Review for 10.1186/1471-230X-8-53 (2008)

Reviewer's report
Title:Plasma Pentraxin3 is a Novel Marker for Nonalcoholic Steatohepatitis
(NASH)
Version: 1Date:27 August 2008
Reviewer: Anna Baranova
Reviewer's report:
Review of “Plasma Pentraxin3 is a Novel Marker for Nonalcoholic Steatohepatitis
(NASH)” by Yoneda et al.
Yoneda et al. conducted a study investigating whether pentraxin 3 (PTX3), as
measured in plasma, may potentially serve as a biomarker that differentiates
nonalcoholic steatohepatitis (NASH) from simple steatosis. The authors
demonstrated that plasma levels of PTX3 are not only useful in differentiating
NASH from simple steatosis, but also are useful in indicating the severity of
nonalcoholic fatty liver diseases (NAFLD) in general. Thus, the manuscript
provides a novel biomarker worthwhile to explore as potential component of
non-invasive NASH/NAFLD diagnostics.
Major Compulsory Revisions
1) Of major concern is that measurements of PTX3 (and all other parameters)
were not conducted on plasma from healthy individuals (i.e. those without any
form of liver disease). If PTX3 is to be used as a biomarker of liver disease in lieu
of liver biopsy, then how will physicians differentiate patients with and without any
form of steatosis? Clearly, a follow-up study is needed to confirm PTX3 as a
useful biomarker for all patients at risk of liver disease.
2) Also, PTX3 value as biomarker should be compared to that of CRP, which is
the member of the same protein family. It is important to remember that CRP
levels are elevated in a wide variety of the diseases. Often these diseases are
present in the NAFLD patients as co-morbidities. CRP protein is rather a marker
of overall morbidity than the particular problem, it is not clear for me whether the
same is not true for PTX3 before the comparison of two markers is made, at least
in NAFLD patients.
Minor Essential Revisions
There also some minor points, for example:
1) Figure 2 is not really necessary
2) in the Methods or Discussion it would be helpful to note (if possible) how the
categorization of NASH vs. simple steatosis falls into the staging of the severity
of NAFLD as described under “Pathology” in the Methods section (i.e. using
macrovesicular fat droplets or fibrosis as an indicator of disease progression ). In
other words, if steatosis is graded as “3” based on macrovesicular fat droplets,
does that still qualify as “not advanced disease?”
Minor mistakes observed in the manuscript:
1. p. 6, line 13: “twofold” has two fonts
2. p.6, end of paragraph: need period at end of last sentence.
3. p.10, line 2: “stage” is misspelled
4. p.13, line 1: two different fonts used in header
5. p. 13, last line: replace “them” with “the two other parameters.”
6. p.15, line 8: change wording as following: “Because there are few effective
treatments for NAFLD, the identification….”
7. p.15, line 13: remove the word “that”
8. p.16, line 8: change “a” and “b” to alpha and beta symbols where appropriate,
since these symbols are used elsewhere
9. p.16, 4th line from bottom: space needed between “beused”
10. p.16, 2nd line from bottom: make “stage” plural
11. p.17, line 1: add word: “but also of the severity…”
12. p.17, line 8: remove “also” since it’s redundant in the sentence
13. p.17, lines 8 – 9: change wording: “advanced stages of NAFLD patient.”
14. p.17, line 11: remove “in conclusion” – redundant with header
15. p.17, line 14: change wording: “appear to show promise as a means to
differentiate…”
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests