Journal Article

Pathogenesis and treatment of non-alcoholic steatohepatitis and its fibrosis

Lee, Kuei-Chuan, Wu, Pei-Shan, Lin, Han-Chieh

2023

Overview

The initial presentation of non-alcoholic steatohepatitis (NASH) is hepatic steatosis. The dysfunction of lipid metabolism within hepatocytes caused by genetic factors, diet, and insulin resistance causes lipid accumulation. Lipotoxicity, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum stress would further contribute to hepatocyte injury and death, leading to inflammation and immune dysfunction in the liver. During the healing process, the accumulation of an excessive amount of fibrosis might occur while healing. During the development of NASH and liver fibrosis, the gut-liver axis, adipose-liver axis, and renin-angiotensin system (RAS) may be dysregulated and impaired. Translocation of bacteria or its end-products entering the liver could activate hepatocytes, Kupffer cells, and hepatic stellate cells, exacerbating hepatic steatosis, inflammation, and fibrosis. Bile acids regulate glucose and lipid metabolism through Farnesoid X receptors in the liver and intestine. Increased adipose tissue-derived non-esterified fatty acids would aggravate hepatic steatosis. Increased leptin also plays a role in hepatic fibrogenesis, and decreased adiponectin may contribute to hepatic insulin resistance. Moreover, dysregulation of peroxisome proliferator-activated receptors in the liver, adipose, and muscle tissues may impair lipid metabolism. In addition, the RAS may contribute to hepatic fatty acid metabolism, inflammation, and fibrosis. The treatment includes lifestyle modification, pharmacological therapy, and non-pharmacological therapy. Currently, weight reduction by lifestyle modification or surgery is the most effective therapy. However, vitamin E, pioglitazone, and obeticholic acid have also been suggested. In this review, we will introduce some new clinical trials and experimental therapies for the treatment of NASH and related fibrosis.

• Publisher: Korean Association for the Study of the Liver,The Korean Association for the Study of the Liver,대한간학회
• Subject: Autophagy / Body fat / Diet / Exercise / Fatty acids / Fatty liver / Fibrosis - etiology / Humans / Inflammation / Inflammation - metabolism / Inflammation - pathology / Insulin Resistance / Kinases / Lipids / Liver - pathology / Liver cancer / Liver cirrhosis / Liver diseases / liver fibrosis / Metabolism / MicroRNAs / Non-alcoholic Fatty Liver Disease - drug therapy / Non-alcoholic Fatty Liver Disease - pathology / Non-alcoholic Fatty Liver Disease - therapy / Obesity / Overweight / Oxidation / Oxidative stress / Pathogenesis / Phosphorylation / Proteins / Review / Sedentary behavior / steatohepatitis / 내과학