Original Article

The challenging role of hepatitis B virus infection and aflatoxin exposure on risk of hepatocellular carcinoma in Turkey

Gulfer Yakici1, Illa Lawali Na Nawache1, Defne Ay Tuncel2, Figen Doran3, Suleyman Altintas4, Melda Meral Ocal1, Fatih Koksal1

1Department of Medical Microbiology, Faculty of Medicine, Cukurova University, Adana, Turkey
2Department of Child Hematology and Oncology, Adana City Training and Research Hospital, Adana, Turkey
3Department of Pathology, Faculty of Medicine, Cukurova University, Adana, Turkey
4Department of Pathology, Adana City Training and Research Hospital, Adana, Turkey


Background: Hepatocellular carcinoma (HCC) is responsible for 70-90% of primary liver cancer cases. This study aimed to evaluate the role of aflatoxin B1 (AFB1) and hepatitis B virus x protein (HBx) on the development of HCC in patient groups with chronic hepatitis B virus (HBV) in the Cukurova region located in the subtropical climate zone of Turkey.
Methods: Blood, urine, and liver biopsy samples were collected from 38 HBsAg positive HCC patients and 21 HBsAg positive patients without HCC as a control group. The presence of the G>T mutation at codon 249 of the TP53 gene was investigated by PCR-RFLP and sequencing. Simultaneously, urinary aflatoxin M1 (AFM1) levels were measured by ELISA.
Results: As a result, target mutation was detected as 18.4% and 9.5% in HCC biopsy samples and control group with both methods (p= 0.666), respectively. Two patients who were found to have TP53 gene mutations in the control group were diagnosed with cirrhosis. The mean AFM1 concentration of the patient and control groups was 272.5 106.90 pg/mL and 160 73.89 pg/mL respectively. In the HBsAg/HCC patient group, both AFM1 levels and TP53 mutations were higher than in the control group.
Conclusions: It has been found that the association between chronic HBV infection and AFB1 exposure to be an important risk for HCC development. The frequency of mutation due to AFB1 exposure is high in HCC patients, but also seen in the control group. Also, AFM1 levels in patients with HCC similar to the control group due to the consumption of aflatoxin-containing foods. The risk of carcinoma development should be investigated considering other environmental and host factors.

Keywords: aflatoxin M1; hepatocellular carcinoma; P53 mutation