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From bed to bench: Which attitude towards the laboratoryliver tests should health care practitioners strike?

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World Journal of Gastroenterology 2007年第37期13卷 4917-4923页

作者： giovanni tarantino Section of Hepatology in Internal Medicine Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of Naples Italy

There is a general consensus in re-interpreting the so-called liver function tests in the light of novel discoveries. At the same time, recent evidence favours the use of different laboratory data to assess liver damage, fibrosis or regenerative process, but this point is not always shared. Actually, balancing the need for diagnosis, prognostic evaluation and therapy response of liver disease with a good cost/benefit ratio is very difficult. New tests are probably not needed but the aim should be for better utilization of existing tests to contain the increasing cost of health care.

关键词： Laboratory liver tests ALanine aminotransferase Aspartate aminotransferase Quantitative testing of liver function Alcoholic liver disease Non-alcoholicsteatohepatitis Hepatitis C virus

Pathogenesis of hepatic steatosis:The link between hypercortisolism and non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2013年第40期19卷 6735-6743页

作者： giovanni tarantino Carmine Finelli Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples80131 NaplesItaly INT "Fondazione Pascale" Cancer Research Center of Mercogliano83013 Mercogliano (AV)Italy Center of Obesity and Eating Disorder Stella Maris Mediterraneum FoundationContrada Santa Lucia 80035ChiaromontePotenzaItaly

Based on the available literature,non alcoholic fatty liver disease or generally speaking,hepatic steatosis,is more frequent among people with diabetes and obesity,and is almost universally present amongst morbidly obese diabetic *** alcoholic fatty liver disease is being increasingly recognized as a common liver condition in the developed world,with non alcoholic steatohepatitis projected to be the leading cause of liver *** data report that only 20%of patients with Cushing’s syndrome have hepatic *** at clarifying the reasons whereby patients suffering from Cushing’s syndrome-a condition characterized by profound metabolic changes-present low prevalence of hepatic steatosis,the Authors reviewed the current concepts on the link between hypercortisolism and obesity/metabolic *** hypothesize that this low prevalence of fat accumulation in the liver of patients with Cushing’s syndrome could result from the inhibition of the so-called low-grade chronicinflammation,mainly mediated by Interleukin 6,due to an excess of cortisol,a hormone characterized by an anti-inflammatory *** Cushing’s syndrome,speculatively considered as an in vivo model of the hepatic steatosis,could also help clarify the mechanisms of non alcoholic fatty liver disease.

关键词： Nonalcoholic fatty liver disease Cushing’s syndrome Hypercotisolism

What is the role of adiponectin in obesity related non-alcoholic fatty liver disease?

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World Journal of Gastroenterology 2013年第6期19卷 802-812页

作者： Carmine Finelli giovanni tarantino Center of Obesity and Eating Disorder Stella Maris Mediterraneum Foundation Department of Clinical and Experimental Medicine Federico ⅡUniversity Medical School of Naples

Non-alcoholic fatty liver disease (NAFLD) is recognized as the most common type of chronic liver disease in Western *** resistance is a key factor in the pathogenesis of NAFLD,the latter being considered as the hepatic component of insulin resistance or *** is the most abundant adipose-specific *** is evidence that adiponectin decreases hepatic and systematic insulin resistance,and attenuates liver inflammation and *** generally predicts steatosis grade and the severity of NAFLD;however,to what extent this is a direct effect or related to the presence of more severe insulin resistance or obesity remains to be *** there is no proven pharmacotherapy for the treatment of NAFLD,recent therapeutic strategies have focused on the indirect upregulation of adiponectin through the administration of various therapeutic agents and/or lifestyle *** this adiponectin-focused review,the pathogenetic role and the potential therapeutic benefits of adiponectin in NAFLD are analyzed systematically.

关键词： Non-alcoholic fatty liver disease Obesity Adiponectin Visceral fat Adipokines

Could metabolic syndrome lead to hepatocarcinoma via non-alcoholic fatty liver disease?

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World Journal of Gastroenterology 2014年第28期20卷 9217-9228页

作者： Antonella Scalerar giovanni tarantino Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples National Cancer Institute "Pascale Foundation"IRCS

It was estimated that from 2002 to 2008 the risk of developing cancer increased a quarter-fold in men and two-fold in women due to excessive BMI. Obesity, metabolic syndrome and type 2 diabetes mellitus are strictly related and are key pathogenetic factors of non-alcoholic fatty liver disease (NAFLD), the most frequent liver disease worldwide. The most important consequence of the “metabolic epidemics” is the probable rise in the incidence of hepatocarcinoma (HCC), and NAFLD is the major causative factor. Adipose tissue is not merely a storage organ where lipids are preserved as an energy source. It is an active organ with important endocrine, paracrine, and autocrine actions in addition to immune functions. Adipocytes produce a wide range of hormones, cytokines, and growth factors that can act locally in the adipose tissue microenvironment and systemically. In this article, the main roles of insulin growth factor (IGF)-1 and IGF-2 are discussed. The role of IGF-2 is not only confined to HCC, but it may also act in early hepato-carcinogenesis, as pre-neoplastic lesions express IGF-2 mRNA. IGF-1 and IGF-2 interact with specific receptors (IGF-1R and IGF-2R). IGF-1R is over-expressed in in vitro and in animal models of HCC and it was demonstrated that IGF ligands exerted their effects on HCC cells through IGF-1R and that it was involved in the degeneration of pre-neoplastic lesions via an increase in their mitotic activity. Both IGF-2R and TGF β, a growth inhibitor, levels are reduced in human HCC compared with adjacent normal liver tissues. Another key mechanism involves peroxisome proliferator-activated receptor (PPAR)γ. In in vitro studies, PPARγ inhibited various carcinomas including HCC, most probably by regulating apoptosis via the p21, p53 and p27 pathways. Finally, as a clinical consequence, to improve survival, efforts to achieve a “healthier diet” should be promoted by physicians and politicians.

关键词： Hepatocarcinoma Non-alcoholic fatty liver disease Insulin growth factor Peroxisome proliferatoractivated receptor γ Adipokines

What about non-alcoholic fatty liver disease as a new criterion to define metabolic syndrome?

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World Journal of Gastroenterology 2013年第22期19卷 3375-3384页

作者： giovanni tarantino Carmine Finelli Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples 80131 Naples Italy Fondazione Pascale Cancer Research Center of Mercogliano 83013 Mercogliano Italy Center of Obesity and Eating Disorders Stella Maris Mediterraneum Foundation Chiaromonte 80035 Potenza Italy

Non-alcoholic fatty liver disease (NAFLD) is currently not a component of the diagnostic criteria for metabolic syndrome (MetS); however, the development of NAFLD has some common mechanisms with the development of MetS, as they share the pathophysiologic basis of insulin resistance. It is also recognized that NAFLD is the hepatic manifestation of MetS. To define MetS, the presence of at least three of the proposed criteria is required, and sometimes it is sufficient to have only one laboratory value, modified by diet or drugs, for the classification of MetS. Ultrasonographically-detected NAFLD (US-NAFLD) is more stable, only changing during the middleto long-term. Although controversies over MetS continue, and considering that abdominal ultrasonography for diagnosing NAFLD has high specificity and guidelines to modify the natural course of NAFLD by diet composition or lifestyle have not yet been established, why should we not introduce US-NAFLD as a new criterion to define MetS?

关键词： Non-alcoholic fatty liver disease Metabolic syndrome Nonalcoholic steatohepatitis Ultrasonography Criteria

Liver-spleen axis: Intersection between immunity, infections and metabolism

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World Journal of Gastroenterology 2013年第23期19卷 3534-3542页

作者： giovanni tarantino Antonella Scalera Carmine Finelli Department of Clinica Medicine and Surgery Federico II University Medical School of Naples80131 Naples Italy INT "Fondazione Pascale" Cancer Research Center of Mercogliano83013 Mercogliano (Av) Italy Center of Obesity and Eating Disorders Stella Maris Mediterraneum Foundation80035 Potenza Italy

Spleen has been considered a neglected organ so far, even though is strictly linked to liver. The spleen plays an important role in the modulation of the immune system and in the maintenance of peripheral tolerance via the clearance of circulating apoptotic cells, the differentiation and activation of T and B cells and production of antibodies in the white pulp. Moreover, splenic macrophages are able to remove bacteria from the blood and protect from sepsis during systemic infections. We review the spleen function and its assessment in humans starting from the description of spleen diseases, ranging from the congenital asplenia to secondary hyposplenism. From the literature data it is clear that obesity in humans affects different compartments of immune system, even thought there are still few data available on the implicated mechamisms. The intent is to enable clinicians to evaluate the newly recognized role of metabolic and endocrine functions of the spleen with special emphasis to obesity and nonalcoholic fatty liver disease in the context of the available ***, understanding the spleen function could be important to develop appropriate prevention strategies in order to counteract the pandemia of obesity. In this direction, we suggest spleen longitudinal diameter at ultrasonography, as simple, cheap and largely available tool, be used as new marker for assessing splenic function, in the context of the so-called liver-spleen axis.

关键词： Spleen size Obesity Non-alcoholic fatty liver disease

Exposure to ambient air particulate matter and non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2013年第25期19卷 3951-3956页

作者： giovanni tarantino Domenico Capone Carmine Finelli Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples INT "Fondazione Pascale" - Cancer Research Center of Mercogliano Unit of Clinical Pharmacology Department of Neuroscience Federico Ⅱ University Medical School of Naples Center of Obesity and Eating Disorders Stella Maris Mediterraneum Foundation C/da S. Lucia Chiaromonte

The present study was designed to alert the public opinion and policy makers on the supposed enhancing effects of exposure to ambient air particulate matter with aerodynamic diameters < 2.5 mm (PM 2.5 ) on non-alcoholic fatty liver disease (NAFLD), the most common chronic liver disease in Western countries. For far too long literature data have been fixated on pulmonary diseases and/or cardiovascular disease, as consequence of particulate exposure, ignoring the link between the explosion of obesity with related syndromes such as NAFLD and air pollution, the worst characteristics of nowadays civilization. In order to delineate a clear picture of this major health problem, further studies should investigate whether and at what extent cigarette smoking and exposure to ambient air PM 2.5 impact the natural history of patients with obesity-related NAFLD,i.e. , development of non alcoholic steatohepatitis, disease characterized by a worse prognosis due its progression towards fibrosis and hepatocarcinoma.

关键词： Non-alcoholic fatty liver disease Particulate matter with aerodynamic diameters < 2.5 μm Cytochrome P-450 Reactive oxygen species

What does irritable bowel syndrome share with non-alcoholic fatty liver disease?

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World Journal of Gastroenterology 2013年第33期19卷 5402-5420页

作者： Antonella Scalera Matteo Nicola Dario Di Minno giovanni tarantino Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples INT "Fondazione Pascale" - Cancer Research Center of Mercogliano

Non-alcoholic fatty liver disease(NAFLD)and irritable bowel syndrome(IBS)are two very common diseases in the general *** date,there are no studies that highlight a direct link between NAFLD and IBS,but some recent reports have found an interesting correlation between obesity and IBS.A systematic PubMed database search was conducted highlighting that common mechanisms are involved in many of the local and systemic manifestations of NAFLD,leading to an increased cardiovascular risk,and IBS,leading to microbial dysbiosis,impaired intestinal barrier and altered intestinal *** is not known when considering local and systemic inflammation/immune system activation,which one has greater importance in NAFLD and IBS ***,the nervous system is *** fact,inflammation participates in the development of mood disorders,such as anxiety and depression,characteristics of obesity and consequently of NAFLD and,on the other hand,in intestinal hypersensitivity and dysmotility.

关键词： Non-alcoholic fatty liver disease Irritable bowel syndrome Low grade chronic inflammation Cytokines

High prevalence of nonalcoholic fatty liver in patients with idiopathic venous thromboembolism

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World Journal of Gastroenterology 2010年第48期16卷 6119-6122页

作者： Matteo Nicola Dario Di Minno Antonella Tufano Anna Rusolillo giovanni Di Minno giovanni tarantino Department of Clinical and Experimental Medicine Federico II University Medical School of Naples

AIM:To assess the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with idiopathic venous thromboembolism (VTE). METHODS:In a case-control study,after excluding subjects with well-consolidated risk factors for VTE,idiopathic VTE was documented in 138 consecutive patients who were referred to our department. Two hundred and seventy-six healthy sex/age/body-massindex-matched subjects,without any clinical/instrumental evidence of VTE,served as controls. All underwent a clinical/laboratory/ultrasound assessment for the presence of metabolic syndrome and NAFLD. RESULTS:NAFLD was detected in 112/138 cases (81%) and in 84/276 controls (30%) [risk ratio:2.7,95% confidence interval (CI):2.2-3.2,P < 0.0001]. Metabolic syndrome and smoking habit were more prevalent in patients with idiopathic VTE. The high prevalence of NAFLD in VTE was also confirmed after adjustment for inherited thrombophilia. NAFLD was clearly predicted by VTE (odds ratio:1.8,95% CI:1.2-2.7,P < 0.0001).

关键词： Thromboembolism Metabolic syndrome Nonalcoholic fatty liver disease