Emerging Molecular Targets for the Treatment of Nonalcoholic Fatty Liver Disease

Gradenigo Hospital, Turin, Italy.
Annual review of medicine (Impact Factor: 12.93). 02/2010; 61(1):375-92. DOI: 10.1146/
Source: PubMed


Nonalcoholic fatty liver disease (NAFLD) is characterized by hepatic fat accumulation in the absence of significant ethanol consumption, viral infection, or other specific causes of liver disease. Currently the most common chronic liver disease, affecting 30% of the Western world, NAFLD may progress to cirrhosis and end-stage liver disease and may increase the risk of developing diabetes and cardiovascular disease. Although its pathogenesis is unclear, NAFLD is tightly associated with insulin resistance and the metabolic syndrome. No established treatment exists, and current research is targeting new molecular mechanisms that underlie NAFLD and associated cardiometabolic disorders. This review discusses some of these emerging molecular mechanisms and their therapeutic implications for the treatment of NAFLD: microRNAs, incretin analogs/antagonists, liver-specific thyromimetics, AMP-activated protein kinase activators, and nuclear receptors farnesoid X receptor and pregane X receptor.

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    • "The most recent investigations demonstrated that miR-33 plays a key regulatory role in the initiation and progression of atherosclerosis.28,29 MiR-33 mediated regulation in the metabolic pathways such as lipid metabolism (cholesterol homeostasis, HDL biogenesis, and fatty acid, phospholipids, and triglyceride, and bile acid metabolism), inflammatory response, insulin signaling, and glucose homeostasis.28 "
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    ABSTRACT: Metabolic syndrome (MetS) is a major public health concerns and increase in the incidence of MetS caused a rise in the rates of global morbidity, and mortality due to cardiovascular disease and diabetes. Lifestyle modification, a healthy diet, and pharmacological treatment and bariatric surgery are recommended in order to control this syndrome. Molecular mechanisms of metabolic disorders are essential in order to develop novel, valid therapeutic strategies. MicroRNA-33 plays imperative regulatory roles in a variety of biological processes including collaboration with sterol regulatory element-binding protein (SREBP) to maintain cholesterol homeostasis, high-density lipoprotein formation, fatty acid oxidation, and insulin signaling. Investigation of these molecules and their genetic targets may potentially identify new pathways involved in complex metabolic disease processes, improve our understanding of metabolic disorders, and influence future approaches to the treatment of obesity. This article reviews the role of miRNA-33 in metabolic syndrome, and highlights the potential of using miRNA-33 as a novel biomarker and therapeutic target for this syndrome.
    ARYA Atherosclerosis 11/2013; 9(6):372-6.
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    • "Today, it is accepted that the inhibition of the energy sensor protein AMPK (AMP activated kinase) is an important step in the development of fatty liver [4], [5], [6]. AMPK activity is reduced in fatty liver and its inhibition is associated with fat accumulation. "
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    ABSTRACT: Fatty liver (hepatic steatosis) is associated with nucleotide turnover, loss of ATP and generation of adenosine monophosphate (AMP). It is well known that in fatty liver, activity of the AMP-activated kinase (AMPK) is reduced and that its stimulation can prevent hepatic steatosis by both enhancing fat oxidation and reducing lipogenesis. Here we show that another AMP dependent enzyme, AMPD2, has opposing effects on fatty acid oxidation when compared to AMPK. In human hepatocytres, AMPD2 activation -either by overexpression or by lowering intracellular phosphate levels with fructose- is associated with a significant reduction in AMPK activity. Likewise, silencing of AMPK spontaneously increases AMPD activity, demonstrating that these enzymes counter-regulate each other. Furthermore, we show that a downstream product of AMP metabolism through AMPD2, uric acid, can inhibit AMPK activity in human hepatocytes. Finally, we show that fructose-induced fat accumulation in hepatocytes is due to a dominant stimulation of AMPD2 despite stimulating AMPK. In this regard, AMPD2-deficient hepatocytes demonstrate a further activation of AMPK after fructose exposure in association with increased fatty acid oxidation, and conversely silencing AMPK enhances AMPD-dependent fat accumulation. In vivo, we show that sucrose fed rats also develop fatty liver that is blocked by metformin in association with both a reduction in AMPD activity and an increase in AMPK activity. In summary, AMPD and AMPK are both important in hepatic fat accumulation and counter-regulate each other. We present the novel finding that uric acid inhibits AMPK kinase activity in fructose-fed hepatocytes thus providing new insights into the pathogenesis of fatty liver.
    PLoS ONE 11/2012; 7(11):e48801. DOI:10.1371/journal.pone.0048801 · 3.23 Impact Factor
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    ABSTRACT: Thyroid hormone affects in a myriad of biological processes such as development, growth, and metabolic control. Triiodothyronine (T3) is the biologically active form of thyroid hormone that acts through nuclear receptors, TRalpha and TRbeta, regulating gene expression. Given that the distribution of these receptors is heterogeneous amongst the different tissues, it is not surprising that some physiological effects of T3 are isoform specific. For example, while TRalpha is the dominant receptor in the brain and skeletal system and mediates most of the synergism between T3 and the sympathetic signaling pathway in the heart, TRbeta is abundant in liver and is probably the isoform that mediates most of the T3 effects on lipid metabolism. Thus, it makes sense to develop compounds that selectively act on either one of the TRs, allowing for the activation of specific T3-dependent pathways. This article reviews the recent progress made in this area, focusing on the physiological effects of compounds that lower serum cholesterol and decrease fat mass, as they spare skeletal muscle and bone masses, as well as the heart. The available studies indicate that achieving selective activation of different TR-mediated pathways is a promising strategy for treating lipid disorders and obesity.
    Thyroid 03/2008; 18(2):197-203. DOI:10.1089/thy.2007.0288 · 4.49 Impact Factor
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