Des-gamma carboxyprothrombin


Des-gamma carboxyprothrombin , also known as protein induced by vitamin K absence/antagonist-II, is an abnormal form of the coagulation protein, prothrombin. Normally, the prothrombin precursor undergoes post-translational carboxylation 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 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 ; 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. A number of subsequent studies have since confirmed this phenomenon.
A 2007 comparison of various HCC tumor markers found DCP the least sensitive to risk factors for HCC, and hence the most useful in predicting HCC. It differentiates HCC from non-malignant liver diseases. Moreover, it has been demonstrated that a combined analysis of DCP and Alpha-fetoprotein can lead to a better prediction in early stages of HCC.
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.

Anticoagulant intoxication

A 1987 report described the use of DCP determination in the detection of intoxication with acenocoumarol, a vitamin K antagonist.