Evaluación del desempeño de tres puntajes no invasivos para el diagnóstico de fibrosis avanzada en una población con hígado graso no alcohólico / Evaluation of the performance of three non-invasive scores for the diagnosis of advanced fibrosis in a population with non-alcoholic fatty liver disease

Introducción. La enfermedad hepática grasa no alcohólica (EHGNA) es la hepatopatía crónica más común en el mundo, y en aproximadamente el 10 % de los casos progresará a cirrosis o a carcinoma hepatocelular. La presencia de fibrosis hepática es el mejor predictor de esta progresión, pero su diagnóstico mediante biopsia hepática es invasivo y con riesgo de complicaciones (alrededor del 2,5 %). Existen puntajes no invasivos que se han desarrollado y validado para estadificar la fibrosis, pero no conocemos su rendimiento en la población colombiana. El objetivo de este estudio fue evaluar el desempeño de los puntajes fibrosis-4 (FIB-4), la relación AST/ALT y el índice AST/plaquetas (APRI) para la detección de fibrosis avanzada en pacientes colombianos con EHGNA. Metodología. Estudio observacional tipo transversal de pacientes con EHGNA, que entre 2008 y 2022 tuvieran disponible el resultado de una biopsia hepática. Se hizo una descripción demográfica básica y se calculó el FIB-4, la relación AST/ALT y el APRI con los laboratorios más recientes previos al procedimiento. Posteriormente se calcularon valores de sensibilidad, especificidad, valores predictivos, razones de verosimilitud y área bajo la curva-característica operativa del receptor (AUC-ROC) para los puntos de corte evaluados previamente en la literatura. Resultados. Se incluyeron 176 pacientes, de los cuales el 14,3 % tenían fibrosis avanzada. El FIB-4 presentó el mejor rendimiento con un valor AUC-ROC de 0,74 para el punto de corte de 1,30 y 2,67. En segundo lugar, estuvo la relación AST/ALT con un valor AUC-ROC de 0,68 con el punto de corte de 0,8, y finalmente el APRI con valor AUC-ROC 0,62 con el punto de corte de 1. Conclusión. En la población analizada los tres puntajes tienen menor rendimiento diagnóstico comparado a los resultados reportados en Europa y Japón. El FIB-4 es el único que alcanza una AUC-ROC con rendimiento razonable, con la limitación que 27,4 % obtuvieron un resultado indeterminado.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, with approximately 10% of cases progressing to cirrhosis or hepatocellular carcinoma. Liver fibrosis presence is the best predictor of this progression, yet its diagnosis through liver biopsy is invasive and poses risk of complications. Although non-invasive scoring systems have been developed and validated for fibrosis staging, their performance remains unexplored in the Colombian population. This study aims to assess the efficacy of the fibrosis-4 (FIB-4) score, AST/ALT ratio, and AST to platelet ratio index (APRI) in detecting advanced fibrosis among Colombian NAFLD patients. Methods. This cross-sectional observational study included NAFLD patients with available liver biopsy results from 2008 to 2022. Basic demographic characteristics were described, and FIB-4, APRI, and AST/ALT ratio were calculated using the latest laboratory data before the procedure. Subsequently, sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUC-ROC) were computed for previously assessed cutoff points. Results. A total of 176 patients were included, among whom 14.3% had advanced fibrosis. FIB-4 demonstrated superior performance with an AUC-ROC value of 0.74 for cutoff points of 1.30 and 2.67. Following was the AST/ALT ratio with an AUC-ROC value of 0.68 for cutoff point of 0.8, and finally, APRI with an AUC-ROC of 0.62 for the cutoff point of 1. Conclusion. All three scores have lower diagnostic efficacy compared to results reported in Europe and Japan. FIB-4 is the only one that achieves an acceptable AUC-ROC performance with the limitation that an indeterminate result was obtained in 27,4% of the sample.

Efecto del confinamiento por COVID-19 en la prevalencia de la enfermedad hepática esteatósica asociada a disfunción metabólica / Effect of COVID-19 lockdown on the prevalence of metabolic dysfunction-associated steatotic liver disease

Introducción. La enfermedad hepática esteatósica asociada a disfunción metabólica (MASLD) es una condición clínica frecuente, relacionada con el sobrepeso, la dislipidemia y la diabetes. Como estos factores de riesgo están a su vez asociados al sedentarismo y la ganancia de peso, se esperaría un impacto como resultado del confinamiento por COVID-19 en la prevalencia de dicha condición. Metodología. Estudio longitudinal retrospectivo en un panel de datos de 132 pacientes de 2017 a 2022, en donde fueron incluidos pacientes con una ecografía hepática y una valoración médica y paraclínica 1,5 años antes y después del periodo de confinamiento (25 de marzo de 2020 a 28 de febrero de 2021). El desenlace primario fue un cambio significativo en la prevalencia de la MASLD, y se utilizó un modelo exploratorio de regresión logística de efectos fijos con panel de datos para hallar los predictores de cambio. Resultados. En un total de 132 pacientes analizados, la prevalencia global de la MASLD antes (31 %; IC95%: 23-39) y después (35,6 %; IC95%: 27,4-43,8) del confinamiento por COVID-19 no cambió significativamente, sin embargo, en las mujeres sí hubo un aumento significativo (RR: 4; IC95%: 1,0004-16). Se encontró una marcada diferencia de prevalencia entre sexos (17 % en mujeres y 46 % en hombres; p=0,001). El confinamiento se asoció a incrementos en la masa corporal (diferencia: +1 kg; IC95%: 0,1-1,9), el colesterol LDL (diferencia: +9,7 mg/dL; IC95%: 4,9-14,4) y al diagnóstico de prediabetes (RR: 2,1; IC95%: 1,4-3,1). La MASLD se asoció positivamente a la preferencia nutricional por la comida rápida (p=0,047). Solo el índice de masa corporal resultó predictor independiente de MASLD (RR: 1,49; IC95%: 1,07-1,93). Conclusión. La prevalencia global de la MASLD no varió después del confinamiento por COVID-19, pero sí se incrementó en mujeres, y algunos de sus factores de riesgo también aumentaron significativamente. Se encontró equivalencia numérica entre la MASLD y la definición previa de la enfermedad. Se requiere un estudio local más grande para desarrollar y validar un mejor modelo predictor del cambio de la MASLD a través del tiempo.

Introduction. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common clinical condition, related to overweight, dyslipidemia and diabetes. As these risk factors are in turn associated with sedentary lifestyle and weight gain, an impact as a result of the COVID-19 confinement on the prevalence of MASLD would be expected. Methodology. Retrospective longitudinal study in a data panel of 132 patients from 2017 to 2022. Patients with a liver ultrasound and a medical and paraclinical assessment 1.5 years before and after the confinement period (March 25, 2020 to February 28, 2021) were included. The primary outcome was a significant change in the prevalence of MASLD, and an exploratory fixed-effects logistic regression model with panel data was used to find predictors of change. Results. In a total of 132 patients analyzed, the overall prevalence of MASLD before (31%, 95%CI: 23-39) and after (35.6%, 95%CI: 27.4-43.8) confinement by COVID-19 did not change significantly, however, in women there was a significant increase (RR: 4, 95%CI: 1.0004-16). A marked difference in prevalence was found between sexes (17% in women and 46% in men; p=0.001). Confinement was associated with increases in body mass (difference: +1 kg, 95%CI: 0.1-1.9), LDL cholesterol (difference: +9.7 mg/dL, 95%CI: 4.9-14.4) and the diagnosis of prediabetes (RR: 2.1, 95%CI: 1.4-3.1). MASLD was positively associated with nutritional preference for fast food (p=0.047). Only body mass index was an independent predictor of MASLD (RR: 1.49, 95%CI: 1.07-1.93). Conclusion. The overall prevalence of MASLD did not change after the COVID-19 lockdown, but it did increase in women, and some of its risk factors also increased significantly. Numerical equivalence was found between MASLD and the previous definition of the disease. A larger local study is required to develop and validate a better predictor model of MASLD change over time.

Intervention effect and mechanism of Wuwei baogan pill on mice with non-alcoholic fatty liver disease / 中国药房

OBJECTIVE To investigate the intervention effect and mechanism of Wuwei baogan pill on mice with non- alcoholic fatty liver disease （NAFLD）. METHODS The mice were given high-fat and high-sugar diet for 19 weeks to induce NAFLD model. The model mice were randomly grouped into model group， positive control group （polyene phosphatidylcholine capsules， 23.30 mg/kg）， Wuwei baogan pill low-dose， medium-dose and high-dose groups （0.11， 0.23， 0.45 g/kg）， with 8 mice in each group； the normal group was additionally set up without modeling. Administration groups were given relevant medicine intragastrically， and model group and normal group were given constant volume of normal saline， once a day， for consecutive 4 weeks. After the last administration， glucose metabolism （including fasting blood glucose， fasting insulin， insulin resistance index）， liver function [liver index， alanine aminotransferase （ALT）， aspartate aminotransferase （AST），liver tissue pathological score]， lipid metabolism [triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high- density lipoprotein cholesterol （HDL-C）] were measured； the pathological morphology of liver tissue， as well as fibrosis， lipid droplet formation， and glycogen synthesis were observed； the levels of free fatty acid （FFA） in serum and inflammatory factors in liver tissue [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-1β] were detected； the expressions of insulin receptor substrate/phosphoinositide 3-kinase/protein kinase B/ glycogen synthase kinase 3β （IRS/PI3K/AKT/GSK3β） signaling pathway-related protein in liver tissue were investigated. RESULTS After intervention with high-dose Wuwei baogan pill， liver index of NAFLD mice， serum levels of ALT， AST， FFA， TC， TG and LDL-C， the levels of TNF-α， IL-6 and IL-1β in liver tissue， fasting blood glucose， fasting insulin， insulin resistance index， liver tissue pathological score， proportions of fibrotic staining area and lipid droplet staining area all significantly decreased （P＜0.05）； the level of HDL-C， proportion of glycogen staining area， the phosphorylation of IRS1， PI3K， AKT and GSK3β protein increased significantly （P＜0.05）； the degree of liver cell necrosis and steatosis was reduced， and the fibrotic lesions were alleviated. The above indexes of mice were improved in Wuwei baogan pill low-dose and medium-dose groups， but there was no statistically significant difference in some indexes. CONCLUSIONS Wuwei baogan pill can regulate lipid and glucose metabolism disorders in the liver of NAFLD mice， and improve liver injury， the mechanism of which may be associated with the activation of IRS/PI3K/AKT/GSK3β signaling pathway.

Intervention effect and mechanism of Wuwei baogan pill on mice with non-alcoholic fatty liver disease / 中国药房

OBJECTIVE To investigate the intervention effect and mechanism of Wuwei baogan pill on mice with non- alcoholic fatty liver disease （NAFLD）. METHODS The mice were given high-fat and high-sugar diet for 19 weeks to induce NAFLD model. The model mice were randomly grouped into model group， positive control group （polyene phosphatidylcholine capsules， 23.30 mg/kg）， Wuwei baogan pill low-dose， medium-dose and high-dose groups （0.11， 0.23， 0.45 g/kg）， with 8 mice in each group； the normal group was additionally set up without modeling. Administration groups were given relevant medicine intragastrically， and model group and normal group were given constant volume of normal saline， once a day， for consecutive 4 weeks. After the last administration， glucose metabolism （including fasting blood glucose， fasting insulin， insulin resistance index）， liver function [liver index， alanine aminotransferase （ALT）， aspartate aminotransferase （AST），liver tissue pathological score]， lipid metabolism [triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， and high- density lipoprotein cholesterol （HDL-C）] were measured； the pathological morphology of liver tissue， as well as fibrosis， lipid droplet formation， and glycogen synthesis were observed； the levels of free fatty acid （FFA） in serum and inflammatory factors in liver tissue [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and IL-1β] were detected； the expressions of insulin receptor substrate/phosphoinositide 3-kinase/protein kinase B/ glycogen synthase kinase 3β （IRS/PI3K/AKT/GSK3β） signaling pathway-related protein in liver tissue were investigated. RESULTS After intervention with high-dose Wuwei baogan pill， liver index of NAFLD mice， serum levels of ALT， AST， FFA， TC， TG and LDL-C， the levels of TNF-α， IL-6 and IL-1β in liver tissue， fasting blood glucose， fasting insulin， insulin resistance index， liver tissue pathological score， proportions of fibrotic staining area and lipid droplet staining area all significantly decreased （P＜0.05）； the level of HDL-C， proportion of glycogen staining area， the phosphorylation of IRS1， PI3K， AKT and GSK3β protein increased significantly （P＜0.05）； the degree of liver cell necrosis and steatosis was reduced， and the fibrotic lesions were alleviated. The above indexes of mice were improved in Wuwei baogan pill low-dose and medium-dose groups， but there was no statistically significant difference in some indexes. CONCLUSIONS Wuwei baogan pill can regulate lipid and glucose metabolism disorders in the liver of NAFLD mice， and improve liver injury， the mechanism of which may be associated with the activation of IRS/PI3K/AKT/GSK3β signaling pathway.

Expression of serum 25-hydroxyvitamin D and its clinical significance in patients with nonalcoholic fatty liver disease and obesity / 临床肝胆病杂志

ObjectiveTo investigate the serum level of 25-hydroxyvitamin D in patients with nonalcoholic fatty liver disease （NAFLD） and obesity， as well as the correlation of 25-hydroxyvitamin D with liver function， blood lipids， and inflammatory indicators. MethodsA total of 90 patients with NAFLD who attended Shanxi Bethune Hospital from January 2022 to March 2023 were enrolled， and according to the body mass index （BMI）， they were divided into NAFLD+obesity group with 60 patients （BMI≥28 kg/m2） and NAFLD group with 30 patients （BMI<28 kg/m2）； 30 individuals who underwent physical examination during the same period of time were enrolled as control group. Related indications were measured for all three groups， including serum 25-hydroxyvitamin D， liver function parameters （alanine aminotransferase ［ALT］， aspartate aminotransferase ［AST］， alkaline phosphatase ［ALP］， gamma-glutamyl transpeptidase ［GGT］， total bilirubin ［TBil］， and direct bilirubin ［DBil］）， blood lipid parameters （high-density lipoprotein ［HDL］， low-density lipoprotein ［LDL］， total cholesterol ［TC］， and triglyceride ［TG］）， inflammatory indicators （high-sensitivity C-reactive protein ［H-CRP］ and Golgi protein 73 ［GP-73］）， cytokines （interleukin-2 ［IL-2］， interleukin-4 ［IL-4］， interleukin-6 ［IL-6］， interleukin-10 ［IL-10］， interleukin-17 ［IL-17］， interleukin-1β ［IL-1β］， tumor necrosis factor-α ［TNF-α］， and interferon gamma ［IFN-γ］）， and liver/spleen volume ratio. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test or the Tamhane’s T2 test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. A Pearson or Spearman correlation analysis was performed. ResultsCompared with the control group， the NAFLD+obesity group had significant reductions in 25-hydroxyvitamin D， HDL， cytokines （IL-2， IL-4， IL-10， and IFN-γ）， and liver/spleen volume ratio （all P<0.05）， as well as significant increases in liver function parameters （ALT， AST， ALP， GGT， TBil， and DBil）， blood lipid parameters （LDL， TC， and TG）， inflammatory indicators （H-CRP and GP-73）， and cytokines （IL-1β， IL-17， and TNF-α） （all P<0.05）. There were significant differences between the NAFLD+obesity group and the NAFLD group in all the above indicators except liver/spleen volume ratio and H-CRP （all P<0.05）. The correlation analysis showed that 25-hydroxyvitamin D level was negatively correlated with ALT （r=-0.324， P=0.012）， AST （r=-0.421， P=0.001）， ALP （r=-0.435， P=0.001）， GGT （r=-0.343， P=0.007）， TBil （r=-0.532， P<0.001）， DBil （r=-0.521， P<0.001）， LDL （r=-0.405， P=0.001）， TC （r=-0.466， P<0.001）， TG （r=-0.551， P<0.001）， H-CRP （r=-0.434， P=0.014）， GP-73 （r=-0.421， P=0.001）， IL-1β （r=-0.433， P=0.001）， IL-17 （r=-0.465， P<0.001）， and TNF-α （r=-0.533， P<0.001）， and it was positively correlated with HDL （r=0.632， P<0.001）， IL-2 （r=0.546， P<0.001）， IL-4 （r=0.533， P<0.001）， IL-10 （r=0.456， P<0.001）， and liver/spleen volume ratio （r=0.543， P<0.001）. ConclusionSerum 25-hydroxyvitamin D is significantly correlated with liver function parameters， blood lipid parameters， and inflammatory indicators in patients with NAFLD and obesity， and it may alleviate the symptoms of patients with NAFLD and obesity by reducing inflammatory response， which provides new intervention strategies for the treatment of NAFLD.

Association between sleep disorders and different stages of nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo investigate the association of sleep disorders with the development and progression of nonalcoholic fatty liver disease （NAFLD）. MethodsA total of 1 868 participants from the health examination cohort and fatty liver cohort of Beijing Friendship Hospital from June 2022 to June 2023 were enrolled as subjects. Related data were collected from all subjects， including age， sex， education level， chronic medical history， and biochemical parameters， and all subjects completed Pittsburgh Sleep Quality Index （PSQI） scale independently. According to the diagnostic criteria， the subjects were divided into non-NAFLD group with 1 122 subjects and NAFLD group with 746 subjects， and according to the stage of progression， the patients in the NAFLD group were further divided into simple fatty liver group （SFL group with 624 subjects） and nonalcoholic steatohepatitis （NASH） group with 122 subjects. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between three groups. The chi-square test was used for comparison of categorical data between the three groups. The binary Logistic regression analysis was used to investigate the association between sleep factors and NAFLD， and the multinomial Logistic regression analysis was used to investigate the association between sleep factors and the different stages of NAFLD； two multivariate models were constructed for adjustment of potential confounding factors， i.e.， an age-sex adjustment model and a multivariate adjustment model， and the multivariate adjustment model adjusted the factors of age， sex， education level， smoking， diabetes， hypertension， body mass index （BMI）， triglyceride （TG）， and high-density lipoprotein cholesterol （HDL-C）. ResultsThere were significant differences in age， sex， BMI， education level， smoking， diabetes， hypertension， alanine aminotransferase， TG， and HDL-C between the non-NAFLD， SFL， and NASH groups （all P<0.05）. There were also significant differences between the three groups in the total score of PSQI scale and the proportion of subjects with a score of 0‍ ‍—‍ ‍3 points for the 7 sleep components （all P<0.05）. The multivariate adjustment model showed no significant association between sleep disorders and SFL， while long sleep latency （odds ratio ［OR］=4.04， 95% confidence interval ［CI］： 2.33‍ ‍—‍ ‍7.03， P<0.001）， short sleep duration （OR=3.53， 95%CI： 1.83‍ ‍—‍ ‍6.82， P<0.001）， and severe sleep disorders （OR=2.96， 95%CI： 1.48‍ ‍—‍ ‍5.93， P=0.002） were closely associated with the risk of NASH. ConclusionOverall sleep condition and its components of sleep disorders are not significantly associated with the simple fatty liver； however， long sleep latency， short sleep duration， and severe sleep disorders can increase the risk of NASH， which should be taken seriously in clinical practice.

Association between Helicobacter pylori and nonalcoholic fatty liver disease： A Meta-analysis / 临床肝胆病杂志

ObjectiveTo investigate the association between Helicobacter pylori infection and nonalcoholic fatty liver disease （NAFLD）. MethodsThis study was conducted acoording to the PRISMA guideline， with a PROSPERO registration number of CRD42023408932. Databases including PubMed， the Cochrane Library， Web of Science， Embase， CBM， Wanfang Data， CNKI， and VIP were searched for related articles published up to June 2023. This study was conducted for the case-control studies， cross-sectional studies， and cohort studies that included clear detection criteria for HP and evaluation criteria for NAFLD and performed the multivariate analysis to investigate the association between HP infection and NAFLD. Odds ratio （OR） and its 95% confidence interval （CI） were selected as the effect measures， and STATA 15.0 software was used to perform the Meta-analysis. ResultsA total of 33 primary studies were included， with 236 514 subjects in total. The Meta-analysis showed that HP was associated with the high prevalence rate of NAFLD （OR=1.25， 95%CI： 1.16‍ ‍—‍ ‍1.35， P<0.05， I2=93.7%）. Subgroup analysis was conducted in terms of sample size， the diagnostic method for HP， the quality of primary study， the health status of subjects， and the type of primary study， but no clear source of heterogeneity was found. The Meta-regression analysis was conducted with the covariates of sample size， the diagnostic method for HP， the quality of primary study， the health status of subjects， and the type of primary study， and the results showed that the health status of subjects and the type of primary study might be the sources of heterogeneity. Sensitivity analysis showed that the overall results were stable， and funnel plots and the Egger test showed no significant publication bias. ConclusionHP is associated with the high prevalence rate of NAFLD in the general population， and large-scale prospective cohort studies are still needed to specifically and comprehensively evaluate the association between HP and NAFLD.

Role of lipophagy in the prevention and treatment of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nowadays， the prevalence of nonalcoholic fatty liver disease （NAFLD） is constantly rising in China and globally， and its incidence rate is increasing year by year， which has seriously affected human life and health. Lipophagy is molecular chaperone-mediated autophagy and has the functions of promoting lipolysis， maintaining the lipid homeostasis of hepatocytes， and alleviating hepatocyte fatty degeneration. Lipophagy has three main processes of lipid droplet catabolism， lipid droplet autophagy， and fatty acid β-oxidation， which are regulated by key genes， receptors， and enzymes. Currently， important advances have been achieved for the intervention methods of traditional Chinese medicine， Western medicine， diet， and exercise in the research on lipophagy， which provides new perspectives for the prevention and treatment strategies for NAFLD.

Mechanism of action of sterol regulatory element-binding proteins in nonalcoholic fatty liver disease and related therapeutic targets / 临床肝胆病杂志

Nonalcoholic fatty liver disease （NAFLD） has become the most common liver disease in the world and is an important risk factor for the progression to hepatocellular carcinoma. However， the pathogenesis of NAFLD remains unclear， and there is still a lack of specific treatment measures. Sterol regulatory element-binding proteins （SREBP） are an important nuclear transcription factor， which mainly maintains the balance of lipid metabolism inside the body by activating the genes associated with the synthesis and uptake of cholesterol， fatty acids， and triglycerides， and therefore， SREBP are a target for the treatment of metabolic diseases. This article reviews the latest advances in SREBP in the pathogenesis of NAFLD and the latest evidence of SREBP-targeted therapy for NAFLD. It is worth noting that recent studies have shown that SREBP inhibition can cause liver injury together with autophagy damage. Therefore， excessive inhibition of lipogenesis may exert a counterproductive effect on the treatment of NAFLD. In conclusion， SREBP is a promising therapeutic target for NAFLD； the molecular mechanism of SREBP in lipid metabolism is regulated by many factors， and these factors are being deeply explored and analyzed， which has an important clinical significance for the treatment of NAFLD.

The Roles of Small Extracellular Vesicles and Small Extracellular Vesicles-derived Non-coding RNA in Non-alcoholic Fatty Liver Disease / 生物化学与生物物理进展

Extracellular vesicles (EVs) are a kind of exsomes secreted by cells, which all cells release them as part of their normal physiology and during acquired abnormalities. EVs can be broadly divided into two categories by their sizes, small EVs (sEVs) and medium/large EVs (m/l EVs). As a kind of extracellular vesicle, sEVs are mostly discoid vesicles with diameters ranging from 40 nm to 200 nm. The medium/large EVs are elliptical with a diameter more than 200 nm. sEVs play a crucial role in intercellular communication and have emerged as important mediators in the development and progression of liver diseases. In this review, we discussed the current understanding of the role of sEVs, particularly sEV derived non-coding RNA in non-alcoholic fatty liver disease (NAFLD) and their potential as diagnostic and therapeutic targets. sEVs are small membrane-bound particles secreted by cells, which fuse with plasma membrane and release to extracellular matrix. Depending on the cell of origin, sEVs could contain many cell constituents, including various DNA, RNA, lipids, metabolites, and cytosolic and cell-surface proteins, biomolecules. In addition, many RNA and DNA molecules contained by sEVs, such as mRNA, microRNA (miRNA), long noncoding RNA (lncRNA) and mitochondrial DNA (mtDNA), can be transferred to recipient cells to effectively promote their biological response, physiological and pathological functions. Such sEVs-mediated responses can be disease promoting or restraining. The intrinsic properties of sEVs in regulating complex intracellular pathways has advanced their potential utility in the therapeutic control of many diseases. Recent studies reviewed here also indicate a functional, targeted, mechanism-driven accumulation of specific cellular components in sEVs, suggesting that they have a role in regulating intercellular communication. Many studies have also shown the involvement of sEVs’ noncoding RNAs (ncRNAs) in controlling cell activities and their crucial functions in regulating lipid metabolism. sEVs ncRNAs, including miRNAs, lncRNAs, and circular RNAs (circRNAs) regulate physiological functions and maintain lipid metabolism homeostasis. miRNA are small non-coding RNA molecules that regulate posttranscriptional gene expression by repressing messenger RNA-targets. These circulating miRNAs are easily accessible, disease-specific and sensitive to small changes, which makes them ideal biomarkers for diagnostic, prognostic, predictive or monitoring purposes. Specific miRNA signatures can be reflective of disease status and development or indicators of poor treatment response in liver diseases. And lncRNAs have been shown to regulate gene expression by interacting with transcription factors or chromatin-modifying enzymes, which regulate gene expression by binding to target mRNAs. Then circRNAs contributed to NAFLD progression by acting as miRNA sponges, functional protein sponges, or novel templates for protein translation. Finally, sEVs could be engineered to deliver diverse therapeutic payloads, including short interfering RNAs, antisense oligonucleotides and so on, with an ability to direct their delivery to a desired target. The potential of targeting sEVs with lncRNAs and miRNAs not only could be potential diagnostic biomarkers for NAFLD, but also have potential therapeutic effects on NAFLD, which might provide new ideas for the NAFLD treatment. In conclusion, this review provides an overview of the current understanding of the roles of sEVs ncRNAs in NAFLD, so we suggest that further research into sEVs could lead to new diagnostic tools and therapeutic strategies for NAFLD.

FGF1-based Drugs for The Treatment of Obesity-related Complications / 生物化学与生物物理进展

At present, the incidence of overweight and obesity has reached epidemic levels worldwide, which call a challenge to the prevention and control of chronic metabolic diseases. Because obesity is a major risk factor for a range of metabolic diseases, including type 2 diabetes (T2DM), non-alcoholic fatty liver disease (NAFLD), cardiovascular and neurodegenerative diseases, sleep apnea, and some types of cancer. However, the drugs remain limited. Therefore, there is an urgent need to develop effective long-term treatments to address obesity-related complications. Fibroblast growth factor 1 (FGF1) is an important regulator of systemic energy homeostasis, glycolipid metabolism and insulin sensitivity. FGF1 is a non-glycosylated polypeptide consisting of 155 amino acids, consisting of 12 inverted parallel β chains with amino and carboxyl terminus, and N-terminus extending freely without the typical secretory signaling sequence, closely related to its own biological activity. Thus, FGF1 mutants or derivatives with different activities can be designed by substitution or splicing modification at theN-terminal. FGF1 plays an irreplaceable role in the development, deposition and function of fat. High-fat diet can regulate available FGF1 through two independent mechanisms of nutritional perception and mechanical perception, and influence the function of fat cells. FGF1 controls blood glucose through peripheral and central effects, enhances insulin sensitivity, improves insulin resistance, and plays a role in diabetic complications, which is expected to become a new target for the treatment of T2DM in the future. FGF1 may be involved in the regulation of NAFLD from mild steatosis to severe non-alcoholic steatohepatitis. FGF1 is closely related to the occurrence and development of a variety of cancers, improve the efficacy of anti-cancer drugs, and play a direct and indirect anti-cancer role. In addition, FGF1 plays an important role in the occurrence and development of the cardiovascular system and the improvement of cardiovascular diseases such as ischemia/reperfusion injury, myocardial infarction, pathological cardiac remodeling, cardiotoxicity. Therefore, FGF1 shows a number of therapeutic benefits in the treatment of obesity and obesity-related complications. But because FGF1 has strong mitotic activity and long-term use has been associated with an increased risk of tumorigenesis, its use in vivo has been limited and enthusiasm for developing it to treat obesity-related complications has been dampened. However, FGF1 was found to induce cell proliferation primarily through FGFR3 and FGFR4, but its metabolic activity was mainly mediated by FGFR1. That is, FGF1 activity that promotes mitosis and anti-obesity-related complications appears to be separable. Currently, many engineered FGF1 variants have been developed, such as FGF1ΔHBS, MT-FGF1ΔHBS, FGF1∆NT, ∆nFGF1, FGF1R50E. Although the effect of FGF1 or its analogues on obesity-related complications has been demonstrated in many rodent studies, there are no relevant clinical results. This may be due to the unknown safety and therapeutic efficacy of FGF1 in large animals and humans, as well as concerns about tumorigenesis that hinder its development into a lifelong therapeutic agent. This review summarizes recent advances in the development of FGF1-based biologic drugs for the treatment of obesity-related complications, highlights major challenges in clinical implementation, and discusses possible strategies to overcome these obstacles.

Effects of liraglutide on cardiovascular metabolism，left ventricular structure and function in NAFLD patients with T2DM / 中国药房

OBJECTIVE To observe the effects of liraglutide on cardiovascular metabolism， left ventricular structure and function of non-alcoholic fatty liver disease （NAFLD） patients with type 2 diabetes mellitus （T2DM）. METHODS Totally 351 NAFLD patients with T2DM were enrolled retrospectively， who visited the Department of Endocrinology in our hospital from January 2019 to December 2022. They were divided into control group （196 cases） and observation group （155 cases） according to different treatment regimens. The control group received conventional standard treatment， and the observation group was additionally given Liraglutide injection 0.6 mg/d subcutaneously once a day based on the control group， adjusted to 1.2 mg/d after 7 days. Both groups received regular treatment for more than 12 months. The propensity matching method was used to match the two groups of patients at a ratio of 1∶1. The cardiovascular metabolism indexes and cardiac ultrasound parameters were compared， and the correlation between left ventricular structure， function parameters and cardiovascular metabolism indexes was analyzed. RESULTS After propensity score matching， there was no significant difference in baseline clinical data between the two groups （each 155 cases） before treatment （P＞0.05）. After 12 months of treatment， the waist circumference， weight， body mass index （BMI）， systolic blood pressure （SBP）， fasting blood glucose （FBG）， glycosylated hemoglobin （HbA1c） and triglyceride （TG） of both groups， as well as the diastolic blood pressure （DBP）， total cholesterol （TC）， uric acid （UA） and left ventricular mass （LVM） of the observation group， exhibited a significant decrease compared to pre-treatment levels （P＜0.05）. The high-density lipoprotein cholesterol （HDL-C）， estimated glomerular filtration rate （eGFR）， and E/A ratio in both groups， as well as the aspartate aminotransferase （AST） in the control group and the left ventricular ejection fraction （LVEF） in the observation group， were all significantly increased compared with before treatment in the same group （P＜0.05）. Moreover， the improvement of the above indicators （except for TG and SBP） in the observation group was generally more significant than those in the control group （P＜0.05）. The left ventricular structure and functional parameters （LVM， LVEF， E/A ratio） of the two groups before and after treatment had varying degrees of correlation with the patients’ waist circumference， body weight， BMI， SBP， FBG and HbA1c. Moreover， BMI （observation group： β＝ 0.229， P＝0.004） and SBP （control group： β＝0.240， P＝0.004； observation group： β＝0.226， P＝0.007） were independent influential factors for LVM of the patients. CONCLUSIONS Liraglutide combined with conventional standard treatment can effectively control blood glucose in NAFLD patients with T2DM， reduce waist circumference， body weight and blood pressure， improve blood lipid disorders， and protect their cardiac structure and function.

Hepatic lipidomics study in chronic cadmium-exposed mice / 局解手术学杂志

Objective To study the change of lipidomics in chronic cadmium-exposed mice,thereby screening out lipid subclasses,lipid molecules and enriched metabolic pathways with significant differences.Methods Twelve SPF male C57BL/6J mice(8 weeks old)were randomly divided into the control group(normal water feeding)and the experimental group[cadmium water(0.6 mg/L of CdCl2)feeding],with 6 mice in each group.Mice were sacrificed after 6 months of cadmium exposure,and fresh liver tissues were collected immediately.Lipid oil red O staining and lipidomics analysis were performed on liver tissue.Results Compared with the control group,the liver tissue of mice in the experimental group did not appear red after lipid oil red O staining.Seventeen lipid subclasses with significant differences and 144 lipid molecules with significant differences were screened out by lipidomics.These lipid molecules with significant differences were enriched in glycerophospholipid metabolism,linoleic acid metabolism,alpha-linolenic acid metabolism,glycosylphosphati-dylinositol biosynthesis,glycerolipid metabolism and arachidonic acid metabolism by KEGG.Conclusion This study reveals that chronic cadmium exposure can induce the disorder of lipid subclasses and lipid metabolites in the liver of mice,which provides a basis for understanding the non-alcoholic fatty liver disease caused by chronic cadmium exposure.

Ultrasonic quantitative measurement of hepatorenal index for diagnosing non-alcoholic fatty liver disease in children / 中国介入影像与治疗学

Objective To explore the value of ultrasonic quantitative measurement of hepatorenal index(HRI)for diagnosing non-alcoholic fatty liver disease(NAFLD)in children.Methods Abdominal ultrasound and upper abdominal MRI data of 70 obese children were retrospectively analyzed.ROI with different sizes and shapes of liver and right kidney were delineated on longitudinal and transverse ultrasound images,respectively,and the echo intensity of ROIs were measured to obtain HRIsmall ROI on longitudinal section,HRIsmall ROI on transverse section,HRIlarge ROI on longitudinal section and HRIlarge ROI on transverse section,i.e.HRI1,HRI2,HRI3,HRI4,while the gray,skewness and kurtosis of liver ultrasound image were recorded.Liver proton density fat fraction(PDFF)were measured based on MRI,and NAFLD was diagnoses taken PDFF≥6%as standard.The correlations of HRI with PDFF and liver ultrasound image related parameters were analyzed.Taken MRI as the standard,receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of HRI for NAFLD.Multivariate logistic regression analysis was performed taken age,sex,body mass index(BMI)percentile,HRI3 and liver ultrasound image related parameters as independent variables and MRI diagnosis of NAFLD as dependent variable to screen the predictors of MRI diagnosis of NAFLD.Results HRI1,HRI2,HRI3 and HRI4 obtained with ultrasound was 1.89±0.52,1.88±0.55,1.97±0.51 and 1.92±0.55,respectively.PDFF obtained with MRI was(12.53±3.14)%,and diagnosed NAFLD in 34 cases.HRI and PDFF had moderate positive correlation(r=0.51-0.61,all P＜0.01).The correlation between HRI3 and PDFF was the strongest(r=0.61),and HRI3 was weakly correlated with liver gray3(r=-0.270,P=0.020),with area under the curve(AUC)for diagnosing NAFLD of 0.93(P＜0.01).BMI percentile(OR=1.06),HRI3(OR=34.20)and liver gray3(OR=0.79)were all predictive factors for MRI diagnosis of NAFLD.Conclusion Ultrasonic quantitative measurement of HRI had high clinical value for diagnosing NAFLD in children.

Effects of different formulations of high-fat diet on establishment of a non-alcoholic fatty liver model in rats / 中国临床药理学与治疗学

AIM:To improve the success rate of experimental modeling of non-alcoholic fatty liver(NAFLD)in rats by high-fat diet through comparing three different formulations of high-fat diets in con-structing non-alcoholic fatty liver rats model,so as to provide a reliable animal model for the study of non-alcoholic fatty liver disease.METHODS:SPF-grade male SD rats were divided into four groups randomly:control group,high-fat diet group1(HFD1),high-fat diet group2(HFD2),high-fat diet group3(HFD3).Each group was given the corre-sponding feed for 8 weeks while modeling.The da-ta on general observation,body weight changes,and ingestion of the rats were recorded during the modeling period.After 8 weeks'feeding,liver ultra-sound,CT and MRI examination were performed for the rats of each group to check the status.Blood and liver samples were collected.Changes in liver function(ALT,AST),blood lipids(TC,TG,HDL-C,LDL-C),and inflammatory indexes(IL-1β,IL-6,TNF-α)were detected.The morphology of the liv-ers was observed with the naked eyes,and the liv-er index and Lee's index were calculated at the end of 8 weeks.The effects of different high-fat diets on the establishment of NAFLD model in SD rats were comprehensively evaluated by comparing the difference of above indexes among the groups.RE-SULTS:Compared with the control group,rats in the HFD1,HFD2 and HFD3 groups showed poor mental deterioration,decreased activity,severe hair loss,decreased food intake,increased body weights,and significantly increased liver index and Lee's in-dex,along with increased liver volume,blunt edge,steatosis and lipid deposition,and the trend was even more pronounced in the HFD3 group.Com-pared with the control group,the serum levels of ALT,AST,TC,TG,LDL-C,IL-1β,IL-6 and TNF-α were significantly increased,while the contents of HDL-C was significantly decreased in the HFD1,HFD2 and HFD3 group,especially in the HFD3 group.Com-pared with the control group,the B ultrasonogra-phy showed an enlarged liver with enhanced paren-chymal echo and pipe unsharpness,CT showed that the liver and spleen CT ratio decreased obvi-ously,and the MRI images showed obvious differ-ence of liver signal intensity between in/out of phase image in the HFD1,HFD2 and HFD3 group,and the most significant imaging changes was ob-served in the HFD3 group.CONCLUSION:The above three kinds of high-fat diets can establish NAFLD model in SD rats after 8 weeks'feeding,the models induced by HFD3 was better than those in-duced by the other two groups.NAFLD lesion is rel-atively serious and expected to last longer in HFD3 group,which are more suitable for investigating the underlying mechanisms of non-alcoholic fatty liver disease and development of lipid-lowering drugs.

Using Mendelian randomization to explore the causal association between gut microbiota and nonalcoholic fatty liver disease / 安徽医科大学学报

Objective To explore the causal association between gut microbes and non-alcoholic fatty liver disease(NAFLD)by Mendelian randomisation analysis.Methods Genetic instrumental variables for gut microbiota were identified from a gene-wide association study of 18 340 participants,and summary statistics for NAFLD were ob-tained from the FinnGen database,which provided data on 894 NAFLD cases and 217 898 controls using the IVW method as the primary analysis.In order to test the robustness of the results,MR-Egger method,WM method,Simple Mode method,Weighted Mode method were used for Mendelian randomisation analysis,and heterogeneity test,sensitivity analysis,and multiplicity analysis were performed.Results class Gammaproteobacteria IVW re-sults showed(OR=0.621,95％CI=0.412～0.934,P=0.022);family Enterobacteriaceae IVW results showed(OR=1.481,95％CI=1.069～2.053,P=0.018);genus Lachnospiraceae IVW results showed(OR=1.405,95％CI=1.036～1.904,P=0.029);genus Prevotella7 IVW results showed(OR=0.834,95％CI=0.714～0.974,P=0.021);genus Prevotella9 IVW results showed(OR=1.251,95％CI=1.025～1.527,P=0.027);order Desulfovibrionales IVW results showed(OR=0.714,95％CI=0.519～0.982,P=0.038);or-der Enterobacteriales IVW results showed(OR=1.481,95％CI=1.069～2.053,P=0.018).And there was no heterogeneity in the heterogeneity test,and the sensitivity analyses all showed robustness and no pleiotropy was found.Conclusion This study implicates class Gammaproteobacteria,family Enterobacteriaceae,genus Lachno-spiraceae,genus Prevotella7,genus Prevotella9,order Desulfovibrionales,order Enterobacteriales seven species of gut microorganisms have a causal relationship with NAFLD.

Research progress in clinical management of nonalcoholic fatty liver disease / 重庆医学

Nonalcoholic fatty liver disease(NAFLD),also known as metabolic associated fatty liver disease(MAFLD),is one of the most common chronic liver diseases characterized by the fat accumulation in the liver and hepatocellular damage.Patients with NAFLD can manifest as simple fatty liver or non-alcoholic steatohepatitis(NASH)in the early stage,and can progress to hepatic fibrosis,hepatic cirrhosis,hepatic fail-ure,and hepatic carcinoma in the late stage.NAFLD has become the most common chronic liver disease,af-fecting more than 30%of the population worldwide,posing a threat to human health that cannot be ignored.However,the current research on NAFLD is still incomplete,and there is no ideal medication for the treat-ment of NAFLD.The clinical management of NAFLD lacks unified standards and evidence-based evidence,and the multiple comorbidities bring challenges to the clinical management of NAFLD.This article was aimed to review the research progress in the clinical management of NAFLD,including the diagnosis and non-invasive examination methods,evaluation and commonly used tools,treatments methods,advantages and disadvanta-ges,so as to provide a reference for the clinical management of NAFLD.

Chaihu Guizhi Ganjiang Decoction Improves Non-alcoholic Fatty Liver in Rats Through RIP1/RIP3/MLKL Pathways Inhibiting Necrotic Apoptosis / 广州中医药大学学报

Objective To investigate the therapeutic effect and mechanism of Chaihu Guizhi Ganjiang Decoction on non-alcoholic fatty liver disease(NAFLD)rats.Methods The experiment was conducted in five groups:normal group,model group,low-and high-dose groups of Chinese medicine(Chaihu Guizhi Ganjiang Decoction)and GSK872[receptor interacting protein kinase(RIP)3 inhibitor]group.Except for the normal group,the NAFLD rat model was constructed using high-fat chow feeding method in the remaining groups,respectively.At the end of treatment,hepatocyte apoptosis was observed by terminal transferase uridyl nick end labeling(TUNEL)method,and serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),lipids[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],and the levels of inflammatory factors tumor necrosis factor α(TNF-α)and interleukin 1β(IL-1β)in liver tissues were measured by enzyme-linked immunosorbent assay(ELISA);and the levels of phosphorylation of RIP1,RIP3,and mixed lineage kinase structural domain-like protein(MLKL)were detected in liver tissues by Western Blot.Results Compared with the normal group,the apoptotic index of rat hepatocytes in the model group was elevated,ALT and AST in serum were significantly elevated,TC,TG and LDL-C levels were significantly elevated,and HDL-C level was significantly reduced,and the contents of TNF-α and IL-1β as well as the phosphorylated expression levels of RIP1,RIP3 and MLKL were significantly elevated in the liver tissues(P＜0.05);compared with the model group,the apoptotic index of hepatocytes in rats in the low-and high-dose groups of Chinese medicine and GSK872 group was reduced,the serum levels of ALT and AST were significantly reduced,the levels of TC,TG and LDL-C were significantly reduced,the level of HDL-C was significantly increased,and the contents of TNF-α and IL-1β and the phosphorylated expressions of RIP1,RIP3 and MLKL in the liver tissues were significantly reduced(P＜0.05);there was no significant difference in the above-mentioned indexes between the low-dose and high-dose groups of Chinese medicine and the GSK872 group(P＞0.05).Conclusion Chaihu Guizhi Ganjiang Decoction can effectively improve NAFLD in rats,and its mechanism may be related to the inhibition of RIP1/RIP3/MLKL signaling pathway activation,which in turn inhibits necrotic apoptosis.

Research progress on the role of ferroptosis in the pathogenesis of non-alcoholic fatty liver disease / 基础医学与临床

Ferroptosis is a new type of cell death proposed in recent years,and its main characteristics are iron overload and lipid peroxidation.Ferroptosis is involved in the occurrence and development of non-alcoholic fatty liv-er disease(NAFLD).Iron overload can generate a large amount of reactive oxygen species through the Fenton reac-tion.Under the action of lipoxygenase,the unsaturated fatty acids on the liver cell membrane undergo lipid peroxi-dation,which induces liver cell death and leads to the occurrence of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis.Blocking ferroptosis may provide one of the therapeutic strategies to protect liver cells.

The Association of Intestinal Flora Metabolite TMAO with Non-alcoholic Fatty Liver Disease / 昆明医科大学学报

Objective To explore the role of TMAO from gut microbiota in non-alcoholic fatty liver disease(NAFLD),we detected the serum level of TMAO and its precursor metabolites in NAFLD,as well as the expression level of Eubacterium rectum,Bacteroidetes multiforme,Lactobacillus and bifidobacterium in the intestinal flora.Methods We collected 118 subjects and divided into NAFLD group(86 cases)and healthy control group(32 cases)randomly.We also detected the serum level of TMAO and its precursor metabolites in subjects by high performance liquid chromatography tandem mass spectrometry detection(LC-MS),and the expression of target bacterial DNA was detected by qRT-PCR.Results Serum TMAO,TMA and choline levels were significantly increased in NAFLD(P<0.05),and liver fat content was positively correlated with TMAO(P<0.05).The expression level of Lactobacillus and Eubacterium rectum in NAFLD group were increased(P<0.05);the expression level of Bifidobacterium and Bacteroides multiform were decreased(P<0.05).The serum TMAO level was positively correlated with Eubacterium rectum(r=0.280,P<0.05),and negatively correlated with Bifidobacterium(r=-0.332,P<0.05).Conclusion The level of TMAO in serum shows a positive correlation with NAFLD.The structure of intestinal flora in individuals with NAFLD is altered and linked to TMAO.This suggests that the intestinal flora may have a significant impact on the development of NAFLD through TMAO.