.. 4. Discussion A metabolite profiling approach was applied to identify biomarker candidates for distinguishing HCC patients within an HCV population. The effectiveness of current HCC surveillance markers or methods such as alpha-fetoprotein (AFP) and

abdominal ultrasound (US) are limited by low sensitivity and specificity. Hence the effectiveness of such approaches in reducing HCC mortality has remained modest [36]. Improved detection methods, such as blood-based biomarkers, are needed to improve this situation. Metabolite biomarkers provide an opportunity to enhance the detection of HCC [29,33]. As shown in the present Inhibitors,research,lifescience,medical work, the entire 1H NMR spectrum can be used to Ipatasertib develop a diagnostic metabolite profile with good sensitivity and specificity [20]. This approach is based on the combination of a large number of metabolite signals, many of which have not yet been identified. Inhibitors,research,lifescience,medical The use of feature selection, based on the Student’s t-test, resulted in 3 relatively strong biomarker candidates. We decided to use the uncorrected p-values, in part because each of these biomarker candidates has some precedence in cancer metabolism and due to our desire to avoid possible false negatives. In the case of creatinine, a gender Inhibitors,research,lifescience,medical imbalance in the two patient cohorts may be reducing its significance (vide infra). The resulting PLS-DA

model based on these 3 metabolites shows good performance, at least better than the model based on the entire CPMG NMR spectrum. In contrast, the use of 19 metabolites without the use of feature selection performs much more poorly. The OSC-PLS analysis of the

full NOESY spectra showed a clear separation between HCC and HCV patients, and this approach may be quite useful for distinguishing Inhibitors,research,lifescience,medical these cohorts. Future studies to validate these findings are planned, including an investigation of which types of lipids are contributing to the separation. However, the Inhibitors,research,lifescience,medical combination of isolated lipid signals and identified metabolites could not provide an improved model compared with the one built using the 3 metabolites (data not shown). An investigation of age and gender until effects on the model was also performed to evaluate possible confounding effects. The averages and standard deviations of the age distributions in HCC and HCV groups are quite similar, indicating that there is no confounding effect to be anticipated due to age. However, the gender distribution differs significantly between the two groups. We, therefore, performed a Student’s t-test for the 3 markers between the male and female patients in each of the two patient cohorts. All p-values were above 0.05 (see Supplemental Table S3), indicating that any gender effect can be neglected for these metabolites in this study. The results also show that the disease effect on creatinine levels dominated any gender effect; creatinine increased overall, in males compared with females, and in females with HCV compared to those with HCC.