Mechanism of PIVKA-II production in hepatocellular carcinoma

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Protein induced by vitamin K absence or antagonist II (PIVKA-II) is an established tumor marker for hepatocellular carcinoma (HCC), but precise mechanism of its production is unknown. We recently demonstrated that cytoskeletal rearrangement during phenotypic changes involved in epithelial mesenchymal transition (EMT) plays a crucial role in PIVKA-II production through impairment of vitamin K uptake. In addition, we demonstrated that hypoxic stimulation induced HCC cells to produce PIVKA-II in the same way. We also demonstrated that further phenotypic changes by hypoxia with malnutrition attenuated protein synthesis in HCC cells through mTOR pathway, resulting in decrease of PIVKA-II production. Thus, our serial findings indicate that PIVKA-II could be a phenotypic marker of HCC as well as a tumor marker.