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Fibrosure in North America), and another consists of hyaluronic acid, tissue inhibitor of metalloproteinase (TIMP)-1, and a-2-macroglobulin (marketed as FibroSpect II).28 The European Liver Fibrosis Group has recently proposed an algorithm combining age, hyaluronic acid, amino-terminal propeptide of type III collagen, and tissue inhibitor of matrix metalloproteinase 1 for detecting liver fibrosis.29 If these noninvasive markers can be proven to have consistently good positive and negative predictive value for hepatic fibrosis, then liver biopsy may be obviated in even more C282Y homozygotes in the future

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