Serum aldo–keto reductase family 1 member B10 predicts advanced liver fibrosis and fatal complications of nonalcoholic steatohepatitis

  • Masataka Kanno
  • Kazunori Kawaguchi
  • Masao HondaEmail author
  • Rika Horii
  • Hajime Takatori
  • Tetsuro Shimakami
  • Kazuya Kitamura
  • Kuniaki Arai
  • Taro Yamashita
  • Yoshio Sakai
  • Tatsuya Yamashita
  • Eishiro Mizukoshi
  • Shuichi Kaneko
Original Article—Liver, Pancreas, and Biliary Tract



Nonalcoholic steatohepatitis (NASH) is associated with liver inflammation in patients with nonalcoholic fatty liver disease, and it can progress to liver fibrosis at an advanced stage, as well as hepatocellular carcinoma (HCC) and portal hypertension. Although liver fibrosis is accurately diagnosed via biopsy, noninvasive methods are preferable. Aldo–keto reductase family 1 member B10 (AKR1B10) is associated with HCC and is secreted into the blood by liver cells via a lysosome-mediated nonclassical pathway. Accordingly, we analyzed whether secretion of AKR1B10 protein is associated with advanced NASH.


We performed histological staging in 85 Matteoni classification type III and IV NASH patients and evaluated the incidence of HCC, formation of gastroesophageal varices, and prognosis according to serum AKR1B10 and Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA(+)-M2BP)(M2BPGi) and by comparison with conventional markers of fibrosis.


 A positive correlation was found between the Brunt classification and serum AKR1B10 level. In Brunt stage 4 patients, AKR1B10 levels were higher than those of other liver fibrosis markers, with higher specificity. The cutoff values for AKR1B10 and WFA(+)-M2BP for stage 4 fibrosis were 1.03 and 3.11, respectively. The rates of stage 4 fibrosis, HCC incidence, and gastroesophageal varix formation were significantly different between the two groups subdivided according to these cutoff levels. Moreover, the patients in the higher value group had significantly worse prognosis after NASH diagnosis


AKR1B10 is a useful serum biomarker for advanced liver fibrosis in NASH and, combined with serum WFA(+)-M2BP, can predict HCC development, gastroesophageal varix formation, and poor prognosis.


Aldo–keto reductase family 1 member B10 Wisteria floribunda agglutinin-positive Mac-2 binding protein Nonalcoholic steatohepatitis 



The authors thank Nami Nishiyama for managing the serum samples.

Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no competing interests.

Supplementary material

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  1. 1.
    Sayiner M, Koenig A, Henry L, et al. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in the United States and the rest of the World. Clin Liver Dis. 2016;20:205–14.CrossRefGoogle Scholar
  2. 2.
    Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64:73–84.CrossRefGoogle Scholar
  3. 3.
    Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: the multiple parallel hits hypothesis. Hepatology. 2010;52:1836–46.CrossRefGoogle Scholar
  4. 4.
    Okanoue T, Ebise H, Kai T, et al. A simple scoring system using type IV collagen 7S and aspartate aminotransferase for diagnosing nonalcoholic steatohepatitis and related fibrosis. J Gastroenterol. 2018;53:129–39.CrossRefGoogle Scholar
  5. 5.
    Abe M, Miyake T, Kuno A, et al. Association between Wisteria floribunda agglutinin-positive Mac-2 binding protein and the fibrosis stage of non-alcoholic fatty liver disease. J Gastroenterol. 2015;50:776–84.CrossRefGoogle Scholar
  6. 6.
    Kawaguchi K, Honda M, Ohta H, et al. Serum Wisteria floribunda agglutinin-positive Mac-2 binding protein predicts hepatocellular carcinoma incidence and recurrence in nucleos(t)ide analogue therapy for chronic hepatitis B. J Gastroenterol. 2018;53:740–51.CrossRefGoogle Scholar
  7. 7.
    Kawanaka M, Tomiyama Y, Hyogo H, et al. Wisteria floribunda agglutinin-positive Mac-2 binding protein predicts the development of hepatocellular carcinoma in patients with non-alcoholic fatty liver disease. Hepatol Res. 2018;48:521–8.CrossRefGoogle Scholar
  8. 8.
    Cao D, Fan ST, Chung SS. Identification and characterization of a novel human aldose reductase-like gene. J Biol Chem. 1998;273:11429–35.CrossRefGoogle Scholar
  9. 9.
    Heringlake S, Hofdmann M, Fiebeler A, et al. Identification and expression analysis of the aldo-ketoreductase 1-B10 gene in primary malignant liver tumours. J Hepatol. 2010;52:220–7.CrossRefGoogle Scholar
  10. 10.
    Starmann J, Falth M, Spindelbock W, et al. Gene expression profiling unravels cancer-related hepatic molecular signatures in steatohepatitis but not in steatosis. PLoS One. 2012;7:e46584.CrossRefGoogle Scholar
  11. 11.
    Sumida Y, Yoneda M, Hyogo H, et al. Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population. BMC Gastroenterol. 2012;12:2.CrossRefGoogle Scholar
  12. 12.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefGoogle Scholar
  13. 13.
    Ooi A, Wong JC, Petillo D, et al. An antioxidant response phenotype shared between hereditary and sporadic type 2 papillary renal cell carcinoma. Cancer Cell. 2011;20:511–23.CrossRefGoogle Scholar
  14. 14.
    Fukumoto S, Yamauchi N, Moriguchi H, et al. Overexpression of the aldo-keto reductase family protein AKR1B10 is highly correlated with smokers’ non-small cell lung carcinomas. Clin Cancer Res. 2005;11:1776–85.CrossRefGoogle Scholar
  15. 15.
    Chung YT, Matkowskyj KA, Li H, et al. Overexpression and oncogenic function of aldo-keto reductase family 1B10 (AKR1B10) in pancreatic carcinoma. Mod Pathol. 2012;25:758–66.CrossRefGoogle Scholar
  16. 16.
    Ma J, Luo DX, Huang C, et al. AKR1B10 overexpression in breast cancer: association with tumor size, lymph node metastasis and patient survival and its potential as a novel serum marker. Int J Cancer. 2012;131:E862–71.CrossRefGoogle Scholar
  17. 17.
    Angulo P, Kleiner DE, Dam-Larsen S, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(389–97):e10.Google Scholar
  18. 18.
    Romeo S, Kozlitina J, Xing C, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nat Genet. 2008;40:1461–5.CrossRefGoogle Scholar
  19. 19.
    Alessi MC, Bastelica D, Mavri A, et al. Plasma PAI-1 levels are more strongly related to liver steatosis than to adipose tissue accumulation. Arterioscler Thromb Vasc Biol. 2003;23:1262–8.CrossRefGoogle Scholar
  20. 20.
    Charlton M, Angulo P, Chalasani N, et al. Low circulating levels of dehydroepiandrosterone in histologically advanced nonalcoholic fatty liver disease. Hepatology. 2008;47:484–92.CrossRefGoogle Scholar
  21. 21.
    Angulo P, Hui JM, Marchesini G, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.CrossRefGoogle Scholar
  22. 22.
    Yoneda M, Imajo K, Eguchi Y, et al. Noninvasive scoring systems in patients with nonalcoholic fatty liver disease with normal alanine aminotransferase levels. J Gastroenterol. 2013;48:1051–60.CrossRefGoogle Scholar
  23. 23.
    Sumida Y, Yoneda M, Hyogo H, et al. A simple clinical scoring system using ferritin, fasting insulin, and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46:257–68.CrossRefGoogle Scholar
  24. 24.
    Harrison SA, Oliver D, Arnold HL, et al. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57:1441–7.CrossRefGoogle Scholar
  25. 25.
    Xu C, Chen Y, Xu L, et al. Serum complement C3 levels are associated with nonalcoholic fatty liver disease independently of metabolic features in Chinese population. Sci Rep. 2016;6:23279.CrossRefGoogle Scholar
  26. 26.
    Daniels SJ, Leeming DJ, Eslam M, et al. ADAPT: an algorithm incorporating PRO-C3 accurately identifies patients with NAFLD and advanced fibrosis. Hepatology. 2018. Scholar
  27. 27.
    Itoh Y, Seko Y, Shima T, et al. Accuracy of non-invasive scoring systems for diagnosing non-alcoholic steatohepatitis-related fibrosis: multicenter validation study. Hepatol Res. 2018;48:1099–107.CrossRefGoogle Scholar
  28. 28.
    Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94:2467–74.CrossRefGoogle Scholar
  29. 29.
    Nishikawa H, Enomoto H, Iwata Y, et al. Clinical significance of serum Wisteria floribunda agglutinin positive Mac-2-binding protein level in non-alcoholic steatohepatitis. Hepatol Res. 2016;46:1194–202.CrossRefGoogle Scholar
  30. 30.
    Ishiba H, Sumida Y, Tanaka S, et al. The novel cutoff points for the FIB4 index categorized by age increase the diagnostic accuracy in NAFLD: a multi-center study. J Gastroenterol. 2018;53:1216–24.CrossRefGoogle Scholar
  31. 31.
    Luo D, Bu Y, Ma J, et al. Heat shock protein 90-alpha mediates aldo-keto reductase 1B10 (AKR1B10) protein secretion through secretory lysosomes. J Biol Chem. 2013;288:36733–40.CrossRefGoogle Scholar
  32. 32.
    Shirabe K, Bekki Y, Gantumur D, et al. Mac-2 binding protein glycan isomer (M2BPGi) is a new serum biomarker for assessing liver fibrosis: more than a biomarker of liver fibrosis. J Gastroenterol. 2018;53:819–26.CrossRefGoogle Scholar
  33. 33.
    Narimatsu H. Development of M2BPGi: a novel fibrosis serum glyco-biomarker for chronic hepatitis/cirrhosis diagnostics. Expert Rev Proteom. 2015;12:683–93.CrossRefGoogle Scholar
  34. 34.
    Yamasaki K, Tateyama M, Abiru S, et al. Elevated serum levels of Wisteria floribunda agglutinin-positive human Mac-2 binding protein predict the development of hepatocellular carcinoma in hepatitis C patients. Hepatology. 2014;60:1563–70.CrossRefGoogle Scholar
  35. 35.
    Umemura T, Joshita S, Sekiguchi T, et al. Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein level predicts liver fibrosis and prognosis in primary biliary cirrhosis. Am J Gastroenterol. 2015;110:857–64.CrossRefGoogle Scholar
  36. 36.
    Nishikawa H, Enomoto H, Iwata Y, et al. Impact of serum Wisteria floribunda agglutinin positive Mac-2-binding protein and serum interferon-gamma-inducible protein-10 in primary biliary cirrhosis. Hepatol Res. 2016;46:575–83.CrossRefGoogle Scholar
  37. 37.
    Xu WP, Wang ZR, Zou X, et al. Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein evaluates liver function and predicts prognosis in liver cirrhosis. J Dig Dis. 2018;19:242–53.CrossRefGoogle Scholar
  38. 38.
    Ito K, Murotani K, Nakade Y, et al. Serum Wisteria floribunda agglutinin-positive Mac-2-binding protein levels and liver fibrosis: a meta-analysis. J Gastroenterol Hepatol. 2017;32:1922–30.CrossRefGoogle Scholar
  39. 39.
    Petta S, Sebastiani G, Bugianesi E, et al. Non-invasive prediction of esophageal varices by stiffness and platelet in non-alcoholic fatty liver disease cirrhosis. J Hepatol. 2018;69:878–85.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Masataka Kanno
    • 1
  • Kazunori Kawaguchi
    • 1
  • Masao Honda
    • 1
    Email author
  • Rika Horii
    • 1
  • Hajime Takatori
    • 1
  • Tetsuro Shimakami
    • 1
  • Kazuya Kitamura
    • 1
  • Kuniaki Arai
    • 1
  • Taro Yamashita
    • 1
  • Yoshio Sakai
    • 1
  • Tatsuya Yamashita
    • 1
  • Eishiro Mizukoshi
    • 1
  • Shuichi Kaneko
    • 1
  1. 1.Department of GastroenterologyKanazawa University Graduate School of Medical ScienceKanazawaJapan

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