Diagnostic potential of Aldo-keto reductase 1B10 in pediatric hepatic malignancies: a narrative, hypothesis-generating translational review based on adult evidence and future research directions.
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OBJECTIVE: The difficulty in diagnosing hepatocellular carcinoma (HCC) at an early stage is a common challenge faced in the management of malignant liver tumors in both adults and children. Serum alpha-fetoprotein (AFP) is currently the most widely used screening marker; however, it lacks sufficient sensitivity for early-stage HCC and exhibits physiologically elevated levels in infants and young children, which interferes with the accurate diagnosis of hepatoblastoma (HB). Aldo-keto reductase 1B10 (AKR1B10) is a liver cancer-associated protein that has attracted significant attention in recent years. It is frequently overexpressed in adult HCC and can be secreted into the bloodstream; however, its expression and function in pediatric liver tumors have not been reported to date. This study aimed to explore the potential research value of AKR1B10 in pediatric liver malignancies and provide a theoretical basis for expanding its clinical applications. METHODS: This narrative review summarizes the molecular structure, catalytic properties, tissue expression patterns, and core molecular mechanisms driving the onset and progression of HCC associated with AKR1B10, as well as its serum diagnostic efficacy and current status of clinical translation in adult HCC. Based on the molecular overlap between adult and pediatric liver tumors in the three signaling pathways-Wnt/β-catenin, lipid metabolism, and retinoic acid signaling-and using theoretical deduction and cross-disease comparative analysis, this study proposes, for the first time, a hypothesis to extend AKR1B10 research to the field of pediatric liver tumors. PROPOSED HYPOTHESES: Based on adult HCC evidence and shared molecular pathways, we hypothesize that: (1) AKR1B10 may be upregulated in HB, which could help address the diagnostic blind spots caused by physiological fluctuations in AFP levels during infancy and early childhood; (2) AKR1B10 may serve as an auxiliary serum biomarker for AFP-negative or low-expressing HB subtypes. CONCLUSION: To our knowledge, this narrative review is the first to propose the potential research value of AKR1B10 in pediatric liver malignancies. This study aims to provide a theoretical foundation and translational direction for future research on AKR1B10 in the pediatric field.