Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 21, 2007; 13(23): 3259-3261
Published online Jun 21, 2007. doi: 10.3748/wjg.v13.i23.3259
Combined treatment of vitamin K2 and angiotensin-converting enzyme inhibitor ameliorates hepatic dysplastic nodule in a patient with liver cirrhosis
Hitoshi Yoshiji, Ryuichi Noguchi, Masaharu Yamazaki, Yasuhide Ikenaka, Masayoshi Sawai, Masatoshi Ishikawa, Hideto Kawaratani, Tsuyoshi Mashitani, Mitsuteru Kitade, Kosuke Kaji, Masahito Uemura, Junichi Yamao, Masao Fujimoto, Akira Mitoro, Masahisa Toyohara, Motoyuki Yoshida, Hiroshi Fukui
Hitoshi Yoshiji, Ryuichi Noguchi, Masaharu Yamazaki, Yasuhide Ikenaka, Masayoshi Sawai, Masatoshi Ishikawa, Hideto Kawaratani, Tsuyoshi Mashitani, Mitsuteru Kitade, Kosuke Kaji, Masahito Uemura, Junichi Yamao, Masao Fujimoto, Akira Mitoro, Masahisa Toyohara, Motoyuki Yoshida, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, Nara, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Hitoshi Yoshiji, MD, PhD, Third Department of Internal Medicine, Nara Medical University, Shijo-cho 840, Kashihara, Nara 634-8522, Japan. yoshijih@naramed-u.ac.jp
Telephone: +81-744-223051-3415 Fax: +81-744-247122
Received: March 20, 2007
Revised: April 6, 2007
Accepted: April 16, 2007
Published online: June 21, 2007
Abstract

Although it is well known that the hepatocellular carcinoma (HCC) is an ominous complication in patients with liver cirrhosis, there has been no approved drug to prevent the development of HCC to date. We previously reported that the combined treatment of vitamin K2 (VK) and angiotensin-converting enzyme inhibitor (ACE-I) significantly suppressed the experimental hepatocarcinogenesis. A 66-year-old Japanese woman with hepatitis C virus (HCV)-related liver cirrhosis developed a dysplastic nodule in the liver detected by enhanced computed tomography along with elevation of the tumor markers, namely, alpha-fetoprotein (AFP) and lectin-reactive demarcation (AFP-L3), suggesting the presence of latent HCC. After oral administration of VK and ACE-I, the serum levels of both AFP and AFP-L3 gradually decreased without any marked alteration of the serum aminotransferase activity. After one-year treatment, not only the serum levels of AFP and AFP-L3 returned to the normal ranges, but also the dysplastic nodule disappeared. Since both VK and ACE-I are widely used without serious side effects, this combined regimen may become a new strategy for chemoprevention against HCC.

Keywords: Vitamin K2; ACE inhibitor; Hepatocellular carcinoma; VEGF; Angiogenesis