration of vitamin K, suggesting a defect in gamma-carboxylation activity rather than vitamin K deficiency. A number of subsequent studies have since confirmed this phenomenon.

A 2007 comparison of various HCC tumor markers found DCP the least sensitive to risk factors for HCC (such as cirrhosis), and hence the most useful in predicting HCC. It differentiates HCC from non-malignant liver diseases. Moreover, it has been demonstrated that a combined analysis of DCP and Alpha-fetoprotein (AFP) can lead to a better prediction in early stages of HCC.

Despite many years of use in Japan, only did a 2003 American study reevaluate its use in an American patient series. It also identified HCC at an earlier stage.

Anticoagulant intoxication

A 1987 report described the use of DCP determination in the detection of intoxication with acenocoumarol, a vitamin K antagonist.

References

  1. Liebman HA, Furie BC, Tong MJ, et al. (1984). "Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma". N. Engl. J. Med. 310 (22): 1427–31. doi:10.1056/NEJM198405313102204. PMID 6201741.
  2. Tsai SL, Huang GT, Yang PM, Sheu JC, Sung JL, Chen DS (1990). "Plasma des-gamma-carboxyprothrombin in the early stage of hepatocellular carcinoma". Hepatology. 11 (3): 481–8. doi:10.1002/hep.1840110321. PMID 2155866.
  3. Cui R, Wang B, Ding H, Shen H, Li Y, Chen X (2002). "Usefulness of determining a protein induced by vitamin K absence in detection of hepatocellular carcinoma". Chin. Med. J. 115 (1): 42–5. PMID 11930656.
  4. ^ Marrero JA, Su GL, Wei W, et al. (2003). "Des-gamma carboxyprothrombin can differentiate hepatocellular carcinoma from nonmalignant chronic liver disease in American patients". Hepatology. 37 (5): 1114–21. doi:10.1053/jhep.2003.50195. PMID 12717392.
  5. Volk ML, Hernandez JC, Su GL, Lok AS, Marrero JA (2007). "Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: a comparison of AFP, DCP, and AFP-L3". Cancer Biomark. 3 (2): 79–87. doi:10.3233/cbm-2007-3202. PMID 17522429.
  6. Lamerz R, Runge M, Stieber P, Meissner E (1999). "Use of serum PIVKA-II (DCP) determination for differentiation between benign and malignant liver diseases". Anticancer Res. 19 (4A): 2489–93. PMID 10470180.
  7. Ertle, JM; Heider, D; Wichert, M; Keller, B; Kueper, R; Hilgard, P; Gerken, G; Schlaak, JF (2013). "A combination of α-fetoprotein and des-γ-carboxy prothrombin is superior in detection of hepatocellular carcinoma". Digestion. 87 (2): 121–31. doi:10.1159/000346080. PMID 23406785.
  8. Lefrere JJ, Gozin D (1987). "Use of des-gamma-carboxyprothrombin in retrospective diagnosis of hidden intoxication of anticoagulants". J. Clin. Pathol. 40 (5): 589. doi:10.1136/jcp.40.5.589-b. PMC 1141034. PMID 3584512.
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