Vitamin D Receptor Gene Polymorphisms and the Risk of Chronic Hepatitis C Related Hepatocellular Carcinoma in Egyptian Population

Amal A. Mohamed1, Sherief Abd-Elsalam2, *, Hanan M. Mostafa3, Asmaa Abdalla4, Ahmed Farouk5, Ahmed M. Aref6, Reham A.A. Elshmiy7, Eman ElSayed8, Nevine F. Shafik7, Maha O. Mahmoud9, Moustafa Al-Daly10, Mariam S. Zaghloul11
1 Department of Biochemistry National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt
2 Department of Tropical Medicine and Infectious Diseases, Tanta, Egypt
3 Department of Internal Medicine, Medical Research Institute, Alexandria University, Alexandria, Egypt
4 Department of Clinical Nutrition, National Nutrition Institute, Cairo, Egypt
5 Department of Radiology, National Institute of Diabetes and Endocrinology, Cairo, Egypt
6 Department of Biotechnology, October University for Modern Sciences and Arts (MSA), Cairo, Egypt
7 Department of Clinical Pathology, Faculty of Biotechnology, National Cancer Institute, Cairo University, Cairo, Egypt
8 Department of Clinical Pathology, Faculty of Medicine, Minia University, Cairo, Egypt
9 Department of Biochemistry, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
10 Department of Clinical Oncology, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
11 Department of Hepatology, Gastroentrology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

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© 2021 Mohamed et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt;



Small percentage of hepatitis C (HCV) patients develop hepatocellular carcinoma (HCC) during their lifetime, suggesting that genetic factors might modulate HCC development. Numerous variations on the vitamin D receptor gene (VDR) have been recognized in human cancers. The majority of them cause VDR to be unable to bind to 1, 25-OH-D. The aim of the present work was to investigate the relation of VDR FokI (rs2228570), BsmI (rs3782905) and ApaI (rs7975232) gene polymorphisms and the risk of HCC development in chronic HCV Egyptian patients.


A total of 311 Egyptian patients were enrolled for this study. They were divided into 3 groups: 103 patients with liver Cirrhosis, 107 patients with HCC and 101 normal healthy subjects as the control group. Human genomic DNA Extraction was carried out using QIAamp® DNA Blood Mini Kit (QIAGEN) Genotyping of VDR ApaI (rs7975232) single nucleotide polymorphism (SNP) was carried out using real-time PCR TaqMan allelic discrimination assay with allele-specific designed fluorescent MGB probes.


Patients with HCC had a higher frequency of ApaI CC genotype (P=0.035) CI (0.031-0.038). Patients with HCC carried a higher ratio of ApaI CC genotype compared to those with liver cirrhosis (x2=5.4 and P = 0.03) or controls (x2=6.8 and P = 0.01). Univariate analysis revealed that age, lower platelet count (<150×103/μL), higher AFP (>100 ng/ml), and ApaI CC genotype were the factors significantly associated with the development of HCC. Stepwise logistic regression analysis showed that all were independent predictors.


ApaI CC VDR gene mutation is an independent risk factor for HCC development in Egyptian Cirrhotic HCV patients.

Keywords: Vitamin D receptor gene polymorphism, Liver Cirrhosis, Hepatocellular carcinoma, HCC, ApaI polymorphism, FokI polymorphism, BsmI polymorphism.