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LETTERS TO EDITOR
Year : 2019  |  Volume : 33  |  Issue : 1  |  Page : 62-63

Nitric oxide, liver fluke opisthorchis viverrini, thalassemia, deferiprone, and cholangiocarcinoma: A clinical interrelationship with reference to endemic area in Indochina


1 Medical Academic Center, Bangkok, Thailand
2 Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India

Date of Web Publication14-Oct-2019

Correspondence Address:
Beuy Joob
Medical Academic Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_3_19

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How to cite this article:
Joob B, Wiwanitkit V. Nitric oxide, liver fluke opisthorchis viverrini, thalassemia, deferiprone, and cholangiocarcinoma: A clinical interrelationship with reference to endemic area in Indochina. J Med Soc 2019;33:62-3

How to cite this URL:
Joob B, Wiwanitkit V. Nitric oxide, liver fluke opisthorchis viverrini, thalassemia, deferiprone, and cholangiocarcinoma: A clinical interrelationship with reference to endemic area in Indochina. J Med Soc [serial online] 2019 [cited 2019 Nov 18];33:62-3. Available from: http://www.jmedsoc.org/text.asp?2019/33/1/62/269105



Sir,

Cholangiocarcinoma is an important biliary tract malignancy. This disease is extremely high prevalence in Indochina. The important etiological factor for this cancer is liver fluke Opisthorchis viverrini infection. In the pathophysiological process of liver fluke-related cholangiocarcinoma, O. viverrini could induce nitric oxide (NO) production which is related to DNA damage and cholangiocarcinogenesis.[1] In the same area of Indochina, another important local endemic medical problem is thalassemia and hemoglobinopathy. A recent study revealed that there is a high prevalence of thalassemia/hemoglobinopathy in patients with cholagiocarcinoma.[2] The interrelationship between the two common endemic problems, O. viverrini-related cholangiocarcinoma and thalassemia/hemoglobinopathy is interesting.

Here, the authors try to use bioinformatics pathway identification to assess the possible interrelationship between the two problems focusing on NO as the possible common linkage. The literature review on the available pathways relating to NO in both O. viverrini-related cholangiocarcinoma and thalassemia/hemoglobinopathy is done. The common pathway analysis is search. According to the pathway analysis, the final common pathway with NO as linkage hub is shown in [Figure 1]. It is evidenced that the use of deferiprone, a common drug for the management of excessive iron accumulation in thalassemia/hemoglobinopathy can induce increased NO production[3] and this can superimpose the increased NO production due to the O. viverrini infection, which might further lead to NO-related DNA damage and increased stimulation of cholgiocarcinogenesis. At present, it should be reassessed for the possible unwanted effect and clinical interrelationship of using deferiprone treatment in the area with a high prevalence of O. viverrini-related cholangiocarcinoma and thalassemia/hemoglobinopathy.
Figure 1: Common pathways relating to nitric oxide in both Opisthorchis viverrini-related cholangiocarcinoma and thalassemia/hemoglobinopathy

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prakobwong S, Pinlaor P, Charoensuk L, Khoontawad J, Yongvanit P, Hiraku Y, et al. The liver fluke Opisthorchis viverrini expresses nitric oxide synthase but not gelatinases. Parasitol Int 2012;61:112-7.  Back to cited text no. 1
    
2.
Insiripong S, Thaisamakr S, Amatachaya C. Hemoglobin typing in cholangiocarcinoma. Southeast Asian J Trop Med Public Health 1997;28:424-7.  Back to cited text no. 2
    
3.
Sriwantana T, Vivithanaporn P, Paiboonsukwong K, Rattanawonsakul K, Srihirun S, Sibmooh N, et al. Deferiprone increases endothelial nitric oxide synthase phosphorylation and nitric oxide production. Can J Physiol Pharmacol 2018;96:879-85.  Back to cited text no. 3
    


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