The prevalence of obesity around the world is booming. Consequently, obesity-associated comorbid diseases, such as non-alcoholic steatohepatitis are also escalating. NASH can progress to cirrhosis and the need for liver transplantation. Thus, many researchers have sought ways to reduce the occurrence of NASH. Recent work from the Mayo Clinic has been promising. Dr. Baskin-Bey and colleagues have ameliorated steatosis, liver inflammation and injury in an animal model of NASH by the induction of key enzymes of fatty acid oxidation.
Currently, the etiopathogenesis of NASH remains to be defined. In hepatic steatosis, an excess of non-esterified fatty acids are released from peripheral tissues into the serum. These excess serum-free fatty acids are discharged by the liver, where they are esterified and accumulate as neutral fat, secondary to a limited capacity to oxidize excess fatty acids. A potential strategy to protect the liver from hepatic steatosis would involve mechanisms to enhance hepatic fatty acid oxidation. Hepatic fatty acid oxidation occurs by three pathways: beta-oxidation is the predominant pathway; peroxisomal beta-oxidation occurs within peroxisomes and is rate-limited by the peroxisomal L-bifunctional enzyme (L-PBE), acetyl-COA oxidase (ACO) and urate oxidase (UO); the third pathway is omega-oxidation, which occurs in the endoplasmic reticulum. This pathway is dependent upon expression of the cytochrome enzymes CYPA410 and CYP4A14. Stimulation of these pathways either individually or collectively could help remove excess free fatty acids from the liver and diminish the occurrence of NASH.