Microvesicular steatosis: a missed item in the management of nonalcoholic fatty liver disease?

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease and cirrhosis. In NAFLD, histological course of steatosis is usually macrovesicular (MacroS), but it may be accompanied by varying degrees of microvesicular steatosis (MicroS). Thus, in this study, we aimed to evaluate the prevalence and significance of MicroS in subjects with NAFLD. METHODS: A retrospective analysis of clinical and laboratory data of patients with histologically proven NAFLD was performed. The liver biopsy specimens which stained with hematoxylin eosin, reticulin, and Masson's Trichrome stains were evaluated by single expert liver pathologist. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). Grading for steatosis, steatosis type, zonal distribution of steatosis and other histological findings were also determined. RESULTS: The prevalence of MicroS among the study population (n= 191) was 30.4%. There was no difference regarding the demographic and biochemical parameters between patients with or without MicroS. On the other hand, the prevalence of ballooning injury and megamitochondria were higher in patients with MicroS (p= 0.019 and p= 0.036, respectively). There was a significant association of MicroS with ballooning injury (OR 2.65, 95% CI= 1.26-5.55 ; p= 0.005) and the presence of megamitochondria (OR 3.72, 95% CI= 1.00-13.72 ; p= 0.037). CONCLUSION: MicroS is common in patients with NAFLD and is associated with early histological findings in this clinically relevant condition. Further longitudinal studies are needed to characterize the role of MicroS in the natural history of NAFLD.

Plasma pentraxin-3 is associated with endothelial dysfunction in non-alcoholic fatty liver disease.

OBJECTIVE: Pentraxin-3 (PTX-3) is an acute-phase protein belonging to the PTX family. It has been reported that PTX-3 is significantly associated with obesity, metabolic syndrome, and cardiovascular diseases (CVD). Non-alcoholic fatty liver disease (NAFLD) is strongly associated with atherosclerosis and CVD. In this study, we aimed to investigate the relationship of PTX-3 with circulating markers of endothelial dysfunction and atherosclerosis in patients with NAFLD. PATIENTS AND METHODS: Seventy patients with biopsy-proven NAFLD and seventy healthy controls were enrolled in the study. Plasma asymmetric dimethylarginine (ADMA), adiponectin, and PTX-3 levels were determined using enzyme-linked immunosorbent assay (ELISA). High-sensitivity C-reactive protein (hsCRP) serum levels were measured with the immunoturbidimetric assay. Insulin resistance was estimated using the HOMA-IR index. RESULTS: PTX-3 and hsCRP levels were higher and adiponectin levels were lower in the NAFLD group compared to the healthy controls (p < 0.001 for all). In correlation analysis, a significant association was observed between PTX-3 and ADMA levels (r = 0.423, p < 0.001). CONCLUSIONS: Our study demonstrated for the first time that increased circulating PTX-3 is strongly associated with endothelial dysfunction in subjects with NAFLD. However, large prospective studies are needed to establish the independent predictive value of PTX-3 for CVD endpoints in this clinically relevant condition.

Alpha fetoprotein levels and its relationship with histopathological findings in patients with non-alcoholic fatty liver disease.

BACKGROUND: Non alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver disorders ranging from simple steatosis (SS) to cirrhosis. In addition, increasing evidence indicates that hepatocellular carcinoma (HCC) may represent a late complication of NAFLD. Alpha-fetoprotein (AFP) serum levels can rise in adults with HCC. AIM: In the present study, we aimed to investigate circulating AFP concentrations in subjects with histologically proven NAFLD. In addition, the relationship of AFP with liver histology was also searched. PATIENTS AND METHODS: One hundred and three male NAFLD patients and 57 healthy male controls were enrolled in the study. In addition, patients with NAFLD grouped as nonalcoholic steatohepatitis (NASH) (n = 72) and SS (n = 31). AFP serum levels were measured in duplicate by the chemiluminescence's method. RESULTS: Age and gender were similar in subjects with NAFLD and controls. AFP serum levels were not different between two groups. In subgroup analysis, AFP levels were also found to be similar in patients with NASH and SS. Moreover, no significant relationship was found between AFP and histopathological findings in patients with NAFLD. CONCLUSIONS: The results of this preliminary study suggest that AFP is not involved in the pathogenesis of NAFLD.