Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication

Abstract Background Direct-acting antiviral (DAA) therapy for chronic hepatitis C (CHC) achieves high sustained virologic response (SVR) rates; however, hepatocellular carcinoma (HCC) can still develop after viral eradication. Reliable biomarkers for predicting the post-SVR HCC risk are lacking. Thi...

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Main Authors: Wei Teng, Wei-Ting Ku, Po-Ting Lin, Guan-Ting Chen, LiChieh Julie Chu, Hsuan Liu, Yung-Chang Lin, Chun-Yen Lin
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Journal of Translational Medicine
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Online Access:https://doi.org/10.1186/s12967-025-06765-z
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author Wei Teng
Wei-Ting Ku
Po-Ting Lin
Guan-Ting Chen
LiChieh Julie Chu
Hsuan Liu
Yung-Chang Lin
Chun-Yen Lin
author_facet Wei Teng
Wei-Ting Ku
Po-Ting Lin
Guan-Ting Chen
LiChieh Julie Chu
Hsuan Liu
Yung-Chang Lin
Chun-Yen Lin
author_sort Wei Teng
collection DOAJ
description Abstract Background Direct-acting antiviral (DAA) therapy for chronic hepatitis C (CHC) achieves high sustained virologic response (SVR) rates; however, hepatocellular carcinoma (HCC) can still develop after viral eradication. Reliable biomarkers for predicting the post-SVR HCC risk are lacking. This study aimed to identify baseline serum extracellular vesicle microRNAs (EV-miRNAs) associated with HCC development following SVR. Materials and methods Eleven CHC patients who achieved SVR were retrospectively enrolled as a discovery cohort to identify candidate EV-miRNAs at SVR12 predictive of future HCC. An independent validation cohort of 89 CHC patients was also analyzed. HCC development was defined as the occurrence of HCC at ≥ 12 months after SVR. EV-miRNA profiles were assessed by small RNA sequencing and validated using a miRNA enzyme immunoassay (miREIA). Results In the discovery cohort, four EV-miRNAs (EV-miR-1-3p, EV-miR-148a-3p, EV-miR-223-3p, and EV-miR-4433b-5p) were significantly different between patients who later developed HCC and those who remained HCC-free at SVR12. In the 89-patient validation cohort, 51 (57.3%) developed HCC with a median disease-free survival (DFS) of 23.1 months, and 12 (13.5%) patients died during a median follow-up of 77 months. High baseline EV-miR-1-3p and EV-miR-148a-3p levels and low EV-miR-4433b-5p were associated with remaining HCC-free. Elevated EV-miR-1-3p and EV-miR-148a-3p levels were also correlated with longer DFS (p < 0.05). In multivariate analysis, EV-miR-1-3p was the only independent predictor of longer DFS (adjusted hazard ratio [HR] 0.459, p = 0.014) and improved overall survival (OS) (adjusted HR 0.390, p = 0.016) after SVR12. Among all biomarkers evaluated, baseline EV-miR-1-3p demonstrated the highest predictive accuracy for HCC occurrence (area under the curve [AUC] 0.843, vs. 0.769 for alpha-fetoprotein [AFP] and 0.755 for FIB-4; p < 0.001) and for OS (AUC 0.876, vs. 0.480 for AFP and 0.655 for FIB-4; p < 0.001). Furthermore, patients with high EV-miR-1-3p levels showed higher platelet counts and albumin, and a lower proportion with FIB-4 ≥ 3.25, suggesting that high EV-miR-1-3p reflects better preserved liver function and less advanced fibrosis. Conclusions Baseline serum EV-miR-1-3p serves as a protective biomarker for stratifying HCC risk and predicting survival in CHC patients after HCV eradication via DAA therapy.
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spelling doaj-art-ed7b46ddc1c94c76a0c9d5682e2873ab2025-08-20T03:04:10ZengBMCJournal of Translational Medicine1479-58762025-07-0123111510.1186/s12967-025-06765-zBaseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradicationWei Teng0Wei-Ting Ku1Po-Ting Lin2Guan-Ting Chen3LiChieh Julie Chu4Hsuan Liu5Yung-Chang Lin6Chun-Yen Lin7Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical CenterDepartment of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical CenterDepartment of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical CenterDepartment of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical CenterGraduate Institute of Biomedical Sciences, College of Medicine, Chang Gung UniversityGraduate Institute of Biomedical Sciences, College of Medicine, Chang Gung UniversityCollege of Medicine, Chang Gung UniversityDepartment of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical CenterAbstract Background Direct-acting antiviral (DAA) therapy for chronic hepatitis C (CHC) achieves high sustained virologic response (SVR) rates; however, hepatocellular carcinoma (HCC) can still develop after viral eradication. Reliable biomarkers for predicting the post-SVR HCC risk are lacking. This study aimed to identify baseline serum extracellular vesicle microRNAs (EV-miRNAs) associated with HCC development following SVR. Materials and methods Eleven CHC patients who achieved SVR were retrospectively enrolled as a discovery cohort to identify candidate EV-miRNAs at SVR12 predictive of future HCC. An independent validation cohort of 89 CHC patients was also analyzed. HCC development was defined as the occurrence of HCC at ≥ 12 months after SVR. EV-miRNA profiles were assessed by small RNA sequencing and validated using a miRNA enzyme immunoassay (miREIA). Results In the discovery cohort, four EV-miRNAs (EV-miR-1-3p, EV-miR-148a-3p, EV-miR-223-3p, and EV-miR-4433b-5p) were significantly different between patients who later developed HCC and those who remained HCC-free at SVR12. In the 89-patient validation cohort, 51 (57.3%) developed HCC with a median disease-free survival (DFS) of 23.1 months, and 12 (13.5%) patients died during a median follow-up of 77 months. High baseline EV-miR-1-3p and EV-miR-148a-3p levels and low EV-miR-4433b-5p were associated with remaining HCC-free. Elevated EV-miR-1-3p and EV-miR-148a-3p levels were also correlated with longer DFS (p < 0.05). In multivariate analysis, EV-miR-1-3p was the only independent predictor of longer DFS (adjusted hazard ratio [HR] 0.459, p = 0.014) and improved overall survival (OS) (adjusted HR 0.390, p = 0.016) after SVR12. Among all biomarkers evaluated, baseline EV-miR-1-3p demonstrated the highest predictive accuracy for HCC occurrence (area under the curve [AUC] 0.843, vs. 0.769 for alpha-fetoprotein [AFP] and 0.755 for FIB-4; p < 0.001) and for OS (AUC 0.876, vs. 0.480 for AFP and 0.655 for FIB-4; p < 0.001). Furthermore, patients with high EV-miR-1-3p levels showed higher platelet counts and albumin, and a lower proportion with FIB-4 ≥ 3.25, suggesting that high EV-miR-1-3p reflects better preserved liver function and less advanced fibrosis. Conclusions Baseline serum EV-miR-1-3p serves as a protective biomarker for stratifying HCC risk and predicting survival in CHC patients after HCV eradication via DAA therapy.https://doi.org/10.1186/s12967-025-06765-zHepatocellular carcinomaExtracellular vesicle MiRNASVR12Direct-acting antivirals
spellingShingle Wei Teng
Wei-Ting Ku
Po-Ting Lin
Guan-Ting Chen
LiChieh Julie Chu
Hsuan Liu
Yung-Chang Lin
Chun-Yen Lin
Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
Journal of Translational Medicine
Hepatocellular carcinoma
Extracellular vesicle MiRNA
SVR12
Direct-acting antivirals
title Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
title_full Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
title_fullStr Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
title_full_unstemmed Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
title_short Baseline serum EV-miR-1-3p as a protective factor and biomarker for hepatocellular carcinoma development after HCV eradication
title_sort baseline serum ev mir 1 3p as a protective factor and biomarker for hepatocellular carcinoma development after hcv eradication
topic Hepatocellular carcinoma
Extracellular vesicle MiRNA
SVR12
Direct-acting antivirals
url https://doi.org/10.1186/s12967-025-06765-z
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