Molecular determinants of insulin resistance, cell apoptosis and lipid accumulation in non-alcoholic steatohepatitis.
OBJECTIVE
Non-alcoholic-steatohepatitis (NASH) is closely related to insulin resistance, but it is unknown whether insulin resistance may be localized in hepatocytes. This study investigates insulin signalling in liver tissue from NASH, and the molecular mechanisms by which insulin-resistance could lead to liver damage (apoptosis). Moreover, to investigate the mechanisms of lipid overload we studied key enzymes in hepatocytes lipid metabolism.


RESULTS
In liver specimens from 11 patients with NASH and 7 histological normal livers, we measured total and phosphorylated Akt (active form), Bax and Bcl-2 by Western-blot analysis. In addition, we studied AMP-activated protein Kinase and Carnitine-Palmitoyl-Transferase-1 gene expression, key regulators of non-esterified fatty acid synthesis and oxidation, by reverse transcription polymerase chain reaction. In NASH, phosphorylated Akt was impaired (104.3+/-10.6 vs 152.6+/-22.4 AU, p<0.002) and correlated with necroinflammatory score (r=-0.62; p<0.05). Bax/Bcl-2 ratio was increased in NASH. Moreover, we observed a decrease of AMP-activated protein Kinase (10.74+/-6 vs 144.7+/-41.6 AU, p<0.0001) and Carnitine-Palmitoyl-Transferase-1 gene expression (38.7+/-14.6 vs 192.1+/-26.2 AU, p<0.0001), and both were correlated with steatosis score (r=-0.56, p<0.05, r=-0.87, p<0.05 respectively).


CONCLUSIONS
Akt, a key molecule of insulin signalling and cell apoptosis is impaired in NASH, suggesting an important role of hepatic insulin resistance in liver failure. Moreover, decreased non-esterified fatty acid oxidation may cause hepatic lipid overload.
Piro
S
S
Clinica di Medicina Interna, Dipartimento di Medicina Interna e Medicina Specialistica, Università degli Studi di Catania, Ospedale Garibaldi Nesima, Via Palermo, 636, 95122 Catania, Italy.
Spadaro
L
L
Russello
M
M
Spampinato
D
D
Oliveri
C E
CE
Vasquez
E
E
Benigno
R
R
Brancato
F
F
Purrello
F
F
Rabuazzo
A M
AM
D000328:Adult; D017209:Apoptosis / Q000235:genetics*; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002334:Carnitine O-Palmitoyltransferase / Q000235:genetics; D005234:Fatty Liver / Q000235:genetics* / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000235:genetics / Q000473:pathology; D007333:Insulin Resistance / Q000235:genetics*; D008055:Lipids / Q000502:physiology*; D008099:Liver / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012016:Reference Values
D001786:Blood Glucose; D008055:Lipids; D002334:Carnitine O-Palmitoyltransferase