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Ironing out Steatohepatitis
V. Nathan Subramaniam*
Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dq0010"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Article commented</span></p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Handa P&#44; Maliken BD&#44; Nelson JE&#44; Hennessy KA&#44; Vemulakonda LA&#44; Morgan-Stevenson V&#44; Dhillon BK&#44; et al&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Differences in hepatic expression of iron&#44; inflammation and stress-related genes in patients with nonalcoholic steatohepatitis&#46;</span></p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Ann Hepatol</span> 2017&#59; 16&#58; 77-85&#46;</p></span></p><p id="p0010" class="elsevierStylePara elsevierViewall">The increasing prevalence of obesity and the metabolic syndrome worldwide is well recognized&#44; the tight association of non-alcoholic fatty liver disease &#40;NAFLD&#41; with these conditions increasingly so&#46; NAFLD can progress to the more severe form of the disorder non-alcoholic stea-tohepatitis &#40;NASH&#41;&#44; which is characterized by worsening liver pathology&#46; The prevalence of iron disorders&#44; in particularly the genetic iron overload disorder hereditary he-mochromatosis&#44; is also high in the European population&#59; up to 1&#58;200 individuals carry the at-risk gene variant &#8211;the p&#46;C282Y mutation in the <span class="elsevierStyleItalic">HFE</span> gene&#8211; which results in significant hepatic iron accumulation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A number of studies have examined the association between increased iron levels&#44; the prevalence of <span class="elsevierStyleItalic">HFE</span> mutations and NAFLD&#47;NASH with conflicting results &#40;reviewed recently in reference <a class="elsevierStyleCrossRef" href="#bib0010">2</a>&#41;&#59; increased iron has also been proposed as the &#8220;second hit&#8221; in NAFLD&#47;NASH&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Annals of Hepatology</span>&#44; Handa&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> report on the analysis of hepatic gene expression in NAFLD and NASH patients&#46; The authors have a longstanding interest in this field and have continued their work towards understanding the pathophysiology of NAFLD&#47;NASH and the relationship of iron to liver disease&#46; In an attempt to define the genes which may be involved in the progression of NAFLD to NASH they examined the expression of a large number genes involved in the regulation of iron metabolism&#44; inflammation&#44; and oxidative stress in patients with NAFLD and NASH&#44; with or without liver iron accumulation&#44; and correlated this with levels of a number cytokines in serum&#46; Their analysis showed that expression of many genes involved in iron regulation were increased in patients with NASH compared to NAFL&#59; these included <span class="elsevierStyleItalic">HAMP</span> &#40;encoding the iron regulatory hormone hepcidin&#41;&#44; <span class="elsevierStyleItalic">TMPRSS6</span> &#40;encoding the negative regulator of hepcidin&#44; transmembrane serine protease 6&#41;&#44; <span class="elsevierStyleItalic">STAT3</span> &#40;encoding the cytokine signalling factor&#44; signal transducer and activator of transcription 3&#41;&#46; Gene expression of proinflammatory cytokines IL-1&#946; and TNF-&#945; were also increased significantly in livers of NASH patients&#59; while an increase in serum levels of IL-6 and IL-8 was noted&#46; Gene expression of HIF1&#945; &#40;hypoxia inducible factor 1&#41; was significantly reduced in livers of NASH compared to NAFL patients&#46; NAFLD patients with liver iron accumulation also had increased gene expression of <span class="elsevierStyleItalic">HAMP</span> levels&#59; however they had lower cytokine gene expression levels and reduced gene expression of <span class="elsevierStyleItalic">CREBH</span> &#40;the liver-specific cAMP responsive- element binding protein&#41;&#46; Based on this data the authors go on to suggest that hepcidin has a regulatory role in the progression from NAFL to NASH in patients&#46; While other studies have previously noted the increase in <span class="elsevierStyleItalic">HAMP</span> in patients with NASH&#59;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> it is unclear why an increase in <span class="elsevierStyleItalic">TMPRSS6</span> levels is associated with an increase in <span class="elsevierStyleItalic">HAMP</span>&#44; since <span class="elsevierStyleItalic">TMPRSS6</span>&#44; at the protein&#47;enzyme level&#44; cleaves hemojuvelin and thus is a negative regulator of <span class="elsevierStyleItalic">HAMP</span>&#46; Similarly while many studies have examined the response of hepcidin to inflammatory cues&#44; a direct role for hepcidin&#44; as suggested by the authors&#44; in modulating the inflammatory response itself is unclear&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">One of the strengths of the study by Handa&#44; <span class="elsevierStyleItalic">et al&#46;</span> is the use of liver biopsies and the significant number available for their analysis&#59; they also examined gene expression of a range of genes involved in iron regulation&#44; inflammation and stress response&#46; Measurements of serum iron&#44; ferritin&#44; transferrin saturation&#44; cytokine levels&#44; markers of inflammation&#44; liver function and cholesterol with a correlation of liver histology and injury provide significant data in this study&#46; However&#44; one of the major limitations of the study&#44; as highlighted by the authors&#44; was the absence of data on serum hepcidin levels&#44; and more importantly <span class="elsevierStyleItalic">HFE</span> geno-typing in the patients&#59; the <span class="elsevierStyleItalic">HFE</span> genotype has been shown to affect both serum and hepatic iron and hepcidin levels&#46; It is unclear if the interpretation of the data would be affected and if so how significantly&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> A second aspect is the absence of protein data on some iron regulatory proteins which are post-translationally regulated&#59; these include phosphorylated <span class="elsevierStyleItalic">STAT3</span> which is the mediator of IL-6 regulation of hepcidin and hemojuvelin &#40;<span class="elsevierStyleItalic">HJV</span>&#44; a positive regulator of hepcidin and a substrate for <span class="elsevierStyleItalic">TMPRSS6</span>&#41;&#46; However&#44; this may be due to the usual and expected paucity of protein material which is obtained from liver biopsies&#46;</p><p id="p0025" class="elsevierStylePara elsevierViewall">Previous studies have attempted to do examine the hepatic gene expression profiles in NAFLD and NASH&#59; the majority of studies however have been performed in cell lines or in animal models of liver disease&#46; In one recent study the authors concluded that expression of a number genes and variants in these genes may contribute to development of NAFLD&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition recent studies suggest that epigenetics&#44; an inheritable but potentially reversible phenomena which affects expression of genes&#44; may also play a role in this chronic liver disease &#40;reviewed in reference <a class="elsevierStyleCrossRef" href="#bib0040">8</a>&#41;&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">In conclusion&#44; the study by Handa&#44; <span class="elsevierStyleItalic">et al&#46;</span> has been important in re-examining the role of iron&#44; inflammation and stress in the progression of NAFLD to NASH and the genes involved&#59; it is however apparent that additional systematic and high-powered molecular studies are required to enable a more thorough understanding of this complex and chronic liver disease&#46;</p></span>"
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos