Mass Spectrometric Identification of Proteotypic Peptides from Clinically Used Tumor Markers

Introduction

With the rapid development of mass spectrometry-based technologies such as multiple reaction monitoring and heavy-isotope-labeled-peptide standards, quantitative analysis of biomarker proteins using mass spectrometry is rapidly progressing toward detection of target proteins/peptides from clinical samples. Proteotypic peptides are a few peptides that are repeatedly and consistently identified from a protein in a mixture and are used for quantitative analysis of the protein in a complex biological sample by mass spectrometry.

Materials and Methods

Using mass spectrometry, we identified peptide sequences and provided a list of tryptic peptides and glycopeptides as proteotypic peptides from five clinically used tumor markers, including prostate-specific antigen, carcinoembryonic antigen, Her-2, human chorionic gonadotropin, and CA125.

Conclusion

These proteotypic peptides have potential for targeted detection as well as heavy-isotope-peptide standards for quantitative analysis of marker proteins in clinical specimens using a highly specific, sensitive, and high-throughout mass spectrometry-based analysis method.     

Mass Spectrometric Identification and Quantification of Hemorphins Extracted from Human Adrenal and Pheochromocytoma Tissue

Abstract: The hemorphins are a family of recently identified opioid receptor binding peptides derived from the proteolytic processing of the β, γ, δ, and ε chains of hemoglobin. They have previously been identified at high concentration in human pituitary glands and in the CSF of patients with cerebral bleeding. Hemorphins are potent inhibitors of angiotensin converting enzyme and therefore possibly have a role to play in blood pressure regulation. We report the presence of four hemorphin peptides in extracts of normal adrenal tissue and in pheochromocytoma tumors. The hemorphins were quantified and structurally characterized using mass spectrometry. High concentrations of hemorphins were found in all samples, comparable with the levels reported in the literature for pituitary and brain tissue.     

Mass Spectrometric Analyses of Brain Synaptic Peptides Containing Taurine

The structure of a number of low-molecular-weight acidic peptides containing taurine prepared from calf brain synaptosomes and their subcellular vesicles was studied using electron impact mass spectrometry. At least seven sequences could be identified: N-acetylaspartyl-glutamyl-taurine, N-acetylaspartyl-taurine, N-acetylglutamyl-taurine, glutamyl-taurine, aspartyl-taurine, seryl-glutamyl-seryl-taurine, and seryl-taurine.     

The Association of Human Apolipoprotein C-III Sialylation Proteoforms with Plasma Triglycerides

Introduction

Apolipoprotein C-III (apoC-III) regulates triglyceride (TG) metabolism. In plasma, apoC-III exists in non-sialylated (apoC-III_0a without glycosylation and apoC-III_0b with glycosylation), monosialylated (apoC-III₁) or disialylated (apoC-III₂) proteoforms. Our aim was to clarify the relationship between apoC-III sialylation proteoforms with fasting plasma TG concentrations.

Methods

In 204 non-diabetic adolescent participants, the relative abundance of apoC-III plasma proteoforms was measured using mass spectrometric immunoassay.

Results

Compared with the healthy weight subgroup (n = 16), the ratios of apoC-III_0a, apoC-III_0b, and apoC-III₁ to apoC-III₂ were significantly greater in overweight (n = 33) and obese participants (n = 155). These ratios were positively correlated with BMI z-scores and negatively correlated with measures of insulin sensitivity (S_i). The relationship of apoC-III₁ / apoC-III₂ with S_i persisted after adjusting for BMI (p = 0.02). Fasting TG was correlated with the ratio of apoC-III_0a / apoC-III₂ (r = 0.47, p<0.001), apoC-III_0b / apoC-III₂ (r = 0.41, p<0.001), apoC-III₁ / apoC-III₂ (r = 0.43, p<0.001). By examining apoC-III concentrations, the association of apoC-III proteoforms with TG was driven by apoC-III_0a (r = 0.57, p<0.001), apoC-III_0b (r = 0.56. p<0.001) and apoC-III₁ (r = 0.67, p<0.001), but not apoC-III₂ (r = 0.006, p = 0.9) concentrations, indicating that apoC-III relationship with plasma TG differed in apoC-III₂ compared with the other proteoforms.

Conclusion

We conclude that apoC-III_0a, apoC-III_0b, and apoC-III₁, but not apoC- III₂ appear to be under metabolic control and associate with fasting plasma TG. Measurement of apoC-III proteoforms can offer insights into the biology of TG metabolism in obesity.     

Genetic Diversity of Schistosoma haematobium Eggs Isolated from Human Urine in Sudan

The genetic diversity of Schistosoma haematobium remains largely unstudied in comparison to that of Schistosoma mansoni. To characterize the extent of genetic diversity in S. haematobium among its definitive host (humans), we collected S. haematobium eggs from the urine of 73 infected schoolchildren at 5 primary schools in White Nile State, Sudan, and then performed a randomly amplified polymorphic DNA marker ITS2 by PCR-RFLP analysis. Among 73 S. haematobium egg-positive cases, 13 were selected based on the presence of the S. haematobium satellite markers A4 and B2 in their genomic DNA, and used for RFLP analysis. The 13 samples were subjected to an RFLP analysis of the S. haematobium ITS2 region; however, there was no variation in size among the fragments. Compared to the ITS2 sequences obtained for S. haematobium from Kenya, the nucleotide sequences of the ITS2 regions of S. haematobium from 4 areas in Sudan were consistent with those from Kenya (> 99%). In this study, we demonstrate for the first time that most of the S. haematobium population in Sudan consists of a pan-African S. haematobium genotype; however, we also report the discovery of Kenyan strain inflow into White Nile, Sudan.     

Characterization of granuloma T lymphocyte function from Schistosoma mansoni-infected mice

This study was undertaken to characterize and compare T lymphocyte function from the vigorous and modulated liver granulomas of Schistosoma mansoni-infected mice. Although both types of lesion contained equal percentages of T lymphocytes, the T cell subset distribution was different. For vigorous lesions, the ratio of helper/effector to suppressor/cytotoxic T cells was 2 to 3:1. For modulated lesions the ratio was lower (1:1). Differences in the phenotypic profiles of vigorous and modulated granuloma (Gr) T cells were reflected in their functional activity. Vigorous Gr T cells were more active in lymphoproliferation, IL-2 production, and granuloma formation than those from modulated lesions. Moreover, modulated Gr T cells suppressed the functional activity of vigorous Gr T cells in a dose-dependent manner. The selective depletion of T cell subsets showed that phenotypically, the Gr delayed-hypersensitivity T cell is L3T4+, Lyt-1+ whereas the Gr Ts cell is an Lyt-2+ lymphocyte. Both of these T cell subsets are present in vigorous and modulated lesions. During acute infection, delayed-hypersensitivity T cell lymphocyte functions predominate, whereas Ts lymphocyte functions appear to prevail during chronic infection.     

Liquid Chromatographic/Mass Spectrometric Procedure for Measurement of NAD Catabolites in Human and Rat Plasma and Urine

Monitoring level of the metabolites of the coenzyme NAD such as nicotinamide and its oxidized and methylated derivatives is important due to therapeutic applications of these compounds and monitoring of oxidative stress. We evaluated feasibility of using HPLC with electrospray ion-trap mass detection for single run separation and quantitation of all the NAD metabolites. We achieved good separation and retention of all the metabolites of interest using reversed-phase with ion-pairing. Single ion monitoring or tandem MS were used for detection and quantitation of the specific compounds with good linearity. The method was able to detect all the physiological metabolites in plasma samples of rats and humans or in urine. However, full validation is necessary before this method could be routinely applied.     

Identification of Nitroxyl-induced Modifications in Human Platelet Proteins Using a Novel Mass Spectrometric Detection Method

Nitroxyl (HNO) exhibits many important pharmacological effects, including inhibition of platelet aggregation, and the HNO donor Angeli''s salt has been proposed as a potential therapeutic agent in the treatment of many diseases including heart failure and alcoholism. Despite this, little is known about the mechanism of action of HNO, and its effects are rarely linked to specific protein targets of HNO or to the actual chemical changes that proteins undergo when in contact with HNO. Here we study the presumed major molecular target of HNO within the body: protein thiols. Cysteine-containing tryptic peptides were reacted with HNO, generating the sulfinamide modification and, to a lesser extent, disulfide linkages with no other long lived intermediates or side products. The sulfinamide modification was subjected to a comprehensive tandem mass spectrometric analysis including MS/MS by CID and electron capture dissociation as well as an MS³ analysis. These studies revealed a characteristic neutral loss of HS(O)NH₂ (65 Da) that is liberated from the modified cysteine upon CID and can be monitored by mass spectrometry. Upon storage, partial conversion of the sulfinamide to sulfinic acid was observed, leading to coinciding neutral losses of 65 and 66 Da (HS(O)OH). Validation of the method was conducted using a targeted study of nitroxylated glyceraldehyde-3-phosphate dehydrogenase extracted from Angeli''s salt-treated human platelets. In these ex vivo experiments, the sample preparation process resulted in complete conversion of sulfinamide to sulfinic acid, making this the sole subject of further ex vivo studies. A global proteomics analysis to discover platelet proteins that carry nitroxyl-induced modifications and a mass spectrometric HNO dose-response analysis of the modified proteins were conducted to gain insight into the specificity and selectivity of this modification. These methods identified 10 proteins that are modified dose dependently in response to HNO, whose functions range from metabolism and cytoskeletal rearrangement to signal transduction, providing for the first time a possible mechanistic link between HNO-induced modification and the physiological effects of HNO donors in platelets.Nitric oxide (NO)¹ has emerged as an important physiological signaling molecule, particularly in the vascular, neuronal, and immune systems. NO regulates many processes including platelet function, vascular tone, and leukocyte recruitment mainly through the cGMP second messenger system (1). More recent studies have shown that nitric oxide can react directly with a number of different biological species including metal centers of proteins, nucleophilic amino acid residues (nitrosation/S-nitrosylation), and aromatic amino acid residues (nitration) (2, 3), and the products of these reactions have been analyzed by mass spectrometry (4–8). The biological relevance of these reactions is slowly coming to light, and NO-mediated S-nitrosylation has now been linked to a number of diseases including diabetes, multiple sclerosis, cystic fibrosis, and asthma (9).Nitroxyl (HNO/NO⁻), an alternative redox form of NO, has only recently begun to draw attention in the biomedical research community. The interest associated with HNO is due to its novel and important biological activity (10–15). There has been particular interest in the effect of HNO on failing hearts as it has been shown to increase left ventricular contractility and, at the same time, to lower cardiac preload and diastolic pressure without increasing arterial resistance (10, 11), effects that indicate the potential for HNO to be developed as a treatment for heart failure (16). As well, treatment of platelets with micromolar concentrations of the HNO donor Angeli''s salt (AS) leads to an inhibition of platelet aggregation that was found to be both time- and dose-dependent (12). Other pharmacological studies have shown that HNO can be protective against excitotoxicity of the N-methyl-d-aspartate receptor (13, 17); it can inhibit aldehyde dehydrogenase, which could be used as an antialcoholic treatment (14, 18, 19); and pretreatment of ischemic (oxygen-depleted) tissues with HNO has been shown to protect against ischemia-reperfusion toxicity (20). Glyceraldehyde-3-phosphate dehydrogenase (GAPDH), a key enzyme in the carbohydrate metabolism pathway, has also been shown to be potently inhibited by HNO both in vitro (19) and in vivo (21), an effect thought to occur through the direct modification of its active site cysteine. At high concentrations (2–5 mm), HNO has been shown to be cytotoxic by eliciting DNA strand breaks and glutathione depletion, causing cellular toxicity due to oxidative protein damage (22). However, this toxicological effect is only relevant if physiological HNO levels are high, and it has thus far not been demonstrated to have any in vivo relevance (23).These HNO-mediated pharmacological effects are dramatically different from those of NO (11) most likely because HNO tends to be much more thiophilic with cysteines being the major site of biochemical reactivity (24–26). Therefore, it is no surprise that NO and HNO tend to have different targets. For example, in the vascular system, HNO can act through a cAMP signal transduction pathway, whereas the vascular activity of NO is primarily due to an elevation in cGMP (27).Although a number of pharmacological and toxicological effects have been shown for HNO, the underlying mechanisms of action are largely unknown. HNO and cysteine are known to react to produce non-cross-linked sulfinamides and cause disulfide formation, and HNO can react with metals/metalloproteins and oxygen and participate in reduction/oxidation reactions (23, 25, 26). However, the molecular targets of HNO have yet to be linked to its pharmacological and toxicological effects.Here we describe a mass spectrometry-based method for the analysis of the major type of biologically relevant HNO reaction, the reaction with the thiol on cysteines to produce non-cross-linked sulfinamides as well as disulfide linkages (23, 25, 26). Although disulfides are produced through many different pathways, non-cross-linked sulfinamides are exclusively produced by HNO and can thus be used to analyze for the presence of HNO and its effects on cysteine-containing proteins. As well, the sulfinamide modification imparts a specific mass change to cysteines making sulfinamide analysis, and indirectly HNO analysis, very amenable to investigation by mass spectrometry. The sulfinamide modification has been observed in MS spectra (28), and in a recent mass spectrometric analysis, Shen and English (29) attributed a mass shift of 65 Da on prominent y-ions upon low energy CID to the elimination of the sulfinamide moiety from the molecule in their mass spectrometric comparison of nitroxyl products formed with free and protein-based cysteines. Here we investigate this mass shift and the formation of a previously unstudied neutral loss to determine an efficient method for the identification of the sulfinamide modification and demonstrate its utility on a sample generated by treatment of live platelets immediately post-isolation, that is ex vivo, with HNO.     

Development of a Purification Procedure for the Isolation of Nucleosides from Urine Prior to Mass Spectrometric Analysis

Abstract

A chromatographic separation of nucleosides from urine has been developed in order to facilitate their mass spectrometric analysis for clinical diagnosis. A number of chromatographic resins were studied in order to develop an effective and efficient purification procedure. The optimized sequential protocol comprises a centrifugation, acidification and neutralization step, followed by application of an affinity chromatographic column and finally further separation on an acidic cation exchange column and a basic anion exchanger. This scheme shows effective clean-up of a standard radiolabelled nucleoside with a recovery of 92.5%, and recovery of nucleosides added to urine samples before extraction showed recoveries of 72 – 82%.     

Use of Mass Spectrometric Methods for Protein Identification in Receptor Research

Abstract

In recent years, mass spectrometry has become the method of choice for identifying small amounts of gel separated proteins. Using high mass accuracy peptide mass mapping followed if necessary by nanoelectrospray sequencing, most mammalian proteins can now be identified quickly and sensitively either in amino acid or in EST sequence databases. These methods are illustrated here using an ongoing project in the author's laboratory, a mass spectrometric screen for new mouse brain receptors and their interaction partners.     

Isolation and Identification of 1-Ribosyl Pyridone Nucleosides from Human Urine

Abstract

1-Ribosylpyridin-4-one-3-carboxamide with lesser amounts of 1-ribosylpyridin-2-one-5-carboxamide have been isolated quantitatively from human urine using ion exchange column chromatography. Absorption spectra and mass spectrometry were used in the identification.     

Apolipoprotein C-III displacement of apolipoprotein E from VLDL: effect of particle size.

ApoC-III and apoE are important determinants of intravascular lipolysis and clearance of triglyceride-rich chylomicrons and VLDL from the blood plasma. Interactions of these two apolipoproteins were studied by adding purified human apoC-III to human plasma at levels observed in hypertriglyceridemic subjects and incubating under specific conditions (2 h, 37 degrees C). As plasma concentrations of apoC-III protein were increased, the contents in both VLDL and HDL were also increased. Addition of apoC-III at concentrations up to four times the intrinsic concentration resulted in the decreasing incremental binding of apoC-III to VLDL while HDL bound increasing amounts without evidence of saturation. No changes were found in lipid content or in particle size of any lipoprotein in these experiments. However, distribution of the intrinsic apoE in different lipoprotein particles changed markedly with displacement of apoE from VLDL to HDL. The fraction of VLDL apoE that was displaced from VLDL to HDL at these high apoC-III concentrations varied among individuals from 20% to 100% its intrinsic level. The proportion of VLDL apoE that was tightly bound (0% to 80%) was found to be reproducible and to correlate with several indices of VLDL particle size. In the group of subjects studied, strongly adherent apoE was essentially absent from VLDL particles having an average content of less than 50,000 molecules of triglyceride.Addition of apoC-III to plasma almost completely displaces apoE from small VLDL particles. Larger VLDL contain tightly bound apoE which are not displaced by increasing concentration of apoC-III.     

Combinatorial Approach for Large-scale Identification of Linked Peptides from Tandem Mass Spectrometry Spectra

The combination of chemical cross-linking and mass spectrometry has recently been shown to constitute a powerful tool for studying protein–protein interactions and elucidating the structure of large protein complexes. However, computational methods for interpreting the complex MS/MS spectra from linked peptides are still in their infancy, making the high-throughput application of this approach largely impractical. Because of the lack of large annotated datasets, most current approaches do not capture the specific fragmentation patterns of linked peptides and therefore are not optimal for the identification of cross-linked peptides. Here we propose a generic approach to address this problem and demonstrate it using disulfide-bridged peptide libraries to (i) efficiently generate large mass spectral reference data for linked peptides at a low cost and (ii) automatically train an algorithm that can efficiently and accurately identify linked peptides from MS/MS spectra. We show that using this approach we were able to identify thousands of MS/MS spectra from disulfide-bridged peptides through comparison with proteome-scale sequence databases and significantly improve the sensitivity of cross-linked peptide identification. This allowed us to identify 60% more direct pairwise interactions between the protein subunits in the 20S proteasome complex than existing tools on cross-linking studies of the proteasome complexes. The basic framework of this approach and the MS/MS reference dataset generated should be valuable resources for the future development of new tools for the identification of linked peptides.The study of protein–protein interactions is crucial to understanding how cellular systems function because proteins act in concert through a highly organized set of interactions. Most cellular processes are carried out by large macromolecular assemblies and regulated through complex cascades of transient protein–protein interactions (1). In the past several years numerous high-throughput studies have pioneered the systematic characterization of protein–protein interactions in model organisms (2–4). Such studies mainly utilize two techniques: the yeast two-hybrid system, which aims at identifying binary interactions (5), and affinity purification combined with tandem mass spectrometry analysis for the identification of multi-protein assemblies (6–8). Together these led to a rapid expansion of known protein–protein interactions in human and other model organisms. Patche and Aloy recently estimated that there are more than one million interactions catalogued to date (9).But despite rapid progress, most current techniques allow one to determine only whether proteins interact, which is only the first step toward understanding how proteins interact. A more complete picture comes from characterizing the three-dimensional structures of protein complexes, which provide mechanistic insights that govern how interactions occur and the high specificity observed inside the cell. Traditionally the gold-standard methods used to solve protein structures are x-ray crystallography and NMR, and there have been several efforts similar to structural genomics (10) aiming to comprehensively solve the structures of protein complexes (11, 12). Although there has been accelerated growth of structures for protein monomers in the Protein Data Bank in recent years (11), the growth of structures for protein complexes has remained relatively small (9). Many factors, including their large size, transient nature, and dynamics of interactions, have prevented many complexes from being solved via traditional approaches in structural biology. Thus, the development of complementary analytical techniques with which to probe the structure of large protein complexes continues to evolve (13–18).Recent developments have advanced the analysis of protein structures and interaction by combining cross-linking and tandem mass spectrometry (17, 19–24). The basic idea behind this technique is to capture and identify pairs of amino acid residues that are spatially close to each other. When these linked pairs of residues are from the same protein (intraprotein cross-links), they provide distance constraints that help one infer the possible conformations of protein structures. Conversely, when pairs of residues come from different proteins (interprotein cross-links), they provide information about how proteins interact with one another. Although cross-linking strategies date back almost a decade (25, 26), difficulty in analyzing the complex MS/MS spectrum generated from linked peptides made this approach challenging, and therefore it was not widely used. With recent advances in mass spectrometry instrumentation, there has been renewed interest in employing this strategy to determine protein structures and identify protein–protein interactions. However, most studies thus far have been focused on purified protein complexes. With today''s mass spectrometers being capable of analyzing tens of thousands of spectra in a single experiment, it is now potentially feasible to extend this approach to the analysis of complex biological samples. Researchers have tried to realize this goal using both experimental and computational approaches. Indeed, a plethora of chemical cross-linking reagents are now available for stabilizing these complexes, and some are designed to allow for easier peptide identification when employed in concert with MS analysis (20, 27, 28). There have also been several recent efforts to develop computational methods for the automatic identification of linked peptides from MS/MS spectra (29–36). However, because of the lack of large annotated training data, most approaches to date either borrow fragmentation models learned from unlinked, linear peptides or learn the fragmentation statistics from training data of limited size (30, 37), which might not generalize well across different samples. In some cases it is possible to generate relatively large training data, but it is often very labor intensive and involves hundreds of separate LC-MS/MS runs (36). Here, employing disulfide-bridged peptides as an example, we propose a novel method that uses a combinatorial peptide library to (a) efficiently generate a large mass spectral reference dataset for linked peptides and (b) use these data to automatically train our new algorithm, MXDB, which can efficiently and accurately identify linked peptides from MS/MS spectra.     

Mass Spectrometric Identification of the Radical Adducts of a Fluorescamine-Derivatized Nitroxide

The radical adducts of fluorescamine-derivatized 3-aminomethyl-2,2,5,5-tetrarnethyl-1-pyrrolidinyloxy free radical are readily identified by mass spectrometry employing a solid source probe and electron impact ionization.     

结直肠癌组织异常表达miRNA的鉴定

目的：筛选结直肠癌组织异常表达的miRNAs。方法：采用Agilem基因芯片（V12．0）分析结直肠癌组织及其配对正常粘膜组织间差异表达的miRNAs,MiRNAs错误发生率（FDR）〈0．05和微矩阵显著性分析（SAM）q值〈0．05为差异显著。结果：鉴定出结直肠癌中32个差异表达的miRNAs,显著上调和下调各16个。实时定量PCR（RT—qPCR）证实基因芯片中4个表达上调的miRNAs在结直肠癌组织中也显著上调。结论：MiRNA基因芯片鉴定出了结直肠癌组织一系列新的差异表达的miRNAs。     

Changes in the small intestine of Schistosoma mansoni-infected mice fed a high-fat diet

The consumption of a high-fat diet modifies both the morphology of the small intestine and experimentally tested effects of schistosomiasis mansoni. However, whether a schistosomiasis infection associated with a high-fat diet causes injury to the small intestine has never been investigated. Mice were fed either a high-fat or a standard-fat diet for 6 months and were then infected with Schistosoma mansoni cercariae. Physical characteristics of the intestinal tissue (mucosal thickness, small intestinal villi length and height, and abundance of goblet cells and enterocytes on the villous surface) and the distribution of granulomas along the intestinal segments and their developmental stage were measured at the time of sacrifice (9 or 17 weeks post-infection). The group fed a high-fat diet exhibited different granuloma stages, whereas the control group possessed only exudative granulomas. The chronically infected mice fed a high-fat diet exhibited higher granuloma and egg numbers than the acutely infected group. Exudative, exudative/exudative-productive and exudative-productive granulomas were present irrespective of diet. Computer-aided morphometric analysis confirmed that villus length, villus width, muscular height and submucosal height of the duodenal and jejunal segments were affected by diet and infection. In conclusion, a high-fat diet and infection had a significant impact on the small intestine morphology and morphometry among the animals tested.     

重组人载脂蛋白C-I在毕赤酵母中的分泌表达及鉴定

目的:在毕赤酵母中高效分泌表达与天然人载脂蛋白C-I具有相同结构和活性的重组人载脂蛋白C-I( rhApoC-I).方法:RT-PCR法自人肝组织调取编码人ApoC-I的cDNA,构建真核分泌型表达载体pPICZα/hApoC-I.重组质粒线性化后转化毕赤酵母感受态细胞,甲醇诱导表达,建立rhApoC-I的毕赤酵母表达体系.对rhApoC-I进行Western blot分析和体外活性研究.结果:经PCR法克隆的hApoC-I cDNA序列与GenBank登录序列一致.SDS-PAGE和Western blot分析均在分子量约6.6kDa出现特异性条带,2L发酵条件下表达量达到80mg/L.结论:首次在毕赤酵母菌中高效分泌表达rhApoC-I,并确定其具有抑制血小板衍生生长因子诱导的平滑肌细胞增殖的抑制作用,为进一步研究其结构与功能提供物质基础.     

Factors controlling the effect of praziquantel on liver fibrosis in Schistosoma mansoni-infected patients

An association study of a cohort of 177 Sudanese patients infected with Schistosoma mansoni [82 (46%) males and 95 (54%) females] was conducted to evaluate the factors controlling the regression of liver fibrosis 39 months after treatment with praziquantel using ultrasound evaluation. Periportal fibrosis (PPF) was regressed in 63 (35.6%) patients, while the disease progressed to higher grades in 24 (13.6%) patients. The grade of PPF did not change in 90 (50.8%) patients. The mean values of portal vein diameter, splenic vein diameter and index liver size in subjects in whom PPF regressed after treatment were significantly lower than in subjects in whom the disease was progressed ( P <0.0001, P =0.031 and P =0.003, respectively). The progression of hepatic fibrosis in males (15, 8.5%) was greater than that in females (9, 5.1%). Patients with regression or progression phenotypes tend to cluster in certain families. Our study indicated that regression, progression and stabilization of PPF after praziquantel therapy is controlled by gender, age, grade of fibrosis and possibly inherited factors.