Des-gamma carboxyprothrombin

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.^[1] A number of subsequent studies have since confirmed this phenomenon.^[2][3][4]

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.^[5] It differentiates HCC from non-malignant liver diseases.^[6]

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.^[4]

Anticoagulant intoxication

A 1987 report described the use of DCP determination in the detection of intoxication with acenocoumarol, a vitamin K antagonist.^[7]

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. ^ ^{a b} 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. 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. ^ 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. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1141034.