Comparative Clinical Pathology

, Volume 27, Issue 5, pp 1133–1140 | Cite as

Estimation of telomerase, AFP, and AFP-L3 levels in Sudanese patients with hepatocellular carcinoma and chronic liver diseases

  • Fayza A. Rahamtalla
  • Mohammed S. M. Abdalla
  • Salma B. M. Mudawi
  • Mohammed A. H. Kheir Elsid
  • Iman M. ShammatEmail author
Original Article


Telomerase enzyme activity is considered a widespread and relatively selective tumor cell marker feature that can be used for detecting the presence of various neoplastic cells. The positive activity of telomerase enzyme was also recorded in chronic liver disease and is evaluated as a more appropriate biomarker for differentiating hepatocellular carcinoma (HCC) from chronic liver diseases. The current study aimed to evaluate telomerase, AFP, and AFP-L3 levels in Sudanese patients with hepatocellular carcinoma and chronic liver diseases. The study enrolled 113 patients: HCC (n = 33), cirrhosis (n = 33), and chronic hepatitis (n = 47), jointly with 50 healthy controls. Enzyme-linked immunosorbent assay (ELISA) technique was used to estimate the telomerase, AFP, and AFP-L3 levels in blood samples. The telomerase level was elevated in 70% of HCC patients, and it was significantly higher in HCC patients compared to that in healthy controls (1.38 versus 0.35 ng/ml, respectively; P < 0.01). Serum alpha-fetoprotein (AFP) and Lens culinaris agglutinin-reactive (AFP-L3) levels were also significantly elevated in HCC patients compared to healthy controls (130.76 versus 5.59 ng/ml; P < 0.01) and (59.76 versus 0.49 ng/ml; P < 0.01), respectively. The combination between telomerase and AFP or AFPL-3 lead to increased telomerase sensitivity (85 and 79%, respectively).Telomerase was found to be further sensitive in patients with a tumor size of less than 5 cm as well as to tumors of more than 5 cm. Two healthy control samples showed an increase in telomerase level. The combined use of telomerase, AFP, and AFP-L3 levels might be useful for achieving better sensitivity for HCC patients.


Hepatocellular carcinoma ELISA telomerase cirrhosis Chronic hepatitis 



Special thanks to Dr. Abdelbagi Ahmed for helping with the statistical analysis. We are grateful to the director and staff of Molecular Biology Laboratory, Faculty of Medical Laboratory Sciences, Alneelain University, for providing lab facilities.


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all4966 individual participants included in the study.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Fayza A. Rahamtalla
    • 1
  • Mohammed S. M. Abdalla
    • 2
  • Salma B. M. Mudawi
    • 3
  • Mohammed A. H. Kheir Elsid
    • 4
  • Iman M. Shammat
    • 5
    Email author
  1. 1.Faculty of Medical Laboratory SciencesOmdurman Islamic UniversityKhartoumSudan
  2. 2.Atomic Energy Commission (SAEC)KhartoumSudan
  3. 3.National Center for GI and Liver DiseaseIbnSina HospitalKhartoumSudan
  4. 4.Faculty of MedicineOmdurman IslamicKhartoumSudan
  5. 5.Biology Department, Faculty of ScienceTaibah UniversityMadinahSaudi Arabia

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