Des-gamma carboxyprothrombin (DCP), also known as protein induced by vitamin K absence/antagonist-II (PIVKA-II), is an abnormal form of the
coagulation protein,
prothrombin. Normally, the prothrombin precursor undergoes
post-translationalcarboxylation (addition of a
carboxylic acid group) by
gamma-glutamyl carboxylase in the
liver prior to secretion into
plasma. DCP/PIVKA-II may be detected in people with deficiency of
vitamin K (due to poor nutrition or
malabsorption) and in those taking
warfarin or other medication that inhibits the action of vitamin K.
Diagnostic use
Hepatocellular carcinoma
A 1984 study first described the use of DCP as a marker of
hepatocellular carcinoma (HCC); it was present in 91% of HCC patients, while not being detectable in other liver diseases. The DCP level did not change with the administration of vitamin K, suggesting a defect in gamma-carboxylation activity rather than vitamin K deficiency.[1] A number of subsequent studies have since confirmed this phenomenon.[2][3][4]
A 2007 comparison of various HCC
tumor markers found DCP the least sensitive to risk factors for HCC (such as
cirrhosis), and hence the most useful in predicting HCC.[5] It differentiates HCC from non-malignant liver diseases.[6] Moreover, it has been demonstrated that a combined analysis of DCP and
Alpha-fetoprotein (AFP) can lead to a better prediction in early stages of HCC.[7]
Despite many years of use in
Japan, only did a 2003 American study reevaluate its use in an American patient series. It also identified HCC at an earlier stage.[4]
Anticoagulant intoxication
A 1987 report described the use of DCP determination in the detection of intoxication with
acenocoumarol, a vitamin K antagonist.[8]
References
^Liebman HA, Furie BC, Tong MJ, et al. (1984). "Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma". N. Engl. J. Med. 310 (22): 1427–31.
doi:
10.1056/NEJM198405313102204.
PMID6201741.
^Tsai SL, Huang GT, Yang PM, Sheu JC, Sung JL,
Chen DS (1990). "Plasma des-gamma-carboxyprothrombin in the early stage of hepatocellular carcinoma". Hepatology. 11 (3): 481–8.
doi:
10.1002/hep.1840110321.
PMID2155866.
^Cui R, Wang B, Ding H, Shen H, Li Y, Chen X (2002). "Usefulness of determining a protein induced by vitamin K absence in detection of hepatocellular carcinoma". Chin. Med. J. 115 (1): 42–5.
PMID11930656.
^Volk ML, Hernandez JC, Su GL, Lok AS, Marrero JA (2007). "Risk factors for hepatocellular carcinoma may impair the performance of biomarkers: a comparison of AFP, DCP, and AFP-L3". Cancer Biomark. 3 (2): 79–87.
PMID17522429.
^Lamerz R, Runge M, Stieber P, Meissner E (1999). "Use of serum PIVKA-II (DCP) determination for differentiation between benign and malignant liver diseases". Anticancer Res. 19 (4A): 2489–93.
PMID10470180.
^Ertle, JM; Heider, D; Wichert, M; Keller, B; Kueper, R; Hilgard, P; Gerken, G; Schlaak, JF (2013). "A combination of α-fetoprotein and des-γ-carboxy prothrombin is superior in detection of hepatocellular carcinoma". Digestion. 87 (2): 121–31.
doi:
10.1159/000346080.
PMID23406785.