Novel Means of Monitoring Hepatic Damage

Abstract

Total serum ferritin levels are elevated in patients with varying types of liver disease. The elevation may be caused by leakage of the intracellular form of ferritin from damaged cells into the serum. Extracellular ferritin can be distinguished from intracellular ferritin by its greater carbohydrate content, as residues are probably added to ferritin during secretion from the cells. Normal serum ferritin is approximately 60-70% glycated, and this can be separated from non glycated ferritin by its reaction with Concanavalin A, a plant lectin that specifically binds glycated residues. The resultant extract and Sepharose control are assayed by radio immunoassay techniques to determine ferritin content. It is then possible to calculate the % glycation of the sample. The aim of the study was to determine what changes in serum ferritin occurred with different types of liver damage, and whether other physiological or pathological conditions resulted in an alteration in total or % glycated serum ferritin. Total serum ferritin was demonstrated to be elevated, together with a reduction in % glycation, in cases of acute and chronic hepatocellular damage. There were no changes associated with cholestatic liver disease without hepatocellular involvement. Insufficient evidence was found to determine whether changes in serum ferritin were a more sensitive indicator of drug induced hepatotoxic reactions than standard liver function tests. There was a wide variation evident in total and % glycated serum ferritin within normal subjects. In addition, changes in ferritin were not specific for hepatocellular damage, and were also seen in cases of diabetes, myocardial infarction, and after alcohol consumption. In view of these findings it is unlikely that the test will have a wide diagnostic use.