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Mohammed DM, Salem MB, Elzallat M, Hammam OA, Suliman AA. Moringa oleifera L. mediated zinc oxide nano-biofertilizer alleviates non-alcoholic steatohepatitis via modulating de novo lipogenesis pathway and miRNA-122 expression. FOOD BIOSCI 2024; 60:104286. [DOI: 10.1016/j.fbio.2024.104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2024]
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2
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Tripathi M, Gauthier K, Sandireddy R, Zhou J, Guptta P, Sakthivel S, Teo WW, Naing YT, Arul K, Tikno K, Park SH, Wu Y, Wang L, Bay BH, Sun L, Giguere V, Chow PKH, Ghosh S, McDonnell DP, Yen PM, Singh BK. Esrra regulates Rplp1-mediated translation of lysosome proteins suppressed in metabolic dysfunction-associated steatohepatitis and reversed by alternate day fasting. Mol Metab 2024; 87:101997. [PMID: 39032642 DOI: 10.1016/j.molmet.2024.101997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/03/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Currently, little is known about the mechanism(s) regulating global and specific protein translation during metabolic dysfunction-associated steatohepatitis (MASH; previously known as non-alcoholic steatohepatitis, NASH). METHODS Unbiased label-free quantitative proteome, puromycin-labelling and polysome profiling were used to understand protein translation activity in vitro and in vivo. RESULTS We observed a global decrease in protein translation during lipotoxicity in human primary hepatocytes, mouse hepatic AML12 cells, and livers from a dietary mouse model of MASH. Interestingly, proteomic analysis showed that Rplp1, which regulates ribosome and translation pathways, was one of the most downregulated proteins. Moreover, decreased Esrra expression and binding to the Rplp1 promoter, diminished Rplp1 gene expression during lipotoxicity. This, in turn, reduced global protein translation and Esrra/Rplp1-dependent translation of lysosome (Lamp2, Ctsd) and autophagy (sqstm1, Map1lc3b) proteins. Of note, Esrra did not increase its binding to these gene promoters or their gene transcription, confirming its regulation of their translation during lipotoxicity. Notably, hepatic Esrra-Rplp1-dependent translation of lysosomal and autophagy proteins also was impaired in MASH patients and liver-specific Esrra knockout mice. Remarkably, alternate day fasting induced Esrra-Rplp1-dependent expression of lysosomal proteins, restored autophagy, and reduced lipotoxicity, inflammation, and fibrosis in hepatic cell culture and in vivo models of MASH. CONCLUSIONS Esrra regulation of Rplp1-mediated translation of lysosome/autolysosome proteins was downregulated during MASH. Alternate day fasting activated this novel pathway and improved MASH, suggesting that Esrra and Rplp1 may serve as therapeutic targets for MASH. Our findings also provided the first example of a nuclear hormone receptor, Esrra, to not only regulate transcription but also protein translation, via induction of Rplp1.
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Affiliation(s)
- Madhulika Tripathi
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Karine Gauthier
- Institut de Génomique Fonctionnelle de Lyon, Université de Lyon, Université Lyon 1, CNRS, Ecole Normale Supérieure de Lyon, 46 Allée d'Italie 69364 Lyon Cedex 07, France
| | - Reddemma Sandireddy
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Jin Zhou
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Priyanka Guptta
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Suganya Sakthivel
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Wei Wen Teo
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Yadanar Than Naing
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Kabilesh Arul
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Keziah Tikno
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Sung-Hee Park
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, C238A Levine Science Research Center, Durham, NC 27710, USA
| | - Yajun Wu
- Department of Anatomy, Yong Loo Lin School of Medicine, NUS 117594, Singapore
| | - Lijin Wang
- Centre for Computational Biology, Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore; Pennington Biomedical Research Center, Laboratory of Bioinformatics and Computational Biology, Baton Rouge, LA 70808, USA
| | - Boon-Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, NUS 117594, Singapore
| | - Lei Sun
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore
| | - Vincent Giguere
- Goodman Cancer Research Centre, McGill University, 1160 Pine Avenue West, Montreal, Québec H3A 1A3, Canada
| | - Pierce K H Chow
- Dept of Surgery, Singapore General Hospital and Dept. of Surgical Oncology, National Cancer Centre 169608, Singapore
| | - Sujoy Ghosh
- Centre for Computational Biology, Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore; Pennington Biomedical Research Center, Laboratory of Bioinformatics and Computational Biology, Baton Rouge, LA 70808, USA
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, C238A Levine Science Research Center, Durham, NC 27710, USA
| | - Paul M Yen
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore; Duke Molecular Physiology Institute and Dept. of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Brijesh K Singh
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (NUS) Medical School, Singapore 169857, Singapore.
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Raja A, Subhash Sagar R, Saeed S, Zia Ul Haq A, Khan O, Dileep Bhimani P, Raja S, Deepak F, Ahmed M, Ashir Shafique M, Saqlain Mustafa M, Sohaib Asghar M, Sharma V. Safety and efficacy of resmetirom in the treatment of patients with non-alcoholic steatohepatitis and liver fibrosis: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:4130-4138. [PMID: 38989228 PMCID: PMC11230798 DOI: 10.1097/ms9.0000000000002195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Non-alcoholic fatty liver disease (NAFLD), spanning from non-alcoholic steatohepatitis (NASH) to liver fibrosis, poses a global health challenge amid rising obesity and metabolic syndrome rates. Effective pharmacological treatments for NASH and liver fibrosis are limited. Objective This study systematically reviews and meta-analyzes the safety and efficacy of resmetirom, a selective thyroid hormone receptor-β agonist, in NASH and liver fibrosis treatment. By analyzing data from clinical trials, we aim to offer evidence-based recommendations for resmetirom's use in managing these conditions and identify avenues for future research. Methods Electronic databases (PubMed, Scopus, Science Direct, Google Scholar, ClinicalTrials.gov, and Cochrane CENTRAL) were systematically searched, supplemented by manual screening of relevant sources. Only English-language randomized controlled trials were included. Data extraction, risk of bias assessment, pooled analyses, and meta-regression were performed. Results Three randomized controlled trials involving 2231 participants were analyzed. Resmetirom demonstrated significant reductions in hepatic fat fraction [standardized mean difference (SMD) -4.61, 95% CI -6.77 to -2.44, P < 0.0001], NASH resolution without worsening fibrosis [risk ratio (RR) 2.51, 95% CI 1.74-3.64, P = 0.00001), and liver fibrosis improvement (RR 2.31, 95% CI 1.20-4.44, P = 0.01). Secondary outcomes showed significant improvements in lipid profiles, liver enzymes, and NASH biomarkers with resmetirom treatment. Meta-regression revealed associations between covariates and primary outcomes. Conclusion Resmetirom exhibits promising efficacy in reducing hepatic fat, improving NASH resolution, and ameliorating liver fibrosis with a favorable safety profile. Further research is warranted to validate findings and optimize therapeutic strategies for NASH and liver fibrosis management.
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Affiliation(s)
- Adarsh Raja
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari
| | - Raja Subhash Sagar
- Department of Internal Medicine, Liaquat University of Medical & Health Science, Jamshoro
| | - Sadia Saeed
- Department of Internal Medicine, Women Medical College Abbotabad, Abbottabad, Pakistan
| | - Amna Zia Ul Haq
- Department of Internal Medicine, Dow University of Health Sciences
| | - Owais Khan
- Department of Internal Medicine, Dow University of Health Sciences
| | | | - Sandesh Raja
- Department of Internal Medicine, Dow University of Health Sciences
| | - Fnu Deepak
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari
| | - Muhammad Ahmed
- Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari
| | | | | | - Muhammad Sohaib Asghar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Varsha Sharma
- Department of Internal Medicine, Nepal Medical College, Gokarneshwar, Nepal
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4
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He Q, He W, Dong H, Guo Y, Yuan G, Shi X, Wang D, Lu F. Role of liver sinusoidal endothelial cell in metabolic dysfunction-associated fatty liver disease. Cell Commun Signal 2024; 22:346. [PMID: 38943171 PMCID: PMC11214243 DOI: 10.1186/s12964-024-01720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024] Open
Abstract
Liver sinusoidal endothelial cells (LSECs) are highly specialized endothelial cells that represent the interface between blood cells on one side and hepatocytes on the other side. LSECs not only form a barrier within the hepatic sinus, but also play important physiological functions such as regulating hepatic vascular pressure, anti-inflammatory and anti-fibrotic. Pathologically, pathogenic factors can induce LSECs capillarization, that is, loss of fenestra and dysfunction, which are conducive to early steatosis, lay the foundation for the progression of metabolic dysfunction-associated fatty liver disease (MAFLD), and accelerate metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis. The unique localization, phenotype, and function of LSECs make them potential candidates for reducing liver injury, inflammation, and preventing or reversing fibrosis in the future.
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Affiliation(s)
- Qiongyao He
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wu He
- Division of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Hui Dong
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yujin Guo
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Gang Yuan
- Department of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoli Shi
- Department of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dingkun Wang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Fuer Lu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China.
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5
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Bai Y, Nan Y, Wu T, Zhu A, Xie X, Sun Y, Deng Y, Dou Z, Hu X, Zhou R, Xu S, Zhang Y, Fan J, Ju D. Lipid Nanoparticle-Mediated Delivery of CRISPR-Cas9 Against Rubicon Ameliorates NAFLD by Modulating CD36 Along with Glycerophospholipid Metabolism. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400493. [PMID: 38894572 DOI: 10.1002/advs.202400493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/20/2024] [Indexed: 06/21/2024]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a prominent cause of various chronic metabolic hepatic diseases with limited therapeutics. Rubicon, an essential regulator in lysosomal degradation, is reported to exacerbate hepatic steatosis in NAFLD mice and patients, indicating its probability of being a therapeutic target for NAFLD treatment. In this study, the therapeutic potential of Rubicon blockage is investigated. Lipid nanoparticles carrying Rubicon-specific CRISPR-Cas9 components exhibited liver accumulation, cell internalization, and Rubicon knockdown. A single administration of the nanoparticles results in attenuated lipid deposition and hepatic steatosis, with lower circulating lipid levels and decreased adipocyte size in NAFLD mice. Furthermore, the increase of phosphatidylcholine and phosphatidylethanolamine levels can be observed in the NAFLD mice livers after Rubicon silencing, along with regulatory effects on metabolism-related genes such as CD36, Gpcpd1, Chka, and Lpin2. The results indicate that knockdown of Rubicon improves glycerophospholipid metabolism and thereby ameliorates the NAFLD progression, which provides a potential strategy for NAFLD therapy via the restoration of Rubicon.
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Affiliation(s)
- Yu Bai
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Yanyang Nan
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Tao Wu
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - An Zhu
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Xinlei Xie
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Yun Sun
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321, P. R. China
| | - Yong Deng
- Department of Research and Development, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321, P. R. China
| | - Zihan Dou
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Xiaozhi Hu
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Rongrui Zhou
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Shuwen Xu
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Yuanzhen Zhang
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
| | - Jiajun Fan
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
- Fudan Zhangjiang Institute, Shanghai, 201203, P. R. China
- Shanghai Hailu Biological Technology Co., Ltd., Shanghai, 201200, P. R. China
| | - Dianwen Ju
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, Fudan University School of Pharmacy, Shanghai, P. R. China
- Fudan Zhangjiang Institute, Shanghai, 201203, P. R. China
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6
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Wang K, Margolis S, Cho JM, Wang S, Arianpour B, Jabalera A, Yin J, Hong W, Zhang Y, Zhao P, Zhu E, Reddy S, Hsiai TK. Non-Invasive Detection of Early-Stage Fatty Liver Disease via an On-Skin Impedance Sensor and Attention-Based Deep Learning. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400596. [PMID: 38887178 DOI: 10.1002/advs.202400596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/17/2024] [Indexed: 06/20/2024]
Abstract
Early-stage nonalcoholic fatty liver disease (NAFLD) is a silent condition, with most cases going undiagnosed, potentially progressing to liver cirrhosis and cancer. A non-invasive and cost-effective detection method for early-stage NAFLD detection is a public health priority but challenging. In this study, an adhesive, soft on-skin sensor with low electrode-skin contact impedance for early-stage NAFLD detection is fabricated. A method is developed to synthesize platinum nanoparticles and reduced graphene quantum dots onto the on-skin sensor to reduce electrode-skin contact impedance by increasing double-layer capacitance, thereby enhancing detection accuracy. Furthermore, an attention-based deep learning algorithm is introduced to differentiate impedance signals associated with early-stage NAFLD in high-fat-diet-fed low-density lipoprotein receptor knockout (Ldlr-/-) mice compared to healthy controls. The integration of an adhesive, soft on-skin sensor with low electrode-skin contact impedance and the attention-based deep learning algorithm significantly enhances the detection accuracy for early-stage NAFLD, achieving a rate above 97.5% with an area under the receiver operating characteristic curve (AUC) of 1.0. The findings present a non-invasive approach for early-stage NAFLD detection and display a strategy for improved early detection through on-skin electronics and deep learning.
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Affiliation(s)
- Kaidong Wang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA, 90073, USA
| | - Samuel Margolis
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Jae Min Cho
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Shaolei Wang
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Brian Arianpour
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Alejandro Jabalera
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Junyi Yin
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Wen Hong
- Department of Materials Science and Engineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Yaran Zhang
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Peng Zhao
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Enbo Zhu
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Materials Science and Engineering, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Srinivasa Reddy
- Department of Molecular and Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Tzung K Hsiai
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Medicine, Greater Los Angeles Veterans Affairs (VA) Healthcare System, Los Angeles, CA, 90073, USA
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7
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Liu D, Chen P. Binary Bacillus subtilis protects the intestinal mucosa barrier and alleviates nonalcoholic steatohepatitis. Animal Model Exp Med 2024; 7:362-366. [PMID: 37469297 PMCID: PMC11228086 DOI: 10.1002/ame2.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Nonalcoholic steatohepatitis (NASH) is characterized by liver steatosis, inflammation, and even fibrosis. NASH is likely to develop into cirrhosis and liver cancer, the major causes of liver related deaths. We aimed to study the effect of probiotics on NASH via the gut-liver axis. METHODS Thirty male Sprague-Dawley rats were divided into three groups. A control group of 10 rats was fed on a standard chow for 16 weeks. Twenty rats fed on a high-fat diet for 8 weeks were separated to two groups: a model group (10 rats) fed on vehicle for 8 weeks and a treatment group (10 rats) supplemented with binary Bacillus subtilis for 8 weeks. Hepatic expression of IL-6 and TNF-ɑ and ileum expression of IL-17 and occludin were measured. RESULTS The high-fat diet caused inflammation of the liver and ileum in rats. Binary Bacillus subtilis treatment reduces liver inflammation through the intestinal liver axis. Increased levels of IL-6 and TNF-α were detected in rats fed a high-fat diet, which were reduced to lower levels after treatment with binary Bacillus subtilis. In rats on the high-fat diet, elevated IL-17 levels and decreased occludin levels were observed. Treatment with Bacillus subtilis reduced IL-17 levels and restored the expression of occludin. CONCLUSION Binary Bacillus subtilis has a beneficial effect on liver inflammation and intestinal damage.
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Affiliation(s)
- Donglin Liu
- Department of Gastroenterology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Pengguo Chen
- Department of Gastroenterology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
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Matchett KP, Paris J, Teichmann SA, Henderson NC. Spatial genomics: mapping human steatotic liver disease. Nat Rev Gastroenterol Hepatol 2024:10.1038/s41575-024-00915-2. [PMID: 38654090 DOI: 10.1038/s41575-024-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD, formerly known as non-alcoholic fatty liver disease) is a leading cause of chronic liver disease worldwide. MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH, formerly known as non-alcoholic steatohepatitis) with subsequent liver cirrhosis and hepatocellular carcinoma formation. The advent of current technologies such as single-cell and single-nuclei RNA sequencing have transformed our understanding of the liver in homeostasis and disease. The next frontier is contextualizing this single-cell information in its native spatial orientation. This understanding will markedly accelerate discovery science in hepatology, resulting in a further step-change in our knowledge of liver biology and pathobiology. In this Review, we discuss up-to-date knowledge of MASLD development and progression and how the burgeoning field of spatial genomics is driving exciting new developments in our understanding of human liver disease pathogenesis and therapeutic target identification.
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Affiliation(s)
- Kylie P Matchett
- Centre for Inflammation Research, Institute for Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Jasmin Paris
- Centre for Inflammation Research, Institute for Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sarah A Teichmann
- Wellcome Sanger Institute, Cambridge, UK
- Department of Physics, Cavendish Laboratory, University of Cambridge, Cambridge, UK
| | - Neil C Henderson
- Centre for Inflammation Research, Institute for Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK.
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
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9
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Senavirathna T, Shafaei A, Lareu R, Balmer L. Unlocking the Therapeutic Potential of Ellagic Acid for Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis. Antioxidants (Basel) 2024; 13:485. [PMID: 38671932 PMCID: PMC11047720 DOI: 10.3390/antiox13040485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Obesity is in epidemic proportions in many parts of the world, contributing to increasing rates of non-alcoholic fatty liver disease (NAFLD). NAFLD represents a range of conditions from the initial stage of fatty liver to non-alcoholic steatohepatitis (NASH), which can progress to severe fibrosis, through to hepatocellular carcinoma. There currently exists no treatment for the long-term management of NAFLD/NASH, however, dietary interventions have been investigated for the treatment of NASH, including several polyphenolic compounds. Ellagic acid is one such polyphenolic compound. Nutraceutical food abundant in ellagic acid undergoes initial hydrolysis to free ellagic acid within the stomach and small intestine. The proposed mechanism of action of ellagic acid extends beyond its initial therapeutic potential, as it is further broken down by the gut microbiome into urolithin. Both ellagic acid and urolithin have been found to alleviate oxidative stress, inflammation, and fibrosis, which are associated with NAFLD/NASH. While progress has been made in understanding the pharmacological and biological activity of ellagic acid and its involvement in NAFLD/NASH, it has yet to be fully elucidated. Thus, the aim of this review is to summarise the currently available literature elucidating the therapeutic potential of ellagic acid and its microbial-derived metabolite urolithin in NAFLD/NASH.
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Affiliation(s)
- Tharani Senavirathna
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia;
| | - Armaghan Shafaei
- Centre for Integrative Metabolomics and Computational Biology, School of Science, Edith Cowan University, Perth, WA 6027, Australia;
| | - Ricky Lareu
- Curtin Medical School and Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Lois Balmer
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA 6027, Australia;
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10
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Ionita-Radu F, Patoni C, Nancoff AS, Marin FS, Gaman L, Bucurica A, Socol C, Jinga M, Dutu M, Bucurica S. Berberine Effects in Pre-Fibrotic Stages of Non-Alcoholic Fatty Liver Disease-Clinical and Pre-Clinical Overview and Systematic Review of the Literature. Int J Mol Sci 2024; 25:4201. [PMID: 38673787 PMCID: PMC11050387 DOI: 10.3390/ijms25084201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the predominant cause of chronic liver conditions, and its progression is marked by evolution to non-alcoholic steatosis, steatohepatitis, cirrhosis related to non-alcoholic steatohepatitis, and the potential occurrence of hepatocellular carcinoma. In our systematic review, we searched two databases, Medline (via Pubmed Central) and Scopus, from inception to 5 February 2024, and included 73 types of research (nine clinical studies and 64 pre-clinical studies) from 2854 published papers. Our extensive research highlights the impact of Berberine on NAFLD pathophysiology mechanisms, such as Adenosine Monophosphate-Activated Protein Kinase (AMPK), gut dysbiosis, peroxisome proliferator-activated receptor (PPAR), Sirtuins, and inflammasome. Studies involving human subjects showed a measurable reduction of liver fat in addition to improved profiles of serum lipids and hepatic enzymes. While current drugs for NAFLD treatment are either scarce or still in development or launch phases, Berberine presents a promising profile. However, improvements in its formulation are necessary to enhance the bioavailability of this natural substance.
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Affiliation(s)
- Florentina Ionita-Radu
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (C.P.); (F.-S.M.); (S.B.)
- Department of Gastroenterology, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Cristina Patoni
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (C.P.); (F.-S.M.); (S.B.)
| | - Andreea Simona Nancoff
- Department of Gastroenterology, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Flavius-Stefan Marin
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (C.P.); (F.-S.M.); (S.B.)
| | - Laura Gaman
- Department of Biochemistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Ana Bucurica
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.B.); (C.S.)
| | - Calin Socol
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.B.); (C.S.)
| | - Mariana Jinga
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (C.P.); (F.-S.M.); (S.B.)
- Department of Gastroenterology, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
| | - Madalina Dutu
- Department of Anesthesiology and Intensive Care, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Anesthesiology and Intensive Care, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Sandica Bucurica
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.I.-R.); (C.P.); (F.-S.M.); (S.B.)
- Department of Gastroenterology, Dr. Carol Davila Central Military Emergency University Hospital, 010242 Bucharest, Romania;
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Chen H, Liu Y, Liu D, Liang Y, Zhu Z, Dong K, Li H, Bao Y, Wu J, Hou X, Jia W. Sex- and age-specific associations between abdominal fat and non-alcoholic fatty liver disease: a prospective cohort study. J Mol Cell Biol 2024; 15:mjad069. [PMID: 38037475 PMCID: PMC11161703 DOI: 10.1093/jmcb/mjad069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/26/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Abstract
Obesity is closely related to non-alcoholic fatty liver disease (NAFLD). Although sex differences in body fat distribution have been well demonstrated, little is known about the sex-specific associations between adipose tissue and the development of NAFLD. Using community-based cohort data, we evaluated the associations between magnetic resonance imaging quantified areas of abdominal adipose tissue, including visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and incident NAFLD in 2830 participants (1205 males and 1625 females) aged 55-70 years. During a 4.6-year median follow-up, the cumulative incidence rates of NAFLD increased with areas of VAT and SAT both in males and in females. Further analyses showed that the above-mentioned positive associations were stronger in males than in females, especially in participants under 60 years old. In contrast, these sex differences disappeared in those over 60 years old. Furthermore, the risk of developing NAFLD increased non-linearly with increasing fat area in a sex-specific pattern. Additionally, sex-specific potential mediators, such as insulin resistance, lipid metabolism, inflammation, and adipokines, may exist in the associations between adipose tissue and NAFLD. This study showed that the associations between abdominal fat and the risk of NAFLD were stratified by sex and age, highlighting the potential need for sex- and age-specific management of NAFLD.
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Affiliation(s)
- Hongli Chen
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Yuexing Liu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Dan Liu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Yebei Liang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Zhijun Zhu
- General Practitioner Teams in Community Health Service Center of Nicheng, Pudong New Area District, Shanghai 201306, China
| | - Keqing Dong
- General Practitioner Teams in Community Health Service Center of Nicheng, Pudong New Area District, Shanghai 201306, China
| | - Huating Li
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Jiarui Wu
- CAS Key Laboratory of Systems Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai 200031, China
| | - Xuhong Hou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China
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12
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Schepp M, Freuer D, Wawro N, Peters A, Heier M, Teupser D, Meisinger C, Linseisen J. Association of the habitual dietary intake with the fatty liver index and effect modification by metabotypes in the population-based KORA-Fit study. Lipids Health Dis 2024; 23:99. [PMID: 38575962 PMCID: PMC10993479 DOI: 10.1186/s12944-024-02094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is an emerging threat for public health with diet being a major risk factor in disease development and progression. However, the effects of habitual food consumption on fatty liver are still inconclusive as well as the proposed role of the individuals' metabolic profiles. Therefore, the aim of our study is to examine the associations between diet and NAFLD with an emphasis on the influence of specific metabotypes in the general population. METHODS A total of 689 participants (304 men and 385 women) of the KORA-Fit (S4) survey, a follow-up study of the population-based KORA cohort study running in the Region of Augsburg, Germany, were included in this analysis. Dietary information was derived from repeated 24-h food lists and a food frequency questionnaire. The intake of energy and energy-providing nutrients were calculated using the national food composition database. The presence of fatty liver was quantified by the fatty liver index (FLI), and metabotypes were calculated using K-means clustering. Multivariable linear regression models were used for the analysis of habitual food groups and FLI; for the evaluation of macronutrients, energy substitution models were applied. RESULTS A higher consumption of nuts and whole grains, and a better diet quality (according to Alternate Healthy Eating Index and Mediterranean Diet Score) were associated with lower FLI values, while the intake of soft drinks, meat, fish and eggs were associated with a higher FLI. The isocaloric substitution of carbohydrates with polyunsaturated fatty acids was associated with a decreased FLI, while substitution with monounsaturated fatty acids and protein showed increased FLI. Statistically significant interactions with the metabotype were observed for most food groups. CONCLUSION The consumption of plant-based food groups, including nuts and whole grains, and diet quality, were associated with lower FLI values, whereas the intake of soft drinks and products of animal origin (meat, fish, eggs) were associated with a higher FLI. The observed statistically significant interactions with the metabotype for most food groups could help to develop targeted prevention strategies on a population-based level if confirmed in independent prospective studies.
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Affiliation(s)
- M Schepp
- University of Augsburg, University Hospital Augsburg, EpidemiologyAugsburg, Germany.
| | - D Freuer
- University of Augsburg, University Hospital Augsburg, EpidemiologyAugsburg, Germany
| | - N Wawro
- University of Augsburg, University Hospital Augsburg, EpidemiologyAugsburg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - A Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - M Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - D Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - C Meisinger
- University of Augsburg, University Hospital Augsburg, EpidemiologyAugsburg, Germany
| | - J Linseisen
- University of Augsburg, University Hospital Augsburg, EpidemiologyAugsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
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13
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Ye D, He J, He X. The role of bile acid receptor TGR5 in regulating inflammatory signalling. Scand J Immunol 2024; 99:e13361. [PMID: 38307496 DOI: 10.1111/sji.13361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
Takeda G protein-coupled receptor 5 (TGR5) is a bile acid receptor, and its role in regulating metabolism after binding with bile acids has been established. Since the immune response depends on metabolism to provide biomolecules and energy to cope with challenging conditions, emerging evidence reveals the regulatory effects of TGR5 on the immune response. An in-depth understanding of the effect of TGR5 on immune regulation can help us disentangle the interaction of metabolism and immune response, accelerating the development of TGR5 as a therapeutic target. Herein, we reviewed more than 200 articles published in the last 20 years in PubMed, to discuss the roles of TGR5 in regulating inflammatory response, the molecular mechanism, as well as existing problems. Particularly, its anti-inflammation effect is emphasized.
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Affiliation(s)
- Daijiao Ye
- Medical Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jiayao He
- Medical Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaofei He
- Medical Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- The Key Laboratory of Pediatric Hematology and Oncology Disease of Wenzhou, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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14
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Wu Y, Zhou J, Zuo X, Kuang Y, Sun L, Zhang X. Yanggan Jiangmei Formula alleviates hepatic inflammation and lipid accumulation in non-alcoholic steatohepatitis by inhibiting the NF-κB/NLRP3 signaling pathway. Chin J Nat Med 2024; 22:224-234. [PMID: 38553190 DOI: 10.1016/s1875-5364(24)60595-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Indexed: 04/02/2024]
Abstract
The role of NF-κB and the NLRP3 inflammasome in the chronic inflammatory microenvironment of non-alcoholic steatohepatitis (NASH) has been posited as crucial. The Yanggan Jiangmei Formula (YGJMF) has shown promise in ameliorating hepatic steatosis in NASH patients, yet its pharmacological mechanisms remain largely unexplored. This study was conducted to investigate the efficacy of YGJMF in NASH and to elucidate its pharmacological underpinnings. To simulate NASH both in vivo and in vitro, high-fat-diet (HFD) rats and HepG2 cells stimulated with free fatty acids (FFAs) were utilized. The severity of liver injury and lipid deposition was assessed using serum indicators, histopathological staining, micro-magnetic resonance imaging (MRI), and the liver-to-muscle signal intensity ratio (SIRL/M). Furthermore, a combination of enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC), immunofluorescence, real-time quantitative polymerase chain reaction (RT-qPCR), and Western blotting analyses was employed to investigate the NF-κB/NLRP3 signaling pathway and associated cytokine levels. The results from liver pathology, MRI assessments, and biochemical tests in rat models demonstrated YGJMF's significant effectiveness in reducing liver damage and lipid accumulation. Additionally, YGJMF markedly reduced hepatocyte inflammation by downregulating inflammatory cytokines in both liver tissue and serum. Furthermore, YGJMF was found to disrupt NF-κB activation, consequently inhibiting the assembly of the NLRP3 inflammasome in both the in vitro and in vivo models. The preliminary findings of this study suggest that YGJMF may alleviate hepatic steatosis and inhibit the NF-κB/NLRP3 signaling pathway, thereby exerting anti-inflammatory effects in NASH.
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Affiliation(s)
- Yuanyuan Wu
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China; The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
| | - Jingwen Zhou
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xinchen Zuo
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China; The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
| | - Yufeng Kuang
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China; The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China
| | - Lixia Sun
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China; The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China.
| | - Xiaolong Zhang
- The Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China.
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15
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Mohamed MAE, Rihan S, Elbakry MMM, Moselhy SS. Molecular docking targeting autophagy pathway mediate abrogation of NASH by specific functional foods: update review. Nat Prod Res 2024:1-24. [PMID: 38362886 DOI: 10.1080/14786419.2024.2316328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Autophagy is a very well-conserved self-digestive mechanism that transports unwanted or disposable cytoplasmic debris to lysosomes for destruction, including misfolded proteins and damaged organelles. Advanced liver illnesses can develop from the prevalent clinical condition known as non-alcoholic steatohepatitis (NASH). There is no effective treatment, is still unclear. Therefore, in order to create novel therapeutics, it is necessary to comprehend the pathogenic pathways causing disease onset and progression. Natural components from medicinal plants are currently the subject of a larger number of studies since they provide fresh promise for NASH. This review provided an overview of the aetiology of NASH, in addition the role of natural products as alternative or complementary therapeutic agent for management of NASH via autophagy induction. It was concluded that, alternative and complementary supplement of natural functional food as Arabica coffee that rich with chlorogenic acid targeting autophagy mechanism mediate amelioration effect of NASH.
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Affiliation(s)
| | - Shaimaa Rihan
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Mustafa M M Elbakry
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
- Faculty of Biotechnology, October University for Modern Sciences and Arts, Cairo, Egypt
| | - Said S Moselhy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
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Afarin R, Hatami M, Monjezi S, Bineshfar F, Ahangarpour A. Suppression of TGF-β/Smad3 signaling pathway by Capparis spinosa and quercetin in a rat model of nonalcoholic steatohepatitis. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2024; 27:1096-1104. [PMID: 39055878 PMCID: PMC11266748 DOI: 10.22038/ijbms.2024.76264.16497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/10/2024] [Indexed: 07/28/2024]
Abstract
Objectives Liver diseases, including non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), pose significant global public health challenges. This study investigates the therapeutic effects of quercetin (QC), Capparis spinosa (CS), a QC and CS combination, and Saroglitazar (SARO) on NASH in a Wistar rat model. Materials and Methods NASH was induced by a 42-day high-fat diet regimen in male Wistar rats. Post-induction, rats were divided into five groups receiving SARO, QC, CS, and CS+QC combination. We monitored changes in liver and body weights and evaluated the expression of genes associated with fatty acid biosynthesis (e.g., ACC and FAS), β-oxidation (e.g., CPT1, PPAR α), inflammation (e.g., TNF-α and IL-6), and fibrosis (e.g., TGF-β and COL1A), as well as protein expression levels of p-Smad2/3 and p-Smad3. Results Treatment with QC+CS significantly decreased liver weight, body mass gain, and liver triglyceride (TG) compared to other treatments. The QC and CS combined therapy also resulted in a greater normalization of hepatic enzymatic activities, including decreases in ALT and AST levels, coupled with improvements in lipid profile indicated by decreased LDL-C and increased HDL-C concentrations, as compared to SARO and QC alone. Furthermore, this combined treatment significantly down-regulated the expression of TGF-β, TNF-α, IL-6 genes, and Smad2/3 and Smad3 protein levels. Conclusion Our study demonstrates that an interactive effect between QC and CS can effectively reduce liver fibrosis and steatosis by inhibiting the TGF-β/Smad3 signaling pathway in a diet-induced model of nonalcoholic steatohepatitis and fibrosis in rats.
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Affiliation(s)
- Reza Afarin
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Hatami
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sajad Monjezi
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Bineshfar
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Akram Ahangarpour
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Medicinal Plant Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Holzhey M, Petroff D, Wirkner K, Engel C, Baber R, Tönjes A, Zeynalova S, Yahiaoui-Doktor M, Berg T, Karlas T, Wiegand J. Relevance of GLP-1 receptor agonists or SGLT-2 inhibitors on the recruitment for clinical studies in patients with NAFLD. Eur J Gastroenterol Hepatol 2024; 36:107-112. [PMID: 37823453 DOI: 10.1097/meg.0000000000002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Guidelines increasingly recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose co-transporter-2 inhibitors (SGLT2i) to prevent cardiovascular and cardiorenal endpoints. Both drugs also show beneficial effects in nonalcoholic fatty liver disease (NAFLD). Preexisting GLP-1 RA and SGLT2i therapies are frequently defined as exclusion criterion in clinical studies to avoid confounding effects. We therefore investigated how this might limit recruitment and design of NAFLD studies. METHODS GLP-1 RA and SGLT2i prescriptions were analyzed in NAFLD patients with diabetes mellitus recruited at a tertiary referral center and from the population-based LIFE-Adult-Study. Individuals were stratified according to noninvasive parameters of liver fibrosis based on vibration-controlled transient elastography (VCTE). RESULTS 97 individuals were recruited at tertiary care and 473 from the LIFE-Adult-Study. VCTE was available in 97/97 and 147/473 cases.GLP-1 RA or SGLT2i were used in 11.9% of the population-based cohort (LSM < 8 kPa), but in 32.0% with LSM ≥ 8 kPa. In the tertiary clinic, it was 30.9% overall, independent of LSM, and 36.8% in patients with medium and high risk for fibrotic NASH (FAST score > 0.35). At baseline, 3.1% of the patients in tertiary care were taking GLP-1 RA and 4.1% SGLT2i. Four years later, the numbers had increased to 15.5% and 21.6%. CONCLUSION GLP-1 RA and SGLT2i are frequently and increasingly prescribed. In candidates for liver biopsy for NASH studies (VCTE ≥ 8 kPa) the use of them exceeds 30%, which needs careful consideration when designing NASH trials.
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Affiliation(s)
- Michael Holzhey
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | | | - Kerstin Wirkner
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Christoph Engel
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Ronny Baber
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig
| | - Anke Tönjes
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig, Germany
| | - Samira Zeynalova
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Maryam Yahiaoui-Doktor
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
- Leipzig Research Centre for Civilization Diseases, University of Leipzig
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Centre
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Centre
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Jin J, He Y, Guo J, Pan Q, Wei X, Xu C, Qi Z, Li Q, Ma S, Lin J, Jiang N, Ma J, Wang X, Jiang L, Ding Q, Osto E, Zhi X, Meng D. BACH1 controls hepatic insulin signaling and glucose homeostasis in mice. Nat Commun 2023; 14:8428. [PMID: 38129407 PMCID: PMC10739811 DOI: 10.1038/s41467-023-44088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Hepatic insulin resistance is central to the metabolic syndrome. Here we investigate the role of BTB and CNC homology 1 (BACH1) in hepatic insulin signaling. BACH1 is elevated in the hepatocytes of individuals with obesity and patients with non-alcoholic fatty liver disease (NAFLD). Hepatocyte-specific Bach1 deletion in male mice on a high-fat diet (HFD) ameliorates hyperglycemia and insulin resistance, improves glucose homeostasis, and protects against steatosis, whereas hepatic overexpression of Bach1 in male mice leads to the opposite phenotype. BACH1 directly interacts with the protein-tyrosine phosphatase 1B (PTP1B) and the insulin receptor β (IR-β), and loss of BACH1 reduces the interaction between PTP1B and IR-β upon insulin stimulation and enhances insulin signaling in hepatocytes. Inhibition of PTP1B significantly attenuates BACH1-mediated suppression of insulin signaling in HFD-fed male mice. Hepatic BACH1 knockdown ameliorates hyperglycemia and improves insulin sensitivity in diabetic male mice. These results demonstrate a critical function for hepatic BACH1 in the regulation of insulin signaling and glucose homeostasis.
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Affiliation(s)
- Jiayu Jin
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yunquan He
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jieyu Guo
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qi Pan
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiangxiang Wei
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhiyuan Qi
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qinhan Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Siyu Ma
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiayi Lin
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Nan Jiang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jinghua Ma
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xinhong Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Lindi Jiang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Qiurong Ding
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Elena Osto
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Xiuling Zhi
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Dan Meng
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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19
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Ren G, Bai C, Yi S, Cong Q, Zhu Y. Mechanisms and Therapeutic Strategies for MAFLD Targeting TLR4 Signaling Pathways. J Innate Immun 2023; 16:45-55. [PMID: 38128497 PMCID: PMC10783892 DOI: 10.1159/000535524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Metabolic-associated fatty liver disease (MAFLD) is one of the most common chronic liver diseases. The underlying pathophysiological mechanisms are intricate and involve various factors. Unfortunately, there is currently a lack of available effective treatment options. Toll-like receptors (TLRs) are a group of pattern-recognition receptors that are responsible for activating the innate immune system. Research has demonstrated that TLR4 plays a pivotal role in the progression of MAFLD by facilitating the pathophysiological mechanisms. SUMMARY Lipid peroxidation, pro-inflammatory factors, insulin resistance (IR), and dysbiosis of intestinal microbiota are considered as the pathogenic mechanisms of MAFLD. This review summarizes the impact of TLR4 signaling pathways on the progression of MAFLD, specifically in relation to lipid metabolic disorders, IR, oxidative stress, and gut microbiota disorders. Additionally, we emphasize the potential therapeutic approaches for MAFLD that target TLR4 signaling pathways, including the use of plant extracts, traditional Chinese medicines, probiotics, pharmaceuticals such as peroxisome proliferator-activated receptor antagonists and farnesol X agonists, and lifestyle modifications such as dietary changes and exercise also considered. Furthermore, TLR4 signaling pathways have also been linked to the lean MAFLD. KEY MESSAGES TLR4 plays a crucial role in MAFLD by triggering IR, buildup of lipids, imbalance in gut microbiota, oxidative stress, and initiation of immune responses. The mitigation of MAFLD can be accomplished by suppressing the TLR4 signaling pathway. In the future, it could potentially emerge as a therapeutic target for the condition.
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Affiliation(s)
- Guanghui Ren
- Department of Infectious Disease, Liver Disease Center of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China,
| | - Changchuan Bai
- Dalian Hospital of Traditional Chinese Medicine, Dalian, China
| | - Sitong Yi
- Department of Infectious Disease, Liver Disease Center of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qingwei Cong
- Department of Infectious Disease, Liver Disease Center of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Zhu
- Department of Infectious Disease, Liver Disease Center of Integrated Traditional Chinese and Western Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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20
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Bacil GP, Romualdo GR, Rodrigues J, Barbisan LF. Indole-3-carbinol and chlorogenic acid combination modulates gut microbiome and attenuates nonalcoholic steatohepatitis in a murine model. Food Res Int 2023; 174:113513. [PMID: 37986509 DOI: 10.1016/j.foodres.2023.113513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, affecting almost 32% of the population and ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). Recent findings indicate that the fast-growing prevalence of NAFLD might be linked to adherence to a Westernized diet (WD), mostly composed of fat/sugar-enriched foods. The WD has been reportedly targeted as a potential driver of gut-liver axis unbalance, suggesting a major role in NASH. On the other hand, bioactive food compounds feature as a potential chemopreventive strategy against NASH, due to their beneficial effects (i.e, anti-inflammatory/oxidant activity and modulation of gut microbiome). Brassicaceae vegetables are known for their high amount of isothiocyanates and polyphenols, as indole-3-carbinol (I3C) and chlorogenic acid (CGA). Thus, we sought to assess the effects of human relevant doses of I3C and CGA isolated or in combination (5/125 mg/Kg of body weight, respectively) on a diet/chemical-induced murine model of NASH. I3C + CGA oral treatment diminished NAFLD activity score (NAS) (p < 0.0001), as well as alleviated the hepatic lipid (p = 0.0011) accumulation, prevented hepatic stellate cell (HSC) activation (p < 0.0001), and subsequent fibrosis (p < 0.0001). The combination also reduced the number of both hepatic CD68-positive macrophages (p < 0.0001) and cleaved caspase-3 hepatocytes (p < 0.0001) and diminished the malondialdehyde levels (p = 0.0155). Additionally, the combination of I3C + CGA restored the relative abundance of Alistipes (p = 0.0299), Allobaculum (p = 0.0014), Bacteroides (p = 0.0046), and Odoribacter (p = 0.0030) bacteria genera on the gut microbiome. Taken together, these findings show that the combination of I3C + CGA at populational-relevant ingestion, rather than the I3C or CGA alone, was able to modulate gut microbiome and attenuate NASH in this hybrid model mouse.
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Affiliation(s)
- Gabriel P Bacil
- São Paulo State University (UNESP), Botucatu Medical School, Department of Pathology, Botucatu, SP, Brazil
| | - Guilherme R Romualdo
- São Paulo State University (UNESP), Botucatu Medical School, Experimental Research Unit (UNIPEX), Multimodel Drug Screening Platform - Laboratory of Chemically induced and Experimental Carcinogenesis (MDSP-LCQE), Botucatu, SP, Brazil; São Paulo State University (UNESP), Biosciences Institute, Department of Structural and Functional Biology, Laboratory of Chemically Induced and Experimental Carcinogenesis (LCQE), Botucatu, SP, Brazil
| | - Josias Rodrigues
- São Paulo State University (UNESP), Biosciences Institute, Department of Chemical and Biological Sciences, Laboratory of Microbiome and Bacterian Genomics (LMGB), Botucatu, Brazil
| | - Luís F Barbisan
- São Paulo State University (UNESP), Botucatu Medical School, Experimental Research Unit (UNIPEX), Multimodel Drug Screening Platform - Laboratory of Chemically induced and Experimental Carcinogenesis (MDSP-LCQE), Botucatu, SP, Brazil; São Paulo State University (UNESP), Biosciences Institute, Department of Structural and Functional Biology, Laboratory of Chemically Induced and Experimental Carcinogenesis (LCQE), Botucatu, SP, Brazil.
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21
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Keating SE, Sabag A, Hallsworth K, Hickman IJ, Macdonald GA, Stine JG, George J, Johnson NA. Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia. Sports Med 2023; 53:2347-2371. [PMID: 37695493 PMCID: PMC10687186 DOI: 10.1007/s40279-023-01918-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150-240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2-4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.
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Affiliation(s)
- Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Room 534, Bd 26B, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Angelo Sabag
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Kate Hallsworth
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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22
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Sanyal AJ, Ratziu V, Loomba R, Anstee QM, Kowdley KV, Rinella ME, Sheikh MY, Trotter JF, Knapple W, Lawitz EJ, Abdelmalek MF, Newsome PN, Boursier J, Mathurin P, Dufour JF, Berrey MM, Shiff SJ, Sawhney S, Capozza T, Leyva R, Harrison SA, Younossi ZM. Results from a new efficacy and safety analysis of the REGENERATE trial of obeticholic acid for treatment of pre-cirrhotic fibrosis due to non-alcoholic steatohepatitis. J Hepatol 2023; 79:1110-1120. [PMID: 37517454 DOI: 10.1016/j.jhep.2023.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND & AIMS Obeticholic acid (OCA) is a first-in-class farnesoid X receptor agonist and antifibrotic agent in development for the treatment of pre-cirrhotic liver fibrosis due to non-alcoholic steatohepatitis (NASH). We aimed to validate the original 18-month liver biopsy analysis from the phase III REGENERATE trial of OCA for the treatment of NASH with a consensus panel analysis, provide additional histology data in a larger population, and evaluate safety from >8,000 total patient-years' exposure with nearly 1,000 participants receiving study drug for >4 years. METHODS Digitized whole-slide images were evaluated independently by panels of three pathologists using the NASH Clinical Research Network scoring system. Primary endpoints were (1) ≥1 stage improvement in fibrosis with no worsening of NASH or (2) NASH resolution with no worsening of fibrosis. Safety was assessed by laboratory values and adverse events. RESULTS Prespecified efficacy analyses included 931 participants. The proportion of participants achieving a ≥1 stage improvement in fibrosis with no worsening of NASH was 22.4% for OCA 25 mg vs. 9.6% for placebo (p <0.0001). More participants receiving OCA 25 mg vs. placebo achieved NASH resolution with no worsening of fibrosis (6.5% vs. 3.5%, respectively; p = 0.093). Histology data in a larger population of 1,607 participants supported these results. Safety data included 2,477 participants. The incidence of treatment-emergent adverse events (TEAEs), serious TEAEs, and deaths was not substantively different across treatment groups. Pruritus was the most common TEAE. Rates of adjudicated hepatic, renal, and cardiovascular events were low and similar across treatment groups. CONCLUSIONS These results confirm the antifibrotic effect of OCA 25 mg. OCA was generally well tolerated over long-term dosing. These data support a positive benefit:risk profile in patients with pre-cirrhotic liver fibrosis due to NASH. IMPACT AND IMPLICATIONS Patients with non-alcoholic steatohepatitis (NASH) often have liver scarring (fibrosis), which causes an increased risk of liver-related illness and death. Preventing progression of fibrosis to cirrhosis or reversing fibrosis are the main goals of drug development for NASH. In this clinical trial of obeticholic acid (OCA) in patients with NASH (REGENERATE), we reaffirmed our previous results demonstrating that OCA was superior to placebo in improving fibrosis using a more rigorous consensus panel analysis of liver biopsies taken at month 18. We also showed that OCA treatment resulted in dose-dependent reductions of serum liver biochemistries and liver stiffness measurements compared with placebo, even in participants in whom histologic fibrosis did not change at 18 months, providing evidence that the benefit of OCA extends beyond what is captured by the ordinal NASH CRN scoring system. OCA was well tolerated with a favorable safety profile supporting a positive benefit: risk profile in patients with pre-cirrhotic liver fibrosis due to NASH.
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Affiliation(s)
- Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
| | - Vlad Ratziu
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Institute for Cardiometabolism and Nutrition, Paris, France
| | - Rohit Loomba
- University of California, San Diego, La Jolla, CA, USA
| | - Quentin M Anstee
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK; Newcastle NIHR Biomedical Research Center, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Mary E Rinella
- University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | | | | | | | - Eric J Lawitz
- Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Philip N Newsome
- National Institute for Health Research Birmingham Biomedical Research Centre, Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jérôme Boursier
- Angers University Hospital, Angers University, Angers, France
| | | | | | | | | | | | | | - Rina Leyva
- Intercept Pharmaceuticals, Morristown, NJ, USA
| | | | - Zobair M Younossi
- Beatty Liver and Obesity Research Program, Center for Liver Diseases, Inova Medicine, Falls Church, VA, USA
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23
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Upadhyay KK, Du X, Chen Y, Buscher B, Chen VL, Oliveri A, Zhao R, Speliotes EK, Brady GF. A common variant that alters SUN1 degradation associates with hepatic steatosis and metabolic traits in multiple cohorts. J Hepatol 2023; 79:1226-1235. [PMID: 37567366 PMCID: PMC10618955 DOI: 10.1016/j.jhep.2023.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD), and its progressive form steatohepatitis (NASH), represent a genetically and phenotypically diverse entity for which there is no approved therapy, making it imperative to define the spectrum of pathways contributing to its pathogenesis. Rare variants in genes encoding nuclear envelope proteins cause lipodystrophy with early-onset NAFLD/NASH; we hypothesized that common variants in nuclear envelope-related genes might also contribute to hepatic steatosis and NAFLD. METHODS Using hepatic steatosis as the outcome of interest, we performed an association meta-analysis of nuclear envelope-related coding variants in three large discovery cohorts (N >120,000 participants), followed by phenotype association studies in large validation cohorts (N >600,000) and functional testing of the top steatosis-associated variant in cell culture. RESULTS A common protein-coding variant, rs6461378 (SUN1 H118Y), was the top steatosis-associated variant in our association meta-analysis (p <0.001). In ancestrally distinct validation cohorts, rs6461378 associated with histologic NAFLD and with NAFLD-related metabolic traits including increased serum fatty acids, type 2 diabetes, hypertension, cardiovascular disease, and decreased HDL. SUN1 H118Y was subject to increased proteasomal degradation relative to wild-type SUN1 in cells, and SUN1 H118Y-expressing cells exhibited insulin resistance and increased lipid accumulation. CONCLUSIONS Collectively, these data support a potential causal role for the common SUN1 variant rs6461378 in NAFLD and metabolic disease. IMPACT AND IMPLICATIONS Non-alcoholic fatty liver disease (NAFLD), with an estimated global prevalence of nearly 30%, is a growing cause of morbidity and mortality for which there is no approved pharmacologic therapy. Our data provide a rationale for broadening current concepts of NAFLD genetics and pathophysiology to include the nuclear envelope, and particularly Sad1 and UNC84 domain containing 1 (SUN1), as novel contributors to this common liver disease. Furthermore, if future studies confirm causality of the common SUN1 H118Y variant, it has the potential to become a broadly relevant therapeutic target in NAFLD and metabolic disease.
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Affiliation(s)
- Kapil K Upadhyay
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Xiaomeng Du
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Yanhua Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Brandon Buscher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Vincent L Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Antonino Oliveri
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Raymond Zhao
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Elizabeth K Speliotes
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Graham F Brady
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ann Arbor, Michigan, USA.
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24
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Yuan X, Gao Z, Hao Z, Ma H, Duan K, Yang C. Effect of long-acting versus short-acting glucagon-like peptide-1 receptor agonists on improving body weight and related metabolic parameters in type 2 diabetes: A head-to-head meta-analysis. Medicine (Baltimore) 2023; 102:e35739. [PMID: 37904378 PMCID: PMC10615555 DOI: 10.1097/md.0000000000035739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1RAs) showed great value in treating nonalcoholic fatty liver disease (NAFLD). We aimed to compare the effectiveness of long-acting and short-acting GLP-1RAs on improving body weight and related metabolic parameters in patients with type 2 diabetes (T2DM) as a reference for the treatment of NAFLD with T2DM. METHODS We searched eligible randomized controlled trials (RCTs) in PubMed, Embase, Cochrane and web of science database until August 2023. The risk of bias of included RCTs were assessed by the Risk Assessment of Cochrane Review items. We mainly drew forest plots to compare the effects of long and short acting GLP-1 RAs using RevMan 5.4. RESULTS Twelve RCTs involving 2751 patients were included in our meta-analysis. Compared with short-acting GLP-1 RAs, the long-acting group was better in body weight (P < .00001, MD = -0.65, 95% confidence interval [CI] [-0.90, -0.40], I2 = 20%), and the same results in glycosylated hemoglobin (HbA1c) (P < .00001, MD = -0.43, 95% CI [-0.54, -0.33], I2 = 55%) and fasting plasma glucose (FPG) (P < .00001, MD = -0.77, 95% CI [-1.01, -0.52], I2 =70%). For the lipid parameters, long-acting drugs lowered cholesterol (TC) (P = .02, SMD = -0.19, 95% CI [-0.35, -0.03], I2 =57%) and low-density lipoprotein (LDL) (P = .02, SMD = -0.17, 95% CI [-0.33, -0.02], I2 =51%) more significantly compared with short-acting drugs. But treatment differences were not significant in triglycerides (TG) (P = .40, SMD = -0.05, 95% CI [-0.15, -0.06], I2 = 0%), and high-density lipoprotein (HDL) (P = .85, SMD = -0.01, 95% CI [-0.11, -0.09], I2 = 0%). CONCLUSION Long-acting GLP-1RAs may be more promise than short-acting GLP-1RAs in improving weight and related metabolic parameters.
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Affiliation(s)
- Xia Yuan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate School of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhe Gao
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhihua Hao
- Department of Health Care, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Kaixin Duan
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate School of Hebei North University, Zhangjiakou, Hebei, China
| | - Caixuan Yang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
- Graduate School of Hebei North University, Zhangjiakou, Hebei, China
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25
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Burger K, Jung F, Baumann A, Brandt A, Staltner R, Sánchez V, Bergheim I. TNFα is a key trigger of inflammation in diet-induced non-obese MASLD in mice. Redox Biol 2023; 66:102870. [PMID: 37683301 PMCID: PMC10493600 DOI: 10.1016/j.redox.2023.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Tumor necrosis factor alpha (TNFα) is thought to be a critical factor in the development of metabolic dysfunction-associated steatotic liver disease (MASLD). Here, we determined the effects of a treatment with the anti-TNFα antibody infliximab and a genetic deletion of TNFα, respectively, in the development of non-obese diet-induced early metabolic dysfunction-associated steatohepatitis (MASH) in mice. The treatment with infliximab improved markers of liver damage in mice with pre-existing early MASH. In TNFα-/- mice, the development of early signs of MASH and insulin resistance was significantly attenuated compared to wild-type animals. While mRNA expression of proinflammatory cytokines like interleukin 1β (Il1b) and interleukin 6 (Il6) were significantly lower in livers of MASH-diet-fed TNFα-/- mice compared to wild-type mice with early MASH, markers of intestinal barrier function were similarly impaired in both MASH-diet-fed groups compared to controls. Our data suggest that TNFα is a key regulator of hepatic inflammation and insulin resistance associated with the development of early non-obese MASH.
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Affiliation(s)
- Katharina Burger
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Finn Jung
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Anja Baumann
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Annette Brandt
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Raphaela Staltner
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Victor Sánchez
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria
| | - Ina Bergheim
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, Vienna, Austria.
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26
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Zheng Y, Ying H, Shi J, Li L, Zhao Y. Alanyl-Glutamine Dipeptide Attenuates Non-Alcoholic Fatty Liver Disease Induced by a High-Fat Diet in Mice by Improving Gut Microbiota Dysbiosis. Nutrients 2023; 15:3988. [PMID: 37764772 PMCID: PMC10534574 DOI: 10.3390/nu15183988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) manifests as a persistent liver ailment marked by the excessive buildup of lipids within the hepatic organ accompanied by inflammatory responses and oxidative stress. Alanyl-glutamine (AG), a dipeptide comprising alanine and glutamine, is commonly employed as a nutritional supplement in clinical settings. This research aims to evaluate the impact of AG on NAFLD triggered by a high-fat diet (HFD), while concurrently delving into the potential mechanisms underlying its effects. The results presented herein demonstrate a notable reduction in the elevated body weight, liver mass, and liver index induced by a HFD upon AG administration. These alterations coincide with the amelioration of liver injury and the attenuation of hepatic histological advancement. Furthermore, AG treatment manifests a discernible diminution in oil-red-O-stained regions and triglyceride (TG) levels within the liver. Noteworthy alterations encompass lowered plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) concentrations, coupled with elevated high-density lipoprotein cholesterol (HDLC) concentrations. The mitigation of hepatic lipid accumulation resultant from AG administration is aligned with the downregulation of ACC1, SCD1, PPAR-γ, and CD36 expression, in conjunction with the upregulation of FXR and SHP expression. Concomitantly, AG administration leads to a reduction in the accumulation of F4/80-positive macrophages within the liver, likely attributable to the downregulated expression of MCP-1. Furthermore, AG treatment yields a decline in hepatic MDA levels and a concurrent increase in the activities of SOD and GPX. A pivotal observation underscores the effect of AG in rectifying the imbalance of gut microbiota in HFD-fed mice. Consequently, this study sheds light on the protective attributes of AG against HFD-induced NAFLD through the modulation of gut microbiota composition.
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Affiliation(s)
- Yigang Zheng
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China; (Y.Z.); (H.Y.); (J.S.); (Y.Z.)
| | - Hanglu Ying
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China; (Y.Z.); (H.Y.); (J.S.); (Y.Z.)
| | - Jiayi Shi
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China; (Y.Z.); (H.Y.); (J.S.); (Y.Z.)
| | - Long Li
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China; (Y.Z.); (H.Y.); (J.S.); (Y.Z.)
- Qian Xuesen Collaborative Research Center of Astrochemistry and Space Life Sciences, Ningbo University, Ningbo 315211, China
| | - Yufen Zhao
- Institute of Drug Discovery Technology, Ningbo University, Ningbo 315211, China; (Y.Z.); (H.Y.); (J.S.); (Y.Z.)
- Qian Xuesen Collaborative Research Center of Astrochemistry and Space Life Sciences, Ningbo University, Ningbo 315211, China
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Ralli T, Saifi Z, Kumari A, Aeri V, Kohli K. In-silico, in-vitro and ex-vivo evidence of combining silymarin phytopharmaceutical with piperine, and fulvic acid for enhancing its solubility and permeability. Pharm Dev Technol 2023; 28:595-610. [PMID: 37342048 DOI: 10.1080/10837450.2023.2227966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023]
Abstract
Non-alcoholic fatty liver disease is one of the leading causes of death worldwide. Even if with such a high mortality there is no definite treatment approved. Thus, there is a need to develop a formulation which can have multiple pharmacological activities. Herbal drugs are among the most promising compounds that act by different pharmacological actions. For increasing the bio-activity of Silymarin we had isolated five active biomarker molecules from silymarin extract (as a Phytopharmaceutical) in our previous work. It possesses lower bioavailability due to poor solubility, lesser permeability and first pass metabolism effect. Therefore, from the literature we had screened two bioavailability enhancers i.e. piperine and fulvic acid for overcoming the drawbacks associated with silymarin. Hence, in this study we had first explored the ADME-T parameters and then evaluated their in-silico activity for different enzymes involved in inflammation and fibrosis. Interestingly, it was found that besides the bioavailability enhancing property, piperine and fulvic acid also shown anti-inflammatory and anti-fibrotic action, particularly more activity was demonstrated by fulvic acid than piperine. Furthermore, the concentration of the bioavailability enhancers i.e. 20% FA and 10% PIP were optimized by QbD assisted solubility studies. Moreover, the percentage release and apparent permeability coefficient of the optimized formulation was found to be 95% and 90%, respectively as compared to 6.54*106 and 1.63*106 respectively by SM suspension alone. Furthermore, it was found that plain rhodamine solution penetrated only up to 10 um whereas, formulation penetrated up to 30 um. Thus, combining these three, can not only increase the bioavailability of silymarin, but might also, increase the physiological action synergistically.
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Affiliation(s)
- Tanya Ralli
- Department of Pharmaceutics, School of Pharmaceutical Education & Research, New Delhi, India
| | - Zoya Saifi
- Department of Pharmaceutics, School of Pharmaceutical Education & Research, New Delhi, India
| | - Amita Kumari
- Indian Patent agent and TIFAC-DST Woman Scientist, Delhi, India
| | - Vidhu Aeri
- Department of Pharmacognosy, School of Pharmaceutical Education & Research, New Delhi, India
| | - Kanchan Kohli
- Department of Pharmaceutics, School of Pharmaceutical Education & Research, New Delhi, India
- Director (Research and publications), Llyod Institute of Management and Technology, Uttar Pradesh, India
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Iglesias Morcillo M, Freuer D, Peters A, Heier M, Teupser D, Meisinger C, Linseisen J. Association between fatty liver index and blood coagulation markers: a population-based study. Lipids Health Dis 2023; 22:83. [PMID: 37386502 PMCID: PMC10308678 DOI: 10.1186/s12944-023-01854-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Population-based studies investigating the association between blood coagulation markers and non-alcoholic fatty liver disease (NAFLD) are rare. Thus, we aimed to investigate the relationship between the Fatty Liver Index (FLI) as a measure of hepatic steatosis and plasma concentrations of antithrombin III, D-dimer, fibrinogen D, protein C, protein S, factor VIII, activated partial thromboplastin time (aPTT), quick value and international thromboplastin time (INR) in the general population. METHODS After the exclusion of participants with anticoagulative treatment, 776 participants (420 women and 356 men, aged 54-74 years) of the population-based KORA Fit study with analytic data on hemostatic factors were included in the present analysis. Linear regression models were used to explore the associations between FLI and hemostatic markers, adjusted for sex, age, alcohol consumption, education, smoking status, and physical activity. In a second model, additional adjustments were made for the history of stroke, hypertension, myocardial infarction, serum non-HDL cholesterol levels, and diabetes status. In addition, analyses were stratified by diabetes status. RESULTS In the multivariable models (with or without health conditions), significantly positive associations with FLI were obtained for plasma concentrations of D-dimers, factor VIII, fibrinogen D, protein C, protein S, and quick value, while INR and antithrombin III were inversely associated. These associations were weaker in pre-diabetic subjects and largely disappeared in diabetic patients. CONCLUSION In this population-based study, an increased FLI is clearly related to changes in the blood coagulation system, possibly increasing the risk of thrombotic events. Due to a generally more pro-coagulative profile of hemostatic factors, such an association is not visible in diabetic subjects.
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Affiliation(s)
| | - Dennis Freuer
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany
| | - Anette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, 85764, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, 85764, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, 85764, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, 86156, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany
| | - Christine Meisinger
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany
| | - Jakob Linseisen
- Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg, 86156, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, 81377, Germany.
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Yao J, Zhao Y. Lp-PLA2 silencing ameliorates inflammation and autophagy in nonalcoholic steatohepatitis through inhibiting the JAK2/STAT3 pathway. PeerJ 2023; 11:e15639. [PMID: 37397012 PMCID: PMC10309053 DOI: 10.7717/peerj.15639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background Nonalcoholic steatohepatitis (NASH), a common cause of liver-related morbidity and mortality worldwide, is characterized by inflammation and hepatocellular injury. Our research focuses on lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammation-related biomarker that has recently garnered interest in the context of NASH due to its potential roles in disease pathogenesis and progression. Methods We established a NASH mouse model using a high-fat diet (HFD) and treated it with sh-Lp-PLA2 and/or rapamycin (an mTOR inhibitor). Lp-PLA2 expression in NASH mice was detected by qRT-PCR. Serum levels of liver function parameters and inflammatory cytokines were detected using corresponding assay kits. We examined pathological changes in liver using hematoxylin-eosin, oil red O, and Masson staining, and observed autophagy through transmission electron microscopy. The protein levels of Lp-PLA2, mTOR, light chain 3 (LC3) II/I, phosphorylated Janus kinase 2 (p-JAK2)/JAK2, and phosphorylated signal transducer and activator of transcription 3 (p-STAT3)/STAT3 were determined by western blotting. Kupffer cells extracted from C57BL/6J mice were treated to replicate NASH conditions and treated with sh-Lp-PLA2, rapamycin, and/or a JAK2-inhibitor to further verify the roles and mechanisms of Lp-PLA2 in NASH. Results Our data indicate an upregulation of Lp-PLA2 expression in HFD-induced NASH mice. Silencing Lp-PLA2 in NASH mice reduced liver damage and inflammation markers (aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol (TC), triglycerides (TG), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)), while increasing IL-10 levels, an anti-inflammatory cytokine. Additionally, Lp-PLA2 silencing decreased lipid and collagen accumulation and promoted autophagy. The beneficial effects of sh-Lp-PLA2 on NASH were enhanced by rapamycin. Furthermore, Lp-PLA2 silencing resulted in the downregulation of the expression of p-JAK2/JAK2 and p-STAT3/STAT3 in NASH mice. Similar results were observed in Kupffer cells treated under NASH conditions; Lp-PLA2 silencing promoted autophagy and repressed inflammation, effects which were potentiated by the addition of rapamycin or a JAK2-inhibitor. Conclusion Our findings suggest that silencing Lp-PLA2 promotes autophagy via deactivating the JAK2/STAT3 signaling pathway, thereby restraining NASH progression. This highlights the potential therapeutic value of targeting Lp-PLA2, adding a new dimension to our understanding of NASH pathogenesis and treatment strategies.
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DiStefano JK. The Role of Choline, Soy Isoflavones, and Probiotics as Adjuvant Treatments in the Prevention and Management of NAFLD in Postmenopausal Women. Nutrients 2023; 15:2670. [PMID: 37375574 DOI: 10.3390/nu15122670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a prevalent condition among postmenopausal women that can lead to severe liver dysfunction and increased mortality. In recent years, research has focused on identifying potential lifestyle dietary interventions that may prevent or treat NAFLD in this population. Due to the complex and multifactorial nature of NAFLD in postmenopausal women, the disease can present as different subtypes, with varying levels of clinical presentation and variable treatment responses. By recognizing the significant heterogeneity of NAFLD in postmenopausal women, it may be possible to identify specific subsets of individuals who may benefit from targeted nutritional interventions. The purpose of this review was to examine the current evidence supporting the role of three specific nutritional factors-choline, soy isoflavones, and probiotics-as potential nutritional adjuvants in the prevention and treatment of NAFLD in postmenopausal women. There is promising evidence supporting the potential benefits of these nutritional factors for NAFLD prevention and treatment, particularly in postmenopausal women, and further research is warranted to confirm their effectiveness in alleviating hepatic steatosis in this population.
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Affiliation(s)
- Johanna K DiStefano
- Diabetes and Metabolic Disease Research Unit, Translational Genomics Research Institute, Phoenix, AZ 85004, USA
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Golabi P, Isakov V, Younossi ZM. Nonalcoholic Fatty Liver Disease: Disease Burden and Disease Awareness. Clin Liver Dis 2023; 27:173-186. [PMID: 37024201 DOI: 10.1016/j.cld.2023.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide and has been implying an unprecedented burden to health care systems. The prevalence of NAFLD has exceeded 30% in developed countries. Considering the asymptomatic nature of undiagnosed NAFLD, high suspicion and noninvasive diagnosis have utmost importance especially in primary care level. At this point, patient and provider awareness should be optimal for early diagnosis and risk stratification for patients at risk of progression.
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Affiliation(s)
- Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Vasily Isakov
- Department of Gastroenterology & Hepatology, Federal Research Center for Nutrition and Biotechnology, 21 Kashirskoe Shosse, Moscow 115446, Russia
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 2202, USA; Inova Medicine, Inova Health System, Falls Church, VA, USA; Inova Medicine Services, Department of Medicine, Inova Fairfax Medical Campus, Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Kountouras J, Kazakos E, Kyrailidi F, Polyzos SA, Zavos C, Arapoglou S, Boziki M, Mouratidou MC, Tzitiridou-Chatzopoulou M, Chatzopoulos D, Doulberis M, Papaefthymiou A, Vardaka E. Innate immunity and nonalcoholic fatty liver disease. Ann Gastroenterol 2023; 36:244-256. [PMID: 37144011 PMCID: PMC10152810 DOI: 10.20524/aog.2023.0793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/14/2023] [Indexed: 05/06/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), recently renamed as metabolic (dysfunction)-associated fatty liver disease (MAFLD), is a complex, multifactorial disease that progresses via nonalcoholic steatohepatitis (NASH) towards severe liver complications. MAFLD/NAFLD affects up to a third of the global population. It is connected with metabolic syndrome parameters and has been increasing in parallel with the rates of metabolic syndrome parameters worldwide. This disease entity exhibits a strong immune-inflammatory dimension. In MAFLD/NAFLD/NASH, a vast network of innate immune cells is mobilized that can provoke liver damage, leading to advanced fibrosis, cirrhosis and its complications, including hepatocellular carcinoma. However, our understanding of the inflammatory signals that drive the onset and progression of MAFLD/NAFLD/NASH is fragmented. Thus, further investigation is required to better understand the role of specific innate immune cell subsets in the disease, and to aid the design of innovative therapeutic agents to target MAFLD/NAFLD/NASH. In this review, we discuss current concepts regarding the role of innate immune system involvement in MAFLD/NAFLD/NASH onset and progression, along with presenting potential stress signals affecting immune tolerance that may trigger aberrant immune responses. A comprehensive understanding of the innate immune mechanisms involved in MAFLD/NAFLD/NASH pathophysiology will help the discovery of early interventions to prevent the disease, and lead to potential innovative therapeutic strategies that may limit its worldwide burden.
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Affiliation(s)
- Jannis Kountouras
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
| | - Evangelos Kazakos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- School of Healthcare Sciences, Midwifery Department, University of West Macedonia, Koila, Kozani, Macedonia, Greece (Evangelos Kazakos)
| | - Foteini Kyrailidi
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
| | - Stergios A. Polyzos
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece (Stergios A. Polyzos, Michael Doulberis, Apostolis Papaefthymiou)
| | - Christos Zavos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
| | - Stergios Arapoglou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- Fifth Surgical Department, Medical School, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Stergios Arapoglou)
| | - Marina Boziki
- 2 Neurology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, Macedonia, Greece (Marina Boziki)
| | - Maria C. Mouratidou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
| | - Maria Tzitiridou-Chatzopoulou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- School of Healthcare Sciences, Midwifery Department, University of West Macedonia, Koila, Kozani, Macedonia, Greece (Maria Tzitiridou-Chatzopoulou)
| | - Dimitrios Chatzopoulos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
| | - Michael Doulberis
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece (Stergios A. Polyzos, Michael Doulberis, Apostolis Papaefthymiou)
- Department of Gastroenterology and Hepatology, University of Zurich, Zurich, Switzerland (Michael Doulberis)
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece (Stergios A. Polyzos, Michael Doulberis, Apostolis Papaefthymiou)
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, UK (Apostolis Papaefthymiou)
| | - Elisabeth Vardaka
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Macedonia, Greece (Jannis Kountouras, Evangelos Kazakos, Foteini Kyrailidi, Christos Zavos, Stergios Arapoglou, Maria C. Mouratidou, Maria Tzitiridou-Chatzopoulou, Dimitrios Chatzopoulos, Michael Doulberis, Apostolis Papaefthymiou, Elisabeth Vardaka)
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Alexander Campus, Macedonia, Greece (Elisabeth Vardaka)
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Patel AH, Peddu D, Amin S, Elsaid MI, Minacapelli CD, Chandler TM, Catalano C, Rustgi VK. Nonalcoholic Fatty Liver Disease in Lean/Nonobese and Obese Individuals: A Comprehensive Review on Prevalence, Pathogenesis, Clinical Outcomes, and Treatment. J Clin Transl Hepatol 2023; 11:502-515. [PMID: 36643037 PMCID: PMC9817050 DOI: 10.14218/jcth.2022.00204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, with an estimated prevalence of 25% globally. NAFLD is closely associated with metabolic syndrome, which are both becoming increasingly more common with increasing rates of insulin resistance, dyslipidemia, and hypertension. Although NAFLD is strongly associated with obesity, lean or nonobese NAFLD is a relatively new phenotype and occurs in patients without increased waist circumference and with or without visceral fat. Currently, there is limited literature comparing and illustrating the differences between lean/nonobese and obese NAFLD patients with regard to risk factors, pathophysiology, and clinical outcomes. In this review, we aim to define and further delineate different phenotypes of NAFLD and present a comprehensive review on the prevalence, incidence, risk factors, genetic predisposition, and pathophysiology. Furthermore, we discuss and compare the clinical outcomes, such as insulin resistance, dyslipidemia, hypertension, coronary artery disease, mortality, and progression to nonalcoholic steatohepatitis, among lean/nonobese and obese NAFLD patients. Finally, we summarize the most up to date current management of NAFLD, including lifestyle interventions, pharmacologic therapies, and surgical options.
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Affiliation(s)
- Ankoor H. Patel
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dhiraj Peddu
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sahil Amin
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Mohamed I. Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA,Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Carlos D. Minacapelli
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Toni-Marie Chandler
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Carolyn Catalano
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vinod K. Rustgi
- Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Center for Liver Diseases and Masses, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA,Correspondence to: Vinod K. Rustgi, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, Medical Education Building, Rm # 466, New Brunswick, NJ 08901, USA. ORCID: https://orcid.org/0000-0002-4105-5783. Tel: +1-301-801-5814, Fax: +1-723-235-5537, E-mail:
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Boye KS, Ford JH, Thieu VT, Lage MJ, Terrell KA. The Association Between Obesity and the 5-Year Prevalence of Morbidity and Mortality Among Adults with Type 2 Diabetes. Diabetes Ther 2023; 14:709-721. [PMID: 36820959 PMCID: PMC9948793 DOI: 10.1007/s13300-023-01384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION This retrospective claims database study examined the prevalence of mortality and morbidity among adults with type 2 diabetes (T2D) and obesity. METHODS The study used deidentified data from 2007 to 2021 from the Optum® Market Clarity Dataset. A cohort of adults with T2D and obesity were identified, and age- and sex-adjusted prevalence rates were calculated for mortality, a composite cardiovascular outcome (CCO), a composite microvascular outcome (CMO), and other complications. Results were examined overall and by obesity class (class 1, class 2, and class 3). RESULTS For the 15,970 adults included in the study, the prevalence of CCO and CMO after 5 years was 15.3% and 60.7%, respectively. The 5-year prevalence of mortality was 10.9%. There were statistically significant differences in prevalence rates by obesity class, with obesity class 3 associated with higher rates of morbidity and mortality compared to obesity classes 1 or 2. Specifically, after 5 years, the prevalence of mortality was 9.4%, 10.3% and 13.6% for obese classes 1, 2 and 3, respectively (P < 0.05 between class 3 and class 2 or 1). Similarly, For obesity classes 1, 2 and 3, the 5-year prevalence of CCO was 13.0%, 14.5% and 18.4% and the rates for CMO were 58.0%, 57.9% and 64.8%, respectively (both P < 0.05 between class 3 and class 2 or 1). Regarding other complications, differences in the prevalence of atherosclerotic cardiovascular disease (ASCVD) and obstructive sleep apnea (OSA) were statistically significantly higher with increasing obesity class. CONCLUSIONS The results indicate that for a cohort of adults with T2D and obesity, obesity class 3 is associated with significantly higher mortality and morbidity, including CCO, CMO, ASCVD and OSA. These findings suggest that treatment which reduces obesity among individuals with T2D may have significant health benefits, although additional studies are needed to confirm the results.
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Affiliation(s)
- Kristina S Boye
- Value, Evidence, and Outcomes Department, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46225, USA
| | - Janet H Ford
- Value, Evidence, and Outcomes Department, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46225, USA
| | - Vivian T Thieu
- Medical Affairs, Diabetes, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46225, USA
| | - Maureen J Lage
- HealthMetrics Outcomes Research, 17 Benton's Knoll, Guilford, CT, 06437, USA.
| | - Kendra A Terrell
- Value, Evidence, and Outcomes Department, Eli Lilly and Company, Lilly Corporate Center, 893 Delaware Street, Indianapolis, IN, 46225, USA
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Tutunchi H, Arefhosseini S, Ebrahimi-Mameghani M. Clinical effectiveness of α-lipoic acid, myo-inositol and propolis supplementation on metabolic profiles and liver function in obese patients with NAFLD: A randomized controlled clinical trial. Clin Nutr ESPEN 2023; 54:412-420. [PMID: 36963888 DOI: 10.1016/j.clnesp.2023.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND To compare the effects of α-lipoic acid (ALA), myo-inositol (MI) and propolis supplementation on metabolic parameters and liver function in obese patients with non-alcoholic fatty liver disease (NAFLD) METHODS: Ninety-two obese patients with NAFLD were randomly allocated into one of the four groups (ALA, MI, propolis, and control groups) for 8 weeks. At pre-and post-intervention, anthropometric measures, metabolic parameters and liver function were assessed. Clinical effectiveness was assessed using Absolute Risk Reduction (ARR) and Number Needed to Treat (NNT). RESULTS After 8 weeks, apart from waist-to-hip ratio, all studied anthropometric measures decreased significantly in each of the groups over the trial. Although the greatest improvements in glycemic indices were observed in MI group (p < 0.05), the differences among the groups were not significant. Control group showed the greatest reduction in serum triglyceride level (p = 0.026) while the greatest improvements in serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were observed in MI group (p = 0.043, p = 0.019 and p = 0.041, respectively). Alanine aminotransferase (ALT) levels reduced significantly in all groups, particularly in propolis group (p = 0.012). The greatest reduction in serum aspartate transaminase (AST) level was observed in control group (p < 0.001), however, the difference among the groups was statistically marginal (p = 0.058). The estimated NNTs for one grade reduction in liver steatosis for MI, ALA and propolis supplementation compared with control group were 1.5, 2.2 and 3, respectively. CONCLUSION Dietary recommendation for weight loss accompanied by MI and then ALA supplementation improved metabolic parameters and liver steatosis. "Registered under ClinicalTrials.gov Identifier no: IRCT20100209003320N22".
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Affiliation(s)
- Helda Tutunchi
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Arefhosseini
- Student Research Committee, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrangiz Ebrahimi-Mameghani
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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36
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Yilmaz Y, Zeybel M, Adali G, Cosar AM, Sertesen E, Gokcan H, Bahcecioglu HI, Sahin M, Tulunay C, Ergun I, Turan I, Idilman IS, Celikel C, Kirimlioglu H, Akyol G, Yilmaz F, Sokmensuer C, Guveli H, Akarca US, Akyuz U, Genc V, Akyildiz M, Yazihan N, Tutar E, Ates F, Dincer D, Balaban Y, Kiyici M, Akdogan M, Sonsuz A, Idilman R, Yapali S, Dursun H, Aladag M, Satman I, Karcaaltincaba M, Arikan C, Gulerman F, Selimoglu A, Ozen H, Basaranoglu M, Karakan T, Yurci A, Demir K, Koruk M, Uygun A, Sezgin O, Gulec S, Besisik F, Simsek H, Hulagu S, Tozun N, Mardinoglu A, Demir M, Doganay L, Akarsu M, Karasu Z, Kaymakoglu S, Gunsar F. TASL Practice Guidance on the Clinical Assessment and Management of Patients with Nonalcoholic Fatty Liver Disease. HEPATOLOGY FORUM 2023; 4:1-32. [PMID: 37920782 PMCID: PMC10588738 DOI: 10.14744/hf.2023.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists.
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Affiliation(s)
- Yusuf Yilmaz
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
| | - Mujdat Zeybel
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
| | - Gupse Adali
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Arif Mansur Cosar
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
| | - Elif Sertesen
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
| | | | - Mustafa Sahin
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
| | - Cansin Tulunay
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
| | - Ihsan Ergun
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
| | | | - Cigdem Celikel
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Hale Kirimlioglu
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
| | - Gulen Akyol
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
| | - Funda Yilmaz
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
| | - Cenk Sokmensuer
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Hakan Guveli
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
| | - Ulus Salih Akarca
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
| | - Umit Akyuz
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Volkan Genc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
| | - Nuray Yazihan
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Fehmi Ates
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
| | - Meral Akdogan
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
| | - Abdullah Sonsuz
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
| | - Members of Fatty Liver Special Interest Group
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Suna Yapali
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Hakan Dursun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Murat Aladag
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ilhan Satman
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Musturay Karcaaltincaba
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Cigdem Arikan
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fulya Gulerman
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ayse Selimoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Hasan Ozen
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Metin Basaranoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Tarkan Karakan
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Alper Yurci
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Kadir Demir
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mehmet Koruk
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Ahmet Uygun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Orhan Sezgin
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sadi Gulec
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fatih Besisik
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Halis Simsek
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sadettin Hulagu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Nurdan Tozun
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Adil Mardinoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mehmet Demir
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Levent Doganay
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Mesut Akarsu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Zeki Karasu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Sabahattin Kaymakoglu
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Recep Tayyip Erdogan University, School of Medicine, Rize, Türkiye
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
- Department of Gastroenterology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Oncology, Health Sciences University, Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Türkiye
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Firat University School of Medicine, Elazig, Türkiye
- Department of Endocrinology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Cardiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Nefrology, Ufuk University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Türkiye
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Pathology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Pathology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Malatya, Türkiye
- Department of Pathology Gazi University School of Medicine, Ankara, Türkiye
- Department of Pathology, Ege University School of Medicine, Izmir, Türkiye
- Department of Pathology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Bahcesehir University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
- Department of General Surgery, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pathophysiology, Ankara University School of Medicine, Ankara, Türkiye
- Department of Pediatric Gastroenterology, Marmara University School of Medicine, Istanbul, Türkiye
- Department of Gastroenterology, Mersin University School of Medicine, Mersin, Türkiye
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Türkiye
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Türkiye
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Türkiye
- Department of Gastroenterology, Health Sciences University, Ankara City Hospital, Ankara, Türkiye
- Department of Gastroenterology, Istanbul University Cerrahpasa School of Medicine, Türkiye
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Huang S, Wu B, He Y, Qiu R, Yang T, Wang S, Lei Y, Li H, Zheng F. Canagliflozin ameliorates the development of NAFLD by preventing NLRP3-mediated pyroptosis through FGF21-ERK1/2 pathway. Hepatol Commun 2023; 7:e0045. [PMID: 36757426 PMCID: PMC9916118 DOI: 10.1097/hc9.0000000000000045] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2023] Open
Abstract
Recent studies have suggested that sodium-glucose co-transporter2 inhibitors go beyond their glycemic advantages to ameliorate the development of NAFLD. However, little research has been done on the underlying mechanisms. Here, we took deep insight into the effect of canagliflozin (CANA), one of the sodium-glucose co-transporter2 inhibitor, on the progression of NAFLD, and explored the molecular mechanisms. Our findings showed that CANA-treated ob/ob and diabetic mice developed improved glucose and insulin tolerance, although their body weights were comparable or even increased compared with the controls. The CANA treatment ameliorated hepatic steatosis and lipid accumulation of free fatty acid-treated AML12 cells, accompanied by decreased lipogenic gene expression and increased fatty acid β oxidation-related gene expression. Furthermore, inflammation and fibrosis genes decreased in the livers of CANA-treated ob/ob and diabetic mice mice. FGF21 and its downstream ERK1/2/AMPK signaling decreased, whereas NLRP3-mediated pyroptosis increased in the livers of the ob/ob and diabetic mice mice, which was reversed by the CANA treatment. In addition, blocking FGF21 or ERK1/2 activity antagonized the effects of CANA on NLRP3-mediated pyroptosis in lipopolysaccharide plus nigericin-treated J774A.1 cells. We conclude that CANA treatment alleviated insulin resistance and the progression of NAFLD in ob/ob and diabetic mice mice independent of the body weight change. CANA protected against the progression of NAFLD by inhibiting NLRP3-mediated pyroptosis and enhancing FGF21-ERK1/2 pathway activity in the liver. These findings suggest the therapeutic potential of sodium-glucose co-transporter2 inhibitors in the treatment of NAFLD.
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Affiliation(s)
- Shaohan Huang
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Beibei Wu
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yingzi He
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ruojun Qiu
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Tian Yang
- Department of Endocrinology, The Affiliated Fourth Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shuo Wang
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yongzhen Lei
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Hong Li
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fenping Zheng
- Department of Endocrinology, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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Duseja A, Singh S, De A, Madan K, Rao PN, Shukla A, Choudhuri G, Saigal S, Shalimar, Arora A, Anand AC, Das A, Kumar A, Eapen CE, Devadas K, Shenoy KT, Panigrahi M, Wadhawan M, Rathi M, Kumar M, Choudhary NS, Saraf N, Nath P, Kar S, Alam S, Shah S, Nijhawan S, Acharya SK, Aggarwal V, Saraswat VA, Chawla YK. Indian National Association for Study of the Liver (INASL) Guidance Paper on Nomenclature, Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD). J Clin Exp Hepatol 2023; 13:273-302. [PMID: 36950481 PMCID: PMC10025685 DOI: 10.1016/j.jceh.2022.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 03/24/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ALD, alcohol-associated liver disease
- ALT, alanine aminotransferase
- APRI, AST-platelet ratio index
- AST, aspartate aminotransferase
- BMI, body mass index
- CAP, controlled attenuation parameter
- CHB, chronic Hepatitis B
- CHC, chronic Hepatitis C
- CK-18, Cytokeratin-18
- CKD, chronic kidney disease
- CRN, Clinical Research Network
- CVD, cardiovascular disease
- DAFLD/DASH, dual etiology fatty liver disease or steatohepatitis
- EBMT, endoscopic bariatric metabolic therapy
- ELF, enhanced liver fibrosis
- FAST, FibroScan-AST
- FIB-4, fibrosis-4
- FLIP, fatty liver inhibition of progression
- FXR, farnesoid X receptor
- GLP-1, glucagon-like peptide-1
- HCC, hepatocellular carcinoma
- INASL, Indian National Association for Study of the Liver
- LAI, liver attenuation index
- LSM, liver stiffness measurement
- MAFLD
- MAFLD, metabolic dysfunction-associated fatty liver disease
- MR-PDFF, magnetic resonance – proton density fat fraction
- MRE, magnetic resonance elastography
- MetS, metabolic syndrome
- NAFL:, nonalcoholic fatty liver
- NAFLD, nonalcoholic fatty liver disease
- NAS, NAFLD activity score
- NASH
- NASH, nonalcoholic steatohepatitis
- NCD, noncommunicable diseases
- NCPF, noncirrhotic portal fibrosis
- NFS, NAFLD fibrosis score
- NHL, non-Hodgkin's lymphoma
- NPCDCS, National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
- OCA, obeticholic acid
- PPAR, peroxisome proliferator activated receptor
- PTMS, post-transplant metabolic syndrome
- SAF, steatosis, activity, and fibrosis
- SGLT-2, sodium-glucose cotransporter-2
- SWE, shear wave elastography
- T2DM, DM: type 2 diabetes mellitus
- USG, ultrasound
- VAT, visceral adipose tissue
- VCTE, vibration controlled transient elastography
- fatty liver
- hepatic steatosis
- nonalcoholic steatohepatitis
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Affiliation(s)
- Ajay Duseja
- Departmentof Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S.P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, India
| | - Arka De
- Departmentof Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaushal Madan
- Max Centre for Gastroenterology, Hepatology and Endoscopy, Max Hospitals, Saket, New Delhi, India
| | - Padaki Nagaraja Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GSMC & KEM Hospital, Mumbai, India
| | - Gourdas Choudhuri
- Department of Gastroenterology and Hepato-Biliary Sciences, Fortis Memorial Research Institute, Gurugram, India
| | - Sanjiv Saigal
- Max Centre for Gastroenterology, Hepatology and Endoscopy, Max Hospitals, Saket, New Delhi, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Arora
- Institute of Liver, Gastroenterology and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil C. Anand
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Ashim Das
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Kumar
- Institute of Liver, Gastroenterology and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Krishnadas Devadas
- Department of Gastroenterology, Government Medical College, Trivandrum, India
| | | | - Manas Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manav Wadhawan
- Institute of Liver & Digestive Diseases, BLK Super Speciality Hospital, Delhi, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | | | - Neeraj Saraf
- Department of Hepatology, Medanta, The Medicity, Gurugram, India
| | - Preetam Nath
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sanjib Kar
- Department of Gastroenterology and Hepatology, Gastro Liver Care, Cuttack, India
| | - Seema Alam
- Department of PediatricHepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Samir Shah
- Department of Hepatology, Institute of Liver Disease, HPB Surgery and Transplant, Global Hospitals, Mumbai, India
| | - Sandeep Nijhawan
- Department of Gastroenterology, Sawai Man Singh Medical College, Jaipur, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Vinayak Aggarwal
- Department of Cardiology, Fortis Memorial Research Institute, Gurugram, India
| | - Vivek A. Saraswat
- Department of Hepatology, Pancreatobiliary Sciences and Liver Transplantation, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - Yogesh K. Chawla
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India
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Unraveling the Potential Role of Tecomella undulata in Experimental NASH. Int J Mol Sci 2023; 24:ijms24043244. [PMID: 36834657 PMCID: PMC9962064 DOI: 10.3390/ijms24043244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
The pathophysiology of nonalcoholic steatohepatitis (NASH) is complex, owing to its diverse pathological drivers and, until recently, there were no approved drugs for this disease. Tecomella is a popular herbal medicine used to treat hepatosplenomegaly, hepatitis, and obesity. However, the potential role of Tecomella undulata in NASH has not yet been scientifically investigated. The administration of Tecomella undulata via oral gavage lowered body weight, insulin resistance, alanine transaminase (ALT), aspartate transaminase (AST), triglycerides, and total cholesterol in western diet sugar water (WDSW) fed mice but had no effect on chow diet normal water (CDNW) fed mice. Tecomella undulata improved steatosis, lobular inflammation, and hepatocyte ballooning and resolved NASH in WDSW mice. Furthermore, Tecomella undulata also alleviated the WDSW-induced Endoplasmic Reticulum stress and oxidative stress, enhanced antioxidant status, and thus reduced inflammation in the treated mice. Of note, these effects were comparable to saroglitazar, the approved drug used to treat human NASH and the positive control used in the study. Thus, our findings indicate the potential of Tecomella undulata to ameliorate WDSW-induced steatohepatitis, and these preclinical data provide a strong rationale for assessing Tecomella undulata for the treatment of NASH.
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Kotsos D, Tziomalos K. Microsomal Prostaglandin E Synthase-1 and -2: Emerging Targets in Non-Alcoholic Fatty Liver Disease. Int J Mol Sci 2023; 24:ijms24033049. [PMID: 36769370 PMCID: PMC9918023 DOI: 10.3390/ijms24033049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) affects a substantial proportion of the general population and is even more prevalent in obese and diabetic patients. NAFLD, and particularly the more advanced manifestation of the disease, nonalcoholic steatohepatitis (NASH), increases the risk for both liver-related and cardiovascular morbidity. The pathogenesis of NAFLD is complex and multifactorial, with many molecular pathways implicated. Emerging data suggest that microsomal prostaglandin E synthase-1 and -2 might participate in the development and progression of NAFLD. It also appears that targeting these enzymes might represent a novel therapeutic approach for NAFLD. In the present review, we discuss the association between microsomal prostaglandin E synthase-1 and -2 and NAFLD.
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Li FR, Liao J, Zhu B, Li X, Cheng Z, Jin C, Mo C, Wu X, Li Q, Liang F. Long-term exposure to air pollution and incident non-alcoholic fatty liver disease and cirrhosis: A cohort study. Liver Int 2023; 43:299-307. [PMID: 36069651 DOI: 10.1111/liv.15416] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/09/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Epidemiological evidence regarding the association of air pollution with the risk of non-alcoholic fatty liver disease (NAFLD) is limited. This study was to examine the associations of long-term exposure to various air pollutants and overall air pollution with risk of incident NAFLD as well as cirrhosis, a major liver-related morbidity for NAFLD. METHODS Included were 456 687 UK residents. Air pollution data included PM2.5 , PM2.5-10 , PM10 , NO2 and NOx . A weighted air pollution score was also generated from PM10 and NOx . Cox proportional hazard models were employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We identified 4978 cases of NAFLD and 1575 cases of incident cirrhosis, over a median follow-up of 11.9 years. PM2.5 , PM10 , NO2 and NOx exposures contributed to the excess risk of NAFLD associated with air pollution score; and the corresponding adjusted HRs (95% CI) were 1.10 (1.05, 1.14), 1.14 (1.09, 1.20), 1.19 (1.13, 1.24) and 1.11 (1.07, 1.15), respectively, for each interquartile range increase in the above specific air pollutants. Similar patterns were also indicated for cirrhosis risk. Alcohol consumption was an effect modifier for the association between air pollution score and NAFLD risk, whereas body mass index modified the association for cirrhosis risk. CONCLUSION Long-term exposure to air pollution was associated with risks of NAFLD and cirrhosis among the UK population.
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Affiliation(s)
- Fu-Rong Li
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Jian Liao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xia Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Zhiyuan Cheng
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Cheng Jin
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Chunbao Mo
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xianbo Wu
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Qian Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Fengchao Liang
- Shenzhen Key Laboratory of Cardiovascular Health and Precision Medicine, Southern University of Science and Technology, Shenzhen, China
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Bacil GP, Romualdo GR, Piagge PMFD, Cardoso DR, Vinken M, Cogliati B, Barbisan LF. Unraveling Hepatic Metabolomic Profiles and Morphological Outcomes in a Hybrid Model of NASH in Different Mouse Strains. Antioxidants (Basel) 2023; 12:antiox12020290. [PMID: 36829849 PMCID: PMC9952348 DOI: 10.3390/antiox12020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) encompasses nonalcoholic steatohepatitis (NASH) and affects 25% of the global population. Although a plethora of experimental models for studying NASH have been proposed, still scarce findings regarding the hepatic metabolomic/molecular profile. In the present study, we sought to unravel the hepatic metabolomic profile of mice subjected to a hybrid model of NASH, by combining a Western diet and carbon tetrachloride administration, for 8 weeks, in male C57BL/6J and BALB/c mice. In both mouse strains, the main traits of NASH-metabolic (glucose intolerance profile), morphologic (extensive microvesicular steatosis and fibrosis, lobular inflammation, and adipose tissue-related inflammation/hypertrophy), and molecular (impaired Nrf2/NF-κB pathway dynamics and altered metabolomic profile)-were observed. The hepatic metabolomic profile revealed that the hybrid protocol impaired, in both strains, the abundance of branched chain-aromatic amino acids, carboxylic acids, and glycosyl compounds, that might be linked to the Nrf2 pathway activation. Moreover, we observed a strain-dependent hepatic metabolomic signature, in which the tricarboxylic acid metabolites and pyruvate metabolism were dissimilarly modulated in C57BL/6J and BALB/c mice. Thus, we provide evidence that the strain-dependent hepatic metabolomic profile might be linked to the distinct underlying mechanisms of NASH, also prospecting potential mechanistic insights into the corresponding disease.
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Affiliation(s)
- Gabriel P. Bacil
- Department of Pathology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-689, Brazil
| | - Guilherme R. Romualdo
- Department of Pathology, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu 18618-689, Brazil
- Department of Structural and Functional Biology, Biosciences Institute, São Paulo State University (UNESP), Botucatu 18618-689, Brazil
| | - Priscila M. F. D. Piagge
- Department of Chemistry and Molecular Physics, São Carlos Institute of Chemistry (IQSC), University of São Paulo (USP), São Carlos 13566-590, Brazil
| | - Daniel R. Cardoso
- Department of Chemistry and Molecular Physics, São Carlos Institute of Chemistry (IQSC), University of São Paulo (USP), São Carlos 13566-590, Brazil
| | - Mathieu Vinken
- Department of Pharmaceutical and Pharmacological Sciences, University of Vrije, 1090 Brussel, Belgium
| | - Bruno Cogliati
- Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo (USP), São Paulo 05508-270, Brazil
| | - Luís F. Barbisan
- Department of Structural and Functional Biology, Biosciences Institute, São Paulo State University (UNESP), Botucatu 18618-689, Brazil
- Correspondence: ; Tel.: +55-14-3880-0469
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Zhang L, Liu S, Gu Y, Li S, Liu M, Zhao W. Comparative efficacy of Chinese patent medicines for non-alcoholic fatty liver disease: A network meta-analysis. Front Pharmacol 2023; 13:1077180. [PMID: 36686656 PMCID: PMC9847677 DOI: 10.3389/fphar.2022.1077180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background: The incidence of Non-alcoholic fatty liver disease (NAFLD) is increasing year by year. Researches showed that Chinese patent medicines (CPMs) had achieved good efficacy in the treatment of Non-alcoholic fatty liver disease. However, the debate on optimum Chinese patent medicine (CPM) persists. Therefore, we conducted a network meta-analysis to objectively compare the efficacy of different Chinese patent medicines in the treatment of Non-alcoholic fatty liver disease. Methods: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Chinese Biomedical Literature Database were used as databases for RCT researches retrieval. The retrieval time was from establishment of the database to July 2022. After effective data was extracted, Review Manager 5.4 and Cochrane Collaboration System Evaluator's Manual were used to assess bias risk. STATA 16.0 based on frequency theory was used for the network meta-analysis. Results: Totally 39 studies were included, involving 13 Chinese patent medicines, including 4049 patients, of which 42 patients were lost. In terms of improving clinical efficiency rate, Zhibitai capsule was most likely the best choice of Chinese patent medicine for Non-alcoholic fatty liver disease. Liuwei Wuling tablet had the best effect in reducing serum ALT and AST; Gandan Shukang capsule had the best effect in reducing serum GGT; Qianggan capsule had the best effect in reducing serum TG; Dangfei Liganning capsule had the best effect in reducing serum TC. None of the included studies had serious adverse reactions. Conclusion: For patients with Non-alcoholic fatty liver disease in this NMA, Zhibitai capsule, Liuwei Wuling tablet, Gandan Shukang capsule, Qianggan capsule, Dangfei Liganning capsule might be noteworthy. Due to the uclear risk bias, better designed double-blind, multi center and large sample RCTs are needed which resolve the problems of blinding, selective reporting and allocation concealment. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022341240.
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Affiliation(s)
- Lihui Zhang
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China.,Department of Spleen, Stomach, Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Zhengzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Sutong Liu
- Department of Spleen, Stomach, Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Zhengzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yajiao Gu
- Department of Spleen, Stomach, Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shanzheng Li
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Minghao Liu
- Department of Spleen, Stomach, Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Zhengzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Wenxia Zhao
- Department of Spleen, Stomach, Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China.,Zhengzhou Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Hepatobiliary Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Xue H, Xing HJ, Wang B, Fu C, Zhang YS, Qiao X, Guo C, Zhang XL, Hu B, Zhao X, Deng LJ, Zhu XC, Zhang Y, Liu YF. Cinchonine, a Potential Oral Small-Molecule Glucagon-Like Peptide-1 Receptor Agonist, Lowers Blood Glucose and Ameliorates Non-Alcoholic Steatohepatitis. Drug Des Devel Ther 2023; 17:1417-1432. [PMID: 37197367 PMCID: PMC10184894 DOI: 10.2147/dddt.s404055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose The glucagon-like peptide-1 receptor (GLP-1R) is an effective therapeutic target for type 2 diabetes mellitus (T2DM) and non-alcoholic steatohepatitis (NASH). Research has focused on small-molecule GLP-1R agonists because of their ease of use in oral formulations and improved patient compliance. However, no small-molecule GLP-1R agonists are currently available in the market. We aimed to screen for a potential oral small-molecule GLP-1R agonist and evaluated its effect on blood glucose and NASH. Methods The Connectivity map database was used to screen for candidate small-molecule compounds. Molecular docking was performed using SYBYL software. Rat pancreatic islets were incubated in different concentrations glucose solutions, with cinchonine or Exendin (9-39) added to determine insulin secretion levels. C57BL/6 mice, GLP-1R-/- mice and hGLP-1R mice were used to conduct oral glucose tolerance test. In addition, we fed ob/ob mice with the GAN diet to induce the NASH model. Cinchonine (50 mg/kg or 100 mg/kg) was administered orally twice daily to the mice. Serum liver enzymes were measured using biochemical analysis. Liver tissues were examined using Hematoxylin-eosin staining, Oil Red O staining and Sirius Red staining. Results Based on the small intestinal transcriptome of geniposide, a recognized small-molecule GLP-1R agonist, we identified that cinchonine exerted GLP-1R agonist-like effects. Cinchonine had a good binding affinity for GLP-1R. Cinchonine promoted glucose-dependent insulin secretion, which could be attenuated significantly by Exendin (9-39), a specific GLP-1R antagonist. Moreover, cinchonine could reduce blood glucose in C57BL/6 and hGLP-1R mice, an effect that could be inhibited with GLP-1R knockout. In addition, cinchonine reduced body weight gain and food intake in ob/ob-GAN NASH mice dose-dependently. 100 mg/kg cinchonine significantly improved liver function by reducing the ALT, ALP and LDH levels. Importantly, 100 mg/kg cinchonine ameliorated hepatic steatosis and fibrosis in NASH mice. Conclusion Cinchonine, a potential oral small-molecule GLP-1R agonist, could reduce blood glucose and ameliorate NASH, providing a strategy for developing small-molecule GLP-1R agonists.
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Affiliation(s)
- Huan Xue
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Hao-Jie Xing
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Bin Wang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Chao Fu
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yu-Shan Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Xi Qiao
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Chao Guo
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Xiao-Li Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Bin Hu
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Xin Zhao
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Li-Jiao Deng
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Xiao-Chan Zhu
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Yi Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
- Correspondence: Yi Zhang; Yun-Feng Liu, Tel +86-18835102847; +86-18703416169, Email ;
| | - Yun-Feng Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
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Dong Q, Bao H, Wang J, Shi W, Zou X, Sheng J, Gao J, Guan C, Xia H, Li J, Kang P, Xu Y, Cui Y, Zhong X. Liver fibrosis and MAFLD: the exploration of multi-drug combination therapy strategies. Front Med (Lausanne) 2023; 10:1120621. [PMID: 37153080 PMCID: PMC10157161 DOI: 10.3389/fmed.2023.1120621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/22/2023] [Indexed: 05/09/2023] Open
Abstract
In recent years, the prevalence of metabolic-associated fatty liver disease (MAFLD) has reached pandemic proportions as a leading cause of liver fibrosis worldwide. However, the stage of liver fibrosis is associated with an increased risk of severe liver-related and cardiovascular events and is the strongest predictor of mortality in MAFLD patients. More and more people believe that MAFLD is a multifactorial disease with multiple pathways are involved in promoting the progression of liver fibrosis. Numerous drug targets and drugs have been explored for various anti-fibrosis pathways. The treatment of single medicines is brutal to obtain satisfactory results, so the strategies of multi-drug combination therapies have attracted increasing attention. In this review, we discuss the mechanism of MAFLD-related liver fibrosis and its regression, summarize the current intervention and treatment methods for this disease, and focus on the analysis of drug combination strategies for MAFLD and its subsequent liver fibrosis in recent years to explore safer and more effective multi-drug combination therapy strategies.
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Affiliation(s)
- Qingfu Dong
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Haolin Bao
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiangang Wang
- Department of General Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Wujiang Shi
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xinlei Zou
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jialin Sheng
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianjun Gao
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Canghai Guan
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Haoming Xia
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinglin Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Pengcheng Kang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yi Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Key Laboratory of Basic Pharmacology of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou, China
- Key Laboratory of Functional and Clinical Translational Medicine, Fujian Province University, Xiamen Medical College, Xiamen, Fujian, China
- Jiangsu Province Engineering Research Center of Tumor Targeted Nano Diagnostic and Therapeutic Materials, Yancheng Teachers University, Yancheng, Jiangsu, China
- Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang, China
- Key Laboratory of Gastrointestinal Cancer, Ministry of Education, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
- State Key Laboratory of Chemical Oncogenomics, Key Laboratory of Chemical Genomics, Peking University Shenzhen Graduate School, Shenzhen, Guangdong, China
- Department of Pathology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Key Laboratory of Intelligent Pharmacy and Individualized Therapy of Huzhou, Department of Pharmacy, Changxing People's Hospital, Changxing, Zhejiang, China
- Yi Xu
| | - Yunfu Cui
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Yunfu Cui
| | - Xiangyu Zhong
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- *Correspondence: Xiangyu Zhong
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Craig K, Abrams M, Amiji M. Cholesterol-Conjugated siRNA Silencing Tnf for the Treatment of Liver Macrophage-Mediated Acute Inflammation in Nonalcoholic Fatty Liver Disease. Nucleic Acid Ther 2023; 33:35-44. [PMID: 36318487 DOI: 10.1089/nat.2022.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Despite wide recognition as a disease of pandemic proportions, effective treatments for nonalcoholic fatty liver disease (NAFLD) remain elusive. Most of the current clinical programs aim to reduce hepatic fat accumulation and, thus, prevent downstream inflammation and fibrosis. To date, this therapeutic approach has helped identify a potential disconnect between steatosis reduction and disease resolution. Mounting preclinical evidence indicates liver inflammation may play a major role in steatosis development and fibrosis but has not garnered the same clinical representation. This may be owing to deficiencies in standard therapeutic modalities that limit their application in NAFLD. RNA interference (RNAi) is an attractive approach to targeting liver inflammation owing to its clinical safety profile, target specificity, and limited biodistribution. In this study, we characterize a simple cholesterol-short-interfering RNA (siRNA) conjugate system targeting Tnf mRNA in liver macrophages for the treatment of NAFLD. First, we observed delivery and anti-inflammatory activity in an acute liver inflammation model. In a follow-up murine NAFLD model, we observed total prevention of nearly all hallmarks of this disease: steatosis, inflammation, and fibrosis. This simple conjugate siRNA delivery system may be the first to show RNAi activity in liver macrophages and provide evidence for a novel therapeutic approach to inflammation in NAFLD.
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Affiliation(s)
- Kevin Craig
- Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts, USA.,Department of Discovery Research, Dicerna Pharmaceuticals, Inc., Lexington, Massachusetts, USA
| | - Marc Abrams
- Department of Discovery Research, Dicerna Pharmaceuticals, Inc., Lexington, Massachusetts, USA
| | - Mansoor Amiji
- Department of Pharmaceutical Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts, USA.,Department of Chemical Engineering, College of Engineering, Northeastern University, Boston, Massachusetts, USA
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Extensive Summary of the Important Roles of Indole Propionic Acid, a Gut Microbial Metabolite in Host Health and Disease. Nutrients 2022; 15:nu15010151. [PMID: 36615808 PMCID: PMC9824871 DOI: 10.3390/nu15010151] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
Increasing evidence suggests that metabolites produced by the gut microbiota play a crucial role in host-microbe interactions. Dietary tryptophan ingested by the host enters the gut, where indole-like metabolites such as indole propionic acid (IPA) are produced under deamination by commensal bacteria. Here, we summarize the IPA-producing bacteria, dietary patterns on IPA content, and functional roles of IPA in various diseases. IPA can not only stimulate the expression of tight junction (TJ) proteins to enhance gut barrier function and inhibit the penetration of toxic factors, but also modulate the immune system to exert anti-inflammatory and antioxidant effects to synergistically regulate body physiology. Moreover, IPA can act on target organs through blood circulation to form the gut-organ axis, which helps maintain systemic homeostasis. IPA shows great potential for the diagnosis and treatment of various clinical diseases, such as NAFLD, Alzheimer's disease, and breast cancer. However, the therapeutic effect of IPA depends on dose, target organ, or time. In future studies, further work should be performed to explore the effects and mechanisms of IPA on host health and disease to further improve the existing treatment program.
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Pan Z, Mao B, Zhang Q, Tang X, Yang B, Zhao J, Cui S, Zhang H. Postbiotics Prepared Using Lactobacillus paracasei CCFM1224 Prevent Nonalcoholic Fatty Liver Disease by Modulating the Gut Microbiota and Liver Metabolism. Int J Mol Sci 2022; 23:ijms232113522. [PMID: 36362307 PMCID: PMC9653709 DOI: 10.3390/ijms232113522] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Postbiotics are rich in a variety of bioactive components, which may have beneficial effects in inhibiting hepatic lipid accumulation. In this study, we investigated the preventive effects of postbiotics (POST) prepared from Lactobacillus paracasei on non-alcoholic fatty liver disease (NAFLD). Our results showed that when mice ingested a high-fat diet (HFD) and POST simultaneously, weight gain was slowed, epididymal white fat hypertrophy and insulin resistance were suppressed, serum biochemical indicators related to blood lipid metabolism were improved, and hepatic steatosis and liver inflammation decreased. Bacterial sequencing showed that POST modulated the gut microbiota in HFD mice, increasing the relative abundance of Akkermansia and reducing the relative abundance of Lachnospiraceae NK4A136 group, Ruminiclostridium and Bilophila. Spearman’s correlation analysis revealed significant correlations between lipid metabolism parameters and gut microbes. Functional prediction results showed that the regulation of gut microbiota was associated with the improvement of metabolic status. The metabolomic analysis of the liver revealed that POST-regulated liver metabolic pathways, such as glycerophospholipid and ether lipid metabolism, pantothenate and CoA biosynthesis, some parts of amino acid metabolism, and other metabolic pathways. In addition, POST regulated the gene expression in hepatocytes at the mRNA level, thereby regulating lipid metabolism. These findings suggest that POST plays a protective role against NAFLD and may exert its efficacy by modulating the gut microbiota and liver metabolism, and these findings may be applied to related functional foods.
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Affiliation(s)
- Zhenghao Pan
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Bingyong Mao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Qiuxiang Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Xin Tang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Bo Yang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Shumao Cui
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- Correspondence: ; Tel.: +86-0510-85912155
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi 214122, China
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Cardoso AC, Tovo CV, Leite NC, El Bacha IA, Calçado FL, Coral GP, Sammarco GN, Cravo C, Carvalho Filho RJ, de Mello Perez R, Luiz RR, Parise ER, Villela-Nogueira CA. Validation and Performance of FibroScan®-AST (FAST) Score on a Brazilian Population with Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2022; 67:5272-5279. [PMID: 35091842 DOI: 10.1007/s10620-021-07363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM FAST score has a good performance for diagnosing the composite of NASH + NAS ≥ 4 + F ≥ 2. However, it has not been evaluated in Latin American individuals with nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the performance of the FAST score in a Brazilian NAFLD population. METHODS Cross-sectional study was held in ≥ 18 years NAFLD patients diagnosed by ultrasonography and submitted to liver biopsy (LB). Liver stiffness (LSM) and CAP measurements were performed with FibroScan®, using M (BMI < 32 kg/m2) or XL probes. Area under receiver operating characteristic (AUROC) curves were calculated as well as sensitivity (S), specificity (Spe), positive predictive value (VPP) and negative predictive value (NPV) for the previously established FAST score cut-offs. RESULTS Among 287 patients included (75% female; mean age 55 ± 10 years), NASH + NAS ≥ 4 + F ≥ 2 was reported in 30% of LB. For the FAST cut-off of 0.35, the S and NPV to rule out NASH + NAS ≥ 4 + F ≥ 2 were 78.8% and 87.8%, respectively. Regarding the cut-off of 0.67, the Spe and PPV to rule-in NASH + NAS ≥ 4 + F ≥ 2 were 89.1%, 61.8%, respectively. The AUROC of FAST for all included patients was 0.78 (95% CI 0.72-0.84) and for those with ≥ 32 kg/m2 was 0.81 (95% CI 0.74-0.88). CONCLUSION FAST score has a good performance in a Brazilian NAFLD population, even in patients with higher BMI when the XL probe is adopted. Therefore, FAST can be used as a noninvasive screening tool mainly for excluding the diagnosis of progressive NASH, reducing the number of unnecessary liver biopsies.
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Affiliation(s)
- Ana Carolina Cardoso
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil
| | - Cristiane Valle Tovo
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Nathalie Carvalho Leite
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil
| | - Ibrahim A El Bacha
- Division of Gastroenterology, Hepatology Section, Federal University of São Paulo, São Paulo, Brazil
| | - Fernanda Luiza Calçado
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil
| | - Gabriela Perdomo Coral
- Gastroenterology and Hepatology Unit, Department of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Glauco Navas Sammarco
- Division of Gastroenterology, Hepatology Section, Federal University of São Paulo, São Paulo, Brazil
| | - Claudia Cravo
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil
| | | | - Renata de Mello Perez
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil
| | - Ronir Raggio Luiz
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edison Roberto Parise
- Division of Gastroenterology, Hepatology Section, Federal University of São Paulo, São Paulo, Brazil
| | - Cristiane A Villela-Nogueira
- Hepatology Unit - Clementino Fraga Filho University Hospital - School of Medicine, Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco 255 - Room 9E16, Rio de Janeiro, 29913-941, Brazil.
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Hidalgo I, Ortiz-Flores M, Villarreal F, Fonseca-Coronado S, Ceballos G, Meaney E, Nájera N. Is it possible to treat nonalcoholic liver disease using a flavanol-based nutraceutical approach? Basic and clinical data. J Basic Clin Physiol Pharmacol 2022; 33:703-714. [PMID: 35119232 DOI: 10.1515/jbcpp-2021-0285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/15/2022] [Indexed: 01/05/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is characterized by a spectrum of diseases, ranging from simple steatosis to hepatocellular carcinoma. The main factors for NAFLD are closely related to obesity, insulin resistance, intestinal microbiota alterations, hyperinsulinism, low-grade systemic inflammation, nitroxidative stress, lipid peroxidation, and mitochondrial dysfunction. Currently, the treatment of NAFLD is based on diet and exercise because, to date, there is no specific pharmacological agent, already approved, that raises the need for new therapeutic strategies. Nutraceuticals, such as polyphenols, have potential beneficial effects for health. In this article, the beneficial effects of epigallocatechin-3-gallate (EGCG) and (-)-epicatechin (EC) are discussed. EGCG is the main catechin in green tea, which has shown in various studies its potential effect preventing and treating NAFLD since it has shown antihyperlipidemic, anti-inflammatory, antifibrotic, antioxidant, and improvement of liver lipid metabolism. However, it has been found that excessive consumption may cause hepatotoxicity. EC is widely distributed in nature (fruits and vegetables). This flavanol has shown many beneficial effects, including antihypertensive, anti-inflammatory, anti-hyperglycemic, antithrombotic, and antifibrotic properties. It increases mitochondrial biogenesis, and it also has effects on the regulation of synthesis and metabolism of lipids. This flavanol is a nontoxic substance; it has been classified by the United States Food and Drug Administration as harmless. The EC-induced effects can be useful for the prevention and/or treatment of NAFLD.
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Affiliation(s)
- Isabel Hidalgo
- Unidad de Investigación Laboratorio de Investigación en Inmunología y Salud Publica, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Estado de México, Mexico
| | - Miguel Ortiz-Flores
- Laboratorio de investigación integral cardiometabólica, Escuela Superior de Medicina, Instituto Politécnico Nacional, CDMX, Mexico
| | | | - Salvador Fonseca-Coronado
- Unidad de Investigación Laboratorio de Investigación en Inmunología y Salud Publica, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Estado de México, Mexico
| | - Guillermo Ceballos
- Laboratorio de investigación integral cardiometabólica, Escuela Superior de Medicina, Instituto Politécnico Nacional, CDMX, Mexico
| | - Eduardo Meaney
- Laboratorio de investigación integral cardiometabólica, Escuela Superior de Medicina, Instituto Politécnico Nacional, CDMX, Mexico
| | - Nayelli Nájera
- Laboratorio de investigación integral cardiometabólica, Escuela Superior de Medicina, Instituto Politécnico Nacional, CDMX, Mexico
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