Tohoku J. Exp. Med., 2020 December, 252(4)

Daily Monitoring of Serum Wisteria floribunda Agglutinin-Positive Mac-2 Binding Protein Is Useful for Predicting Therapeutic Effect of Tolvaptan in Cirrhotic Ascites

MASAAKI TAKAMURA,¹ AKIRA SAKAMAKI,¹ YOSHIHISA ARAO,¹ TORU SETSU,¹ HIROTERU KAMIMURA,¹ TAKESHI YOKOO,¹ KENYA KAMIMURA,¹ ATSUNORI TSUCHIYA¹ and SHUJI TERAI¹

¹Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan

Wisteria floribunda agglutinin (WFA) is a lectin that binds to the sugar chain of Mac-2 binding protein (M2BP), and WFA-positive M2BP (WFA⁺-M2BP) has been reported as a useful marker for assessing liver fibrosis in chronic liver disease. Tolvaptan (TLV), a selective vasopressin V2 receptor antagonist, is used for cirrhotic ascites in Japan, but good predictors of treatment efficacy remain to be established. Our aim was to investigate whether WFA⁺-M2BP monitoring before and after TLV administration can predict treatment efficacy in patients with cirrhotic ascites. Twenty patients (10 men), with a median age of 72 years, were enrolled. Cirrhosis was caused by hepatitis B virus (n = 3), hepatitis C virus (n = 4), alcohol (n = 8), and others (n = 5). Responders were defined as having a body weight loss of 1.5 kg/week after TLV administration. Serum WFA⁺-M2BP levels were measured at baseline and days 1, 3, and 7 after TLV treatment. Twelve patients (60%) were responders. Baseline WFA⁺-M2BP levels were correlated with serum albumin levels (r = 0.544, P = 0.013). The baseline furosemide dose was lower and platelet count was higher in responders than in non-responders (P < 0.05). The ratio of WFA⁺-M2BP levels on day 1 after TLV administration to baseline was lower in responders than in non-responders (P < 0.05). The decrease in the ratio discriminated responders from non-responders (AUC = 0.844, P < 0.05). In conclusion, monitoring serum WFA⁺-M2BP is helpful for predicting the efficacy of TLV treatment in patients with cirrhotic ascites.

Keywords —— hepatic ascites; liver cirrhosis; tolvaptan; treatment efficacy; Wisteria floribunda agglutinin-positive Mac-2 binding protein

© 2020 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2020 252, 287-296.

Correspondence: Masaaki Takamura, M.D., Ph.D., Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata 951-8510, Japan.

e-mail: atmc@med.niigata-u.ac.jp