Research Article Details
| Article ID: | A19787 |
| PMID: | 26349165 |
| Source: | Trop Gastroenterol |
| Title: | Nonalcoholic Fatty Liver Disease--The Clinician's Perspective. |
| Abstract: | Non alcoholic fatty liver (NAFLD) is a common cause of liver disease worldwide with prevalence ranging from 10-30%. It encompasses a spectrum ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis and hepatocellular carcinoma (HCC) in some patients. The diagnosis of hepatic steatosis can be made reliably by imaging. Differentiating simple steatosis from NASH usually requires liver biopsy although various non-invasive methods are under evaluation. Similarly, liver biopsy is the gold standard for staging of fibrosis but NAFLD fibrosis score and transient elastography are now validated for non-invasive assessment of fibrosis in patients with NAFLD. Liver biopsy should be reserved for patients at high risk of having NASH or advanced fibrosis, those needing evaluation of competing diagnoses or those enrolled in therapeutic trials. Treatment can be directed against various pathophysiological aspects of NAFLD and includes management of obesity, insulin resistance, hyperlipidemia and oxidative stress, suppression of inflammation and modulation of gut bacteria. Lifestyle modification with diet, exercise and weight loss is the cornerstone of therapy. Pharmacological treatment of NAFLD is still evolving with vitamin E and pioglitazone being the only approved drugs as of now. Bariatric surgery can lead to improvement in NASH in morbidly obese patients. Optimal therapy of NAFLD includes a multidisciplinary approach involving management of metabolic syndrome and cardiovascular disease. Management of NASH related cirrhosis and HCC is like that of other etiologies. Indications and outcomes of liver transplantation in patients with NASH are same as for other etiologies of liver disease. |
| DOI: | 10.7869/tg.219 |
| Strategy ID | Therapy Strategy | Synonyms | Therapy Targets | Therapy Drugs | |
|---|---|---|---|---|---|
| S01 | Improve insulin resistance | insulin sensitizer; insulin resistance; glucose tolerance | Biguanide: increases 5-AMP activated protein kinase signaling; SGLT-2 inhibitor; Thiazalidinedione: selective PPAR-γ agonists; GLP-1 agonist | Metformin; Empagliflozin; Canagliflozin; Rosiglitazone; Pioglitazone; Liraglutide | Details |
| S03 | Anti-fibrosis | fibrosis | Angiotensin Receptor Blocker (ARB); CCR2/CCR5 antagonist; Thyroid receptor β agonist; PEGylated human FGF21 analogue; Monoclonal antibody to lysyl oxidase-like 2 (LOXL2); Galectin-3 inhibitor; FGF19 variant | Losartan; Cenicriviroc; VK-2809; MGL-3196; Pegbelfermin; Simtuzumab; GR-MD-02; NGM282 | Details |
| S04 | Anti-oxidative stress | oxidative stress | α-tocopherol: antioxidant | Vitamin E | Details |
| S08 | Lifestyle measures | Lifestyle intervention; weight loss; diet adaptation; dietary interventions; lifestyle modifications; Exercise | -- | -- | Details |
| S09 | Bariatric surgery | Metabolic surgery | -- | -- | Details |
| S10 | Liver transplantation | -- | -- | -- | Details |
| Diseases ID | DO ID | Disease Name | Definition | Class | |
|---|---|---|---|---|---|
| I05 | 9352 | Type 2 diabetes mellitus | A diabetes that is characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. A diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. http://en.wikipedia.org/wiki/Diabetes, http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2 | disease of metabolism/inherited metabolic disorder/ carbohydrate metabolic disorder/glucose metabolism disease/diabetes/ diabetes mellitus | Details |
| I14 | 9970 | Obesity | An overnutrition that is characterized by excess body fat, traditionally defined as an elevated ratio of weight to height (specifically 30 kilograms per meter squared), has_material_basis_in a multifactorial etiology related to excess nutrition intake, decreased caloric utilization, and genetic susceptibility, and possibly medications and certain disorders of metabolism, endocrine function, and mental illness. https://en.wikipedia.org/wiki/Obesity | disease of metabolism/acquired metabolic disease/ nutrition disease/overnutrition | Details |
| Drug ID | Drug Name | Type | DrugBank ID | Targets | Category | Latest Progress | |
|---|---|---|---|---|---|---|---|
| D579 | Emfilermin | Miscellany | -- | adipocytes | Enhance lipid metabolism | Under investigation | Details |
| D388 | Vitamin E | Supplement | DB00163 | NR1I2; ALOX5; DGKA | Anti-inflammatory | Under clinical trials | Details |
| D328 | Serine | Chemical drug | DB00133 | SRR | Improve insulin resistance | Under clinical trials | Details |
| D275 | Pioglitazone | Chemical drug | DB01132 | PPARG agonist | Improve insulin resistance | Advanced in clinical trials | Details |
| D182 | Insulin | Biological drug | DB00030 | INSR agonist; CPE modulator&product of | -- | Under clinical trials | Details |
| D316 | S-adenosyl-L-methionine | Chemical drug | DB00118 | GNMT cofactor | Antiviral | Under clinical trials | Details |