publicado em 01/06/2012 às 16h37:00
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Noninvasive test detects fatty liver disease with 94% accuracy

Currently, diagnosis of the condition is performed and requires histological liver biopsy, an invasive procedure error prone

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CIC bioGUNE researchers, in collaboration with OWL, CIBERehd and eleven hospitals and research centres from Spain, France and the USA, have developed the first metabolome-based serum test for the n

NAFLD is a progressive disease evolving from a simple accumulation of fat (steatosis) to non-alcoholic steatohepatitis or NASH (inflammation around the fat). Non-alcoholic fatty liver disease is the most common hepatic illness in Europe and the United States, and its prevalence is on the increase in many other parts of the world such as Asia and India.

In the West, the prevalence of steatosis and of NASH amongst adults is around 30% and 3% respectively. NASH is the most serious stage of NAFLD, as some 20% of patients with NASH develop cirrhosis after 10 years, and more than a quarter of these patients end up with hepatocellular carcinoma or CHC (liver cancer) within a period of approximately 10 years.

Currently diagnosis for NASH is undertaken histologically and requires a precise liver biopsy. Hepatic biopsy is an invasive procedure as a result of which complications may arise (risk of death near 0.01%) and is prone to sampling errors. Diagnostic imaging techniques such as RMI or ultrasound, apart from the liver biopsy, measures fat, although it cannot distinguish between a simple steatosis and NASH. Given these limitations of liver biopsy and diagnostic imaging techniques, patients with NAFLD can benefit from the non-invasive, metabolome-based method proposed for the prediction of NASH.

The research, undertaken between 2009 and 2011, analysed 467 biopsied patients, 90 of which had a normal histology while, of those diagnosed with NAFLD, 246 had steatosis and 131 NASH. An analysis of 700 serum metabolites was subsequently undertaken (including aminoacids, glycerolipids, phospholipids, sphingolipids, fatty acids, acylcarnitines and biliar acids) by means of a technique known as ultra-performance liquid chromatography mass spectrometry (UPLC-MS).

According to the director of bioGUNE, Mr. José María Mato, "the analysis of this great quantity of metabolomic information revealed that the metabolic footprint of NAFLD depends on the body mass index or BMI of patients, indicating that the pathogenic mechanism of NAFLD can vary depending on the degree of obesity of the individual".

The BMI is the index that measures the weight of a person in relation to his or her height, dividing their weight in kilos by the square of their height in metres. Anything above 30 is considered overweight and increases the risk of developing the fatty liver condition.

According to Mr. Mato, " metabolomics is set to enable the early diagnosis of complex diseases, such as liver, cardiovascular and neurodegenerative illnesses, and will also be used to monitor response to treatment, i.e. to distinguish at an early stage between those responding to a given treatment and those who do not, as well as rapidly diagnosing those patients who may have an adverse reaction to the pharmaceutical drugs administered" .

To this end, in this project to develop the first non-invasive diagnostic test, a multivariant model was generated, stratified on the basis of the BMI, and based on NAFLD serum metabolic footprint in order to distinguish between patients with and without NASH. This metabolomic-based diagnostic test for NASH, already being marketed by the Basque OWL company under the owlliver brand, correctly typifies NASH in 94% of patients.

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fatty liver disease    NAFLD    non-invasive test    Center for Cooperative Research in Biosciences    José María Mato   
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