Alpha-fetoprotein: Past, present, and future

  • Hepatol Commun. 2024 Apr 12;8(5):e0422. doi: 10.1097/HC9.0000000000000422.
Yee Hui Yeo  1 ,  Yi-Te Lee  1 ,  Hsian-Rong Tseng  2  3 ,  Yazhen Zhu  2  3  4 ,  Sungyong You  5  6 ,  Vatche G Agopian  7 ,  Ju Dong Yang  1  5  8
Affiliations
  • 1. Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • 2. Department of Molecular and Medical Pharmacology, California NanoSystems Institute, Crump Institute for Molecular Imaging, University of California, Los Angeles, California, USA.
  • 3. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA.
  • 4. Department of Pathology and Laboratory Medicine, Ronald Reagan Medical Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • 5. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • 6. Department of Surgery, Division of Cancer Biology and Therapeutics, Cedars-Sinai Medical Center, Los Angeles, California, USA.
  • 7. Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
  • 8. Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.
PMID: 38619448 DOI: 10.1097/HC9.0000000000000422
Abstract

Alpha-fetoprotein (AFP) is a glycoprotein that plays an important role in immune regulation with critical involvement in early human development and maintaining the immune balance during pregnancy. Postfetal development, the regulatory mechanisms controlling AFP undergo a shift and AFP gene transcription is suppressed. Instead, these enhancers refocus their activity to maintain albumin gene transcription throughout adulthood. During the postnatal period, AFP expression can increase in the setting of hepatocyte injury, regeneration, and malignant transformation. It is the first oncoprotein discovered and is routinely used as part of a screening strategy for HCC. AFP has been shown to be a powerful prognostic biomarker, and multiple HCC prognosis models confirmed the independent prognostic utility of AFP. AFP is also a useful predictive biomarker for monitoring the treatment response of HCC. In addition to its role as a biomarker, AFP plays important roles in immune modulation to promote tumorigenesis and thus has been investigated as a therapeutic target in HCC. In this review article, we aim to provide an overview of AFP, encompassing the discovery, biological role, and utility as an HCC biomarker in combination with Other biomarkers and how it impacts clinical practice and future direction.

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