Wisteria floribunda agglutinin‐positive Mac‐2‐binding protein and type 4 collagen 7S: useful markers for the diagnosis of significant fibrosis in patients with non‐alcoholic fatty liver disease

NAFLD encompasses a spectrum of liver conditions ranging from simple steatosis (fatty liver) to non-alcoholic steatohepatitis (NASH), which can progress to fibrosis, cirrhosis, and hepatocellular carcinoma. Liver biopsy is the gold standard for diagnosing fibrosis but is invasive and carries risks. Therefore, there is a need for reliable non-invasive biomarkers to assess fibrosis.

WFA+-M2BP is a glycoprotein that becomes glycosylated in the presence of liver fibrosis. The Wisteria floribunda agglutinin (WFA) lectin can bind specifically to this glycosylated form, making it detectable in the blood.

Role in Fibrosis: WFA+-M2BP reflects the activity of hepatic stellate cells, which are key players in liver fibrogenesis. Elevated levels of WFA+-M2BP indicate active fibrogenesis and significant liver fibrosis.

Clinical Utility: Studies have shown that serum WFA+-M2BP levels correlate well with histological stages of fibrosis in NAFLD patients. It serves as a non-invasive marker, allowing for regular monitoring without the need for repeated biopsies.

Type 4 collagen is a major component of the basement membrane and is involved in the structural integrity of the liver. The 7S domain of type 4 collagen is released into the bloodstream during liver fibrosis.

Role in Fibrosis: Type 4 collagen 7S fragments are produced and deposited in the extracellular matrix during fibrosis. Increased serum levels of these fragments are indicative of ongoing fibrogenesis.

Clinical Utility: Type 4 collagen 7S has been validated as a reliable marker for liver fibrosis. Its serum levels correlate with the severity of fibrosis, making it useful for diagnosing and staging fibrosis in NAFLD.

Non-Invasive: Both markers can be measured through blood tests, reducing the need for invasive liver biopsies.

Early Detection: They enable early detection and monitoring of fibrosis progression, allowing timely intervention and management.

Improved Patient Compliance: Non-invasive tests are more acceptable to patients, leading to better compliance with regular monitoring protocols.

Cost-Effective: Reducing the need for biopsies can lower healthcare costs associated with managing NAFLD.

Validation and Standardization: While these biomarkers show promise, there is a need for widespread clinical validation and the establishment of standardized cut-off values.

Integration into Practice: Clinicians must be trained in interpreting these biomarker levels and integrating them into routine clinical practice for managing NAFLD.

Combination with Other Markers: Using WFA+-M2BP and type 4 collagen 7S in conjunction with other non-invasive markers or imaging techniques may enhance diagnostic accuracy.

WFA+-M2BP and type 4 collagen 7S represent significant advancements in the non-invasive diagnosis of liver fibrosis in NAFLD patients. Their ability to reflect fibrogenesis accurately provides clinicians with powerful tools for early detection, monitoring, and management of fibrosis. As these markers become more widely validated and integrated into clinical practice, they have the potential to significantly improve the care and outcomes of patients with NAFLD.