title: Retinol-binding protein 4: a promising circulating marker of liver damage in pediatric nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Noninvasive methods are needed to identify pediatric nonalcoholic fatty liver disease (NAFLD), the most frequent chronic liver disease in children and adolescents in industrialized countries. Retinol-binding protein 4 (RBP4) is an adipocytokine that has been associated with the pathogenesis of insulin resistance. We tested the serum levels of RBP4 to assess their associations with the metabolic profile and histologic features in a large well-characterized group of children with NAFLD.
  
  
  METHODS
  The study included 59 children with biopsy-proven NAFLD. Histologic analyses were performed by an experienced hepatopathologist; the NAFLD activity score and fibrosis score were calculated for each patient. RBP4 levels in serum samples were measured by an enzyme-linked immunosorbent assay analysis. Anthropometric, blood pressure, and metabolic profile analyses (including glucose tolerance, fasting glucose, insulin, and lipid panel tests) were performed on samples from all patients.
  
  
  RESULTS
  Decreasing levels of RBP4 were associated significantly with increasing levels of serum triglyceride. High levels of RBP4 were associated significantly with low necroinflammatory activity, a low NAFLD activity score, and a low fibrosis score. Furthermore, serum RBP4 levels decreased significantly as disease severity increased; there was a stepwise decrease in RBP4 from children with steatosis (3.8 mg/dL) to borderline nonalcoholic steatohepatitis (2.9 mg/dL) to definitive nonalcoholic steatohepatitis (1.9 mg/dL) (P < .0001). This association remained significant after adjusting for other relevant clinical variables.
  
  
  CONCLUSIONS
  Our study shows an inverse relationship between RBP4 levels and degree of liver damage. RBP4 therefore might be a potential novel noninvasive marker of severity of pediatric NAFLD.
authors.affiliation: Liver Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy. nobili66@yahoo.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
authors.forename: Anna
authors.initials: A
authors.lastname: Alisi
authors.forename: Simonetta
authors.initials: S
authors.lastname: Ottino
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Melania
authors.initials: M
authors.lastname: Manco
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Feldstein
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D002648:Child; D005234:Fatty Liver / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000473:pathology; D008297:Male; D055442:Metabolome; D054839:Retinol-Binding Proteins, Plasma / Q000032:analysis*; D044967:Serum / Q000737:chemistry*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C101326:RBP4 protein, human; D054839:Retinol-Binding Proteins, Plasma