The effects of pantethine on fatty liver and fat distribution

Gentiopicroside prevents alcoholic liver damage by improving mitochondrial dysfunction in the rat model

Gentianae Radix et Rhizoma is a medical plant that is widely cultivated in China, North Korea, Japan, and Russia, and gentiopicroside is one of its major active compounds. In this study, the hepatoprotective activity of gentiopicroside on rats with alcoholic liver damage (ALD) was evaluated using the transaminase and blood lipid levels and antioxidant capacity. The potential mechanism of hepatoprotective effect of gentiopicroside was evaluated by mitochondrial function detection, gas chromatography-mass spectrometry (GC-MS) metabolomic analysis, and anti-apoptosis analysis. Results showed that the gentiopicroside exhibited good hepatoprotective activity on rats with ALD by decreasing the transaminase levels, regulating the blood lipid levels, and increasing the antioxidant capacity. The potential mechanisms were related to regulating mitochondrial dysfunction by recovering mitochondrial membrane potential level, adenosine triphosphate concentration, activities of key enzymes in tricarboxylic acid cycle, and activities of complex I-V, regulating micromolecular metabolism and anti-apoptosis. These findings supported the further exploration of Gentianae Radix et Rhizoma as effective phytotherapy to prevent and treat ALD.

Expression of perilipin and adipophilin in nonalcoholic fatty liver disease; relevance to oxidative injury and hepatocyte ballooning

AIMS

Perilipin and adipophilin, PAT family proteins, play important roles in lipid metabolism. Although nonalcoholic fatty liver disease (NAFLD) is initiated by hepatocyte lipidation, little is known about the relationship between these proteins and hepatocellular injury. We investigated the expressions of perilipin and adipophilin and their relation to inflammation, fibrosis, hepatocellular ballooning, and oxidized phosphatidylcholine (oxPC) localization in human NAFLD.

METHODS AND RESULTS

Liver biopsies of nonalcoholic steatohepatitis (NASH, n=39) or simple steatosis (n=9) were studied by immunohistochemical techniques using anti-perilipin, anti-adipophilin and anti-oxPC antibodies. The severity of liver damage was histologically assessed by the Brunt system and NAFLD activity score (NAS). Enlarged hepatocytes usually containing Mallory-Denk bodies were defined as ballooned. Perilipin and adipophilin were detected on the rim of lipid droplets in both NASH and simple steatosis. Perilipin was more evident in larger lipid droplets while adipophilin expression was frequent in lipid droplets of ballooned hepatocytes. The frequency of adipophilin-positive ballooned hepatocytes was correlated to inflammation (Rs=0.72, p<0.0001), fibrosis (Rs=0.46, p=0.005), NAS (Rs=0.47, p=0.004) and oxPC-positive ballooned hepatocytes (Rs=0.35, p=0.033).

CONCLUSIONS

Expression patterns of perilipin and adipophilin in NASH livers varied with the size of lipid droplets. In partiew or, adipophilin expression in ballooned hepatocytes was closely associated with oxidative damage.

Combined pantethine and probucol therapy for Japanese patients with non-alcoholic steatohepatitis

AIMS

To evaluate the efficacy and mechanism of combined pantethine and probucol therapy in Japanese patients with non-alcoholic steatohepatitis (NASH), liver function, serum cytokines, serum adiponectin and liver biopsy findings were investigated.

METHODS

Sixteen patients with NASH and hyperlipidemia were treated with pantethine (600 mg/day) and probucol (500 mg/day) for 48 weeks.

RESULTS

The mean pretreatment aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 66 IU/L and 113 IU/L, respectively, which showed a significant decrease with treatment to 33 IU/L and 51 IU/L (P < 0.01 and P < 0.05), respectively. Total cholesterol was also significantlydecreased (P < 0.01). In addition, the mean serum TGF-beta level was significantly decreased, while the mean serum level of high molecular adiponectin was increased. In eight patients, liver biopsy was performed both before and after treatment. In four of these patients, inflammation was improved, and fibrosis was improved in two patients. No side-effects of this treatment were noted.

CONCLUSION

Combined pantethine and probucol therapy was safe and effective for Japanese NASH patients, with its efficacy being mediated through adiponectin and TGF-beta.

Dietary and Nutraceutical Options for Managing the Hypertriglyceridemic Patient

Scientific evidence continues to accumulate regarding fasting serum triglycerides as an independent risk factor for coronary heart disease. In response, the National Cholesterol Education Program has revised the acceptable level of fasting triglycerides from <200 mg/dL to <150 mg/dL. A significant percentage of Americans suffer from hypertriglyceridemia, and considering the expanding numbers of individuals who are physically inactive, overweight, and suffering from the metabolic syndrome, it is expected that these numbers will continue to rise over the next decade. Fortunately, nutraceutical and lifestyle options have been shown to substantially and consistently reduce this risk factor. This review will focus on management options for the hypertriglyceridemic patient with an emphasis on nicotinic acid, pantethine, fish oils (eicosapentaenoic and docosahexaenoic acids), and modified carbohydrate diets.

Effect of nutritional counselling on hepatic, muscle and adipose tissue fat content and distribution in non-alcoholic fatty liver disease

AIM: To assess the effectiveness of the current UK clinical practice in reducing hepatic fat (IHCL).

METHODS: Whole body MRI and ¹H MRS were obtained, before and after 6 mo nutritional counselling, from liver, soleus and tibialis muscles in 10 subjects with non-alcoholic fatty liver disease (NAFLD).

RESULTS: A 500 Kcal-restricted diet resulted in an average weight loss of 4% (-3.4 kg,) accompanied by significant reductions in most adipose tissue (AT) depots, including subcutaneous (-9.9%), abdominal subcutaneous (-10.2%) and intra-abdominal-AT (-11.4%). Intramyocellular lipids (IMCL) were significantly reduced in the tibialis muscle (-28.2%). Decreases in both IHCL (-39.9%) and soleus IMCL (-12.2%) content were also observed, although these were not significant. Several individuals showed dramatic decreases in IHCL, while others paradoxically showed increases in IHCL content. Changes in body composition were accompanied by improvements in certain liver function tests: serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Significant correlations were found between decreases in IHCL and reductions in both intra-abdominal and abdominal subcutaneous AT. Improvements in liver function tests were associated with reductions in intra-abdominal AT, but not with changes in IHCL.

CONCLUSION: This study shows that even a very modest reduction in body weight achieved through lifestyle modification can result in changes in body fat depots and improvements in LFTs.

Pharmacotherapy for dyslipidaemia--current therapies and future agents

Current lipid-altering agents that lower low density lipoprotein cholesterol (LDL-C) primarily through increased hepatic LDL receptor activity include statins, bile acid sequestrants/resins and cholesterol absorption inhibitors such as ezetimibe, plant stanols/sterols, polyphenols, as well as nutraceuticals such as oat bran, psyllium and soy proteins; those currently in development include newer statins, phytostanol analogues, squalene synthase inhibitors, bile acid transport inhibitors and SREBP cleavage-activating protein (SCAP) activating ligands. Other current agents that affect lipid metabolism include nicotinic acid (niacin), acipimox, high-dose fish oils, antioxidants and policosanol, whilst those in development include microsomal triglyceride transfer protein (MTP) inhibitors, acylcoenzyme A: cholesterol acyltransferase (ACAT) inhibitors, gemcabene, lifibrol, pantothenic acid analogues, nicotinic acid-receptor agonists, anti-inflammatory agents (such as Lp-PLA(2) antagonists and AGI1067) and functional oils. Current agents that affect nuclear receptors include PPAR-alpha and -gamma agonists, while in development are newer PPAR-alpha, -gamma and -delta agonists, as well as dual PPAR-alpha/gamma and 'pan' PPAR-alpha/gamma/delta agonists. Liver X receptor (LXR), farnesoid X receptor (FXR) and sterol-regulatory element binding protein (SREBP) are also nuclear receptor targets of investigational agents. Agents in development also may affect high density lipoprotein cholesterol (HDL-C) blood levels or flux and include cholesteryl ester transfer protein (CETP) inhibitors (such as torcetrapib), CETP vaccines, various HDL 'therapies' and upregulators of ATP-binding cassette transporter (ABC) A1, lecithin cholesterol acyltransferase (LCAT) and scavenger receptor class B Type 1 (SRB1), as well as synthetic apolipoprotein (Apo)E-related peptides. Fixed-dose combination lipid-altering drugs are currently available such as extended-release niacin/lovastatin, whilst atorvastatin/amlodipine, ezetimibe/simvastatin, atorvastatin/CETP inhibitor, statin/PPAR agonist, extended-release niacin/simvastatin and pravastatin/aspirin are under development. Finally, current and future lipid-altering drugs may include anti-obesity agents which could favourably affect lipid levels.