Looking for clues to dangerous fatty liver disease

June 26, 2017 by Naseem S. Miller, Orlando Sentinel

In his lab in Lake Nona, Dr. Peter Crawford has been studying nonalcoholic fatty liver disease, a condition that's closely linked to obesity and Type 2 diabetes.

He is using cutting edge metabolic and genetic tools to try to figure out how and why nonalcoholic fatty disease, or "fatty liver," progresses into a more severe form, putting the patients at a higher risk of developing cirrhosis and .

"It's a real scare, and it's directly linked to the obesity epidemic," said Crawford, a physician and research scientist at Sanford Burnham Prebys Medical Discovery Institute.

In nonalcoholic fatty liver disease, retain fat. The condition has a strong association with developing cardiovascular disease. In a small portion of individuals it can progress to the point that they need a transplant or get cancer.

The disease began making its mark on medical charts not long after obesity became an epidemic in the 1980s.

Its cause is not exactly known, but it is strongly linked to diabetes, obesity and high cholesterol, making it the most common liver disorder in Western industrialized countries. By 2030 the condition will be the most common reason for in the United States, according to a 2014 study by researchers at the Cleveland Clinic.

Meanwhile, most patients who have fatty liver aren't aware of it, and the condition can evade primary care providers too, because it usually doesn't affect the results of routine blood work. For those who are eventually diagnosed - usually after the disease progresses to its more severe form - there are currently no drugs available.

"When you combine the fact that the natural history of the disease is unclear; it's difficulty to diagnose, treat and stage it; and there's no FDA-approved medicine, it becomes a huge issue," said Dr. Jaideep Behari, associate professor of medicine at the University of Pittsburgh and director of Fatty Liver Clinic.

The issue is more pronounced in states like Florida, where more than a quarter of the population is obese, and as a result more likely to have type 2 diabetes.

For local doctors, who continue to see liver disease cases related to hepatitis infections and alcohol abuse, fatty liver is a rapidly growing third category.

"It's becoming an epidemic," said Dr. Nasim Ahmed, a gastroenterologist at Gastroenterology Consultants CFL in Orlando

At Digestive and Liver Center of Florida, one of the large local independent practices, the proportion of patients who have liver disease because of alcohol, hepatitis and obesity is almost equal these days, said Dr. Srinivas Seela, one of the practice's founding partners.

"It's frustrating that these patients have no medical treatment," said Dr. Harinath Sheela, a Seela's partner and brother.

About 10 percent to 15 percent of the patients develop the more severe condition called nonalcoholic steatohepatitis, or NASH, but it's not yet known which patients are more likely to fall in this category, adding to doctors' frustration.

For now, the standard treatment is lifestyle change. Patients are advised to lose weight and get their diabetes under control, although not all patients follow the advice.

But there's hope, because fatty liver has become an active area of research.

At least 200 drugs targeting the conditions are currently in clinical trials and a handful are in the advanced stages of research. The National Institute of Diabetes and Digestive and Kidney Disease has created a nationwide clinical research network to conduct studies for preventing and treating the disease.

"So it's possible that there will be a therapies within the next three to five years that will decrease the rates (of the disease)," said Behari of the University of Pittsburgh.

He was also encouraged by Crawford's research.

Crawford's recent findings from animal studies has amplified the silent dialogue between liver cells and their neighboring immune cells, showing that when certain fuels produced by the liver cells are off balance, the immune cells in the liver go rogue and cause scarring and worsening of fatty liver disease.

"That's a very exciting finding," said Behari, who's not involved in the research. "Anything that helps us open up that black box and understand the at the molecular level is a big deal."

Crawford, who's in the process of publishing the results of his most recent study, hopes the findings would pave the way toward developing a drug and help identify who are at a higher risk of developing severe forms of nonalcoholic .

He added that the findings also reiterate another important point.

"One way to look at it is that even in one strict cell type, having a balanced nutrition is important," Crawford said.

Explore further: Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis


Related Stories

Family of patients with NAFLD and cirrhosis are at increased risk of liver fibrosis

June 19, 2017
Non-alcoholic fatty liver disease (NAFLD) is a common disorder characterized by abnormal accumulation of fat in the liver. NAFLD is diagnosed in up to one in three adults and one in 10 children in the United States, and obesity ...

Both low and high birth weight linked to fatty liver disease in children

April 19, 2017
A study published in the Journal of Pediatrics suggests that children born with lower or higher weight than normal may be at increased risk for developing nonalcoholic fatty liver disease (NAFLD). These children also were ...

Inflammatory signature of nonalcoholic fatty liver disease

May 16, 2017
A team of investigators led by Rohit Kohli, MBBS, MS, of Children's Hospital Los Angeles, has identified key inflammatory cells involved in nonalcoholic fatty liver disease. Current treatment for the disorder involves changes ...

Fatty liver disease contributes to cardiovascular disease and vice versa

November 10, 2016
For the first time, researchers have shown that a bi-directional relationship exists between fatty liver disease and cardiovascular disease. Fatty liver disease can lead to increased cardiovascular disease risk and vice versa.

Cellular stress in the brain may contribute to non-alcoholic fatty liver disease

May 25, 2017
Disruptions in a protein folding process occurring in the brain, known as endoplasmic reticulum (ER) stress, may cause non-alcoholic fatty liver disease, independent of other factors. A research team at the George Washington ...

Unveiling the biology behind nonalcoholic fatty liver disease

January 17, 2017
EPFL scientists have discovered a new biological mechanism behind nonalcoholic fatty liver disease.

Recommended for you

Two Group A Streptococcus genes linked to 'flesh-eating' bacterial infections

September 22, 2017
Group A Streptococcus bacteria cause a variety of illnesses that range from mild nuisances like strep throat to life-threatening conditions including pneumonia, toxic shock syndrome and the flesh-eating disease formally known ...

Ecosystem approach makes urinary tract infection more treatable

September 22, 2017
The biological term 'ecosystem' is not usually associated with urinary tract infections, but this should change according to Wageningen scientists.

Residents: Frontline defenders against antibiotic resistance?

September 22, 2017
Antibiotic resistance continues to grow around the world, with sometimes disastrous results. Some strains of bacteria no longer respond to any currently available antibiotic, making death by infections that were once easily ...

Individualized diets for irritable bowel syndrome better than placebo

September 21, 2017
Patients with irritable bowel syndrome who follow individualized diets based on food sensitivity testing experience fewer symptoms, say Yale researchers. Their study is among the first to provide scientific evidence for this ...

Superbug's spread to Vietnam threatens malaria control

September 21, 2017
A highly drug resistant malaria 'superbug' from western Cambodia is now present in southern Vietnam, leading to alarming failure rates for dihydroartemisinin (DHA)-piperaquine—Vietnam's national first-line malaria treatment, ...

Investigators may unlock mystery of how staph cells dodge the body's immune system

September 21, 2017
For years, medical investigators have tried and failed to develop vaccines for a type of staph bacteria associated with the deadly superbug MRSA. But a new study by Cedars-Sinai investigators shows how staph cells evade the ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.