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World J Hepatol. Mar 27, 2015; 7(3): 593-599
Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.593
Prevention of hepatocellular carcinoma: Focusing on antioxidant therapy
Koji Miyanishi, Toshifumi Hoki, Shingo Tanaka, Junji Kato
Koji Miyanishi, Toshifumi Hoki, Shingo Tanaka, Junji Kato, Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan
Author contributions: Miyanishi K contributed to the review design and drafting the manuscript; Hoki T and Tanaka S contributed to drafting the manuscript; Kato J contributed to drafting the manuscript and revision.
Conflict-of-interest: The authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Koji Miyanishi, MD, PhD, Department of Medical Oncology and Hematology, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-Ku, Sapporo 060-8543, Japan. miyako@sapmed.ac.jp
Telephone: +81-11-6112111 Fax: +81-11-6127987
Received: August 22, 2014
Peer-review started: August 23, 2014
First decision: September 28, 2014
Revised: October 20, 2014
Accepted: December 29, 2014
Article in press: December 29, 2014
Published online: March 27, 2015
Abstract

Oxidative stress has been investigated in the context of alcoholic liver injury for many years and shown to be a causal factor of chronic hepatitis C (CHC), nonalcoholic steatohepatitis (NASH), drug-induced liver injury, Wilson’s disease, and hemochromatosis. In CHC, it has been demonstrated that oxidative stress plays an important role in hepatocarcinogenesis. In cases with persistent hepatitis due to failure of hepatitis C virus eradication, or chronic liver disease, such as NASH, the treatment of which remains unestablished, it is important to reduce serum alanine aminotransferase levels and prevent liver fibrosis and development of hepatocellular carcinoma. This also suggests the importance of antioxidant therapy. Among treatment options where it would be expected that anti-inflammatory activity plays a role in their confirmed efficacy for chronic hepatitis, iron depletion therapy, glycyrrhizin, ursodeoxycholic acid, Sho-Saiko-To, and vitamin E can all be considered antioxidant therapies. To date, however, the ability of these treatments to prevent cancer has been confirmed only in CHC. Nevertheless, anti-inflammatory and anti-fibrotic effects have been demonstrated in other liver diseases and these therapies may potentially be effective for cancer prevention.

Keywords: Chronic hepatitis, Antioxidant therapy, Hepatocellular carcinoma, Prevention, Iron depletion therapy

Core tip: Among treatment options where it would be expected that anti-inflammatory activity plays a role in their confirmed efficacy for chronic hepatitis, iron depletion therapy, glycyrrhizin, ursodeoxycholic acid, Sho-Saiko-To, and vitamin E can all be considered antioxidant therapies. In chronic liver diseases, it has been demonstrated that antioxidant therapy may potentially be effective for suppressing inflammation and liver fibrosis and expected to prevent carcinogenesis.