title: TNFalpha genotype affects TNFalpha release, insulin sensitivity and the severity of liver disease in HCV chronic hepatitis.
abstract: OBJECTIVE
  TNFalpha induces insulin resistance and promoter polymorphisms of TNFalpha gene affect the release of this cytokine, implicated in the pathogenesis of HCV-related diabetes and fatty liver. The aim was to define whether in patients with HCV chronic hepatitis TNFalpha genotype influences TNFalpha activity, insulin resistance, and the severity of the disease.
  
  
  METHODS
  186 patients, 65% with steatosis, 17% with diabetes. TNFalpha and sTNFR2 were determined by ELISA, insulin resistance by HOMA-R index and TNFalpha -238, -308, and -863 polymorphisms by restriction analysis.
  
  
  RESULTS
  TNFalpha, sTNFR2, and insulin resistance were higher in patients than in 89 controls. TNFalpha pathway activity was correlated with LDL cholesterol, steatosis, and insulin resistance, which, in turn, was correlated with the severity of liver damage. Patients subdivided according to TNFalpha genotype significantly differed for TNFalpha release, insulin sensitivity and the prevalence of cirrhosis. The -308 and -238 TNFalpha polymorphisms, characterized by increased promoter activity, were associated with higher TNFalpha activity, insulin resistance and severity of the disease, whereas the -863 polymorphism, characterized by reduced promoter activity, with lower TNFalpha activity, and higher insulin sensitivity.
  
  
  CONCLUSIONS
  TNFalpha genotype modulates the activity of the TNFalpha pathway, influences insulin sensitivity and the severity of HCV chronic hepatitis.
authors.affiliation: Dipartimento di Medicina Interna, Ospedale Maggiore IRCCS, Università degli Studi, Pad Granelli, Via F Sforza 35, 20122 Milano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Valenti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Pulixi
authors.forename: Anna Ludovica
authors.initials: AL
authors.lastname: Fracanzani
authors.forename: Paola
authors.initials: P
authors.lastname: Dongiovanni
authors.forename: Marco
authors.initials: M
authors.lastname: Maggioni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Orsatti
authors.forename: Cristina
authors.initials: C
authors.lastname: Gianni
authors.forename: Silvia
authors.initials: S
authors.lastname: Fargion
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000503:physiopathology; D005234:Fatty Liver / Q000150:complications / Q000235:genetics; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000235:genetics / Q000503:physiopathology*; D006801:Humans; D007328:Insulin / Q000096:biosynthesis; D007333:Insulin Resistance / Q000235:genetics* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000235:genetics; D015398:Signal Transduction; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D007328:Insulin; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha