Overview and developments in noninvasive diagnosis of nonalcoholic fatty liver disease

High prevalence of non-alcoholic fatty liver disease (NAFLD) and very diverse outcomes that are related to disease form and severity at presentation have made the search for noninvasive diagnostic tools in NAFLD one of the areas with most intense development in hepatology today.Various methods have been investigated in the recent years,including imaging methods like ultrasound and magnetic resonance imaging,different forms of liver stiffness measurement,various biomarkers of necroinflammatory processes (acute phase reactants,cytokines,markers of apoptosis),hyaluronic acid and other biomarkers of liver fibrosis.Multicomponent tests,scoring systems and diagnostic panels were also developed with the purposes of differentiating non-alcoholic steatohepatitis from simple steatosis or discriminating between various fibrosis stages.In all of the cases,performance of noninvasive methods was compared with liver biopsy,which is still considered to be a gold standard in diagnosis,but is by itself far from a perfect comparative measure.We present here the overview of the published data on various noninvasive diagnostic tools,some of which appear to be very promising,and we address as well some of still unresolved issues in this interesting field.

Protective Effects of Chaihu Shugan San(柴胡疏肝散) on Nonalcoholic Fatty Liver Disease in Rats with Insulin Resistance

Objective： To investigate the protective effects of Chinese medicine formulation Chaihu Shugan San（柴胡疏肝散, CHSGS） on nonalcoholic fatty liver disease（NAFLD） in rats with insulin resistance（IR） and its molecular mechanisms. Methods： Male Sprague-Dawley rats were randomly divided into six groups： the control group, the model group, Dongbao Gantai group（东宝肝泰, DBGT, 0.09 g methionine/kg）, CHSGS high-dose group（CHSG-H, 12.6 g crude drug/kg）, CHSGS medium-dose group（CHSG-M, 6.3 g crude drug/kg）, and CHSGS low-dose group（CHSG-L, 3.15 g crude drug/kg）. After establishing the NAFLD rat model and treatment for 8 weeks, total cholesterol（TC）, triglyceride（TG）, high-density lipoprotein cholesterol（HDL-C）, free fatty acid（FFA）, fasting blood glucose（FBG）, fasting insulin（FINS） contents in blood serum, and TC, TG contents in the hepatic homogenate were measured by an automatic biochemical analyzer, and a homeostasis model assessment was applied to assess the status of IR, insulin sensitivity index（ISI）, and homeostasis model assessment for insulin secretion（HOMA-IS）. The expression levels of adiponectin and leptin mRNA in liver tissue were analyzed by reverse transcription polymerase chain reaction. Pathological changes of livers were observed by hematoxylineosin staining of paraffin section. Results： Compared with the model group, the serum levels of TC, TG, FFA, FBG, FINS, IRI, ISI, and the liver levels of TC and TG in CHSG-H, CHSG-M, CHSG-L groups showed significant declines（P〈0.01 or P〈0.05）; the serum levels of HDL-C, HOMA-IS were significantly increased（P〈0.01 or P〈0.05）; the expression of leptin mRNA was dramatically decreased and the expression of adiponectin mRNA was increased in the hepatic tissue（P〈0.01 or P〈0.05）. The fatty deposition of liver cells could also be alleviated. Conclusion： CHSGS could up-regulate the expression of adiponectin mRNA and down-regulate the expression of leptin mRNA on the liver, suggesting the CHSGS had positive therapeutic effect on NAFLD in rats with IR.

Altered nuclear factor-kappaB inducing kinase expression in insulin-resistant mice

Background Insulin resistance is an underlying feature of both type 2 diabetes and metabolic syndrome. Currently, it is unclear whether nuclear factor （NF）-KB inducing kinase （NIK） plays a role in the development of insulin resistance. The present in vivo study investigated the roles of NIK and IKB kinase a （IKKa） in obesity-induced insulin resistance using animal models. Methods NIK expression was evaluated by Western blotting in male Lepob mice and C57BL/6J mice fed a high-fat diet （HFD） （45% fat）. After metformin and sulfasalazine treatment, NIK expression was investigated during the improvement of insulin resistance. Results NIK was increased by about 1-fold in the renal tissues of Lepab mice and C57BL/6J mice fed a HFD for 12 weeks. After 1 and 3 weeks of high-fat feeding, we observed an almost 50% decrease in NIK and IKKa expression in the liver and renal tissues of C57BL/6J mice. NIK expression was significantly lower in the liver and renal tissues of HFD-fed mice that were treated with insulin sensitizers, metformin and sulfasalazine. However, IKKa expression was increased after metformin treatment in both tissues. Conclusion These results suggest a possible role of NIK in the liver and renal tissues of insulin-resistant mice.