1 6441 109 THERAPEUTIC APPROACHES FOR NONALCOHOLIC FATTY LIVER DISEASE: ESTABLISHED TARGETS AND DRUGS. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD), AS A MULTISYSTEMIC DISEASE, IS THE MOST PREVALENT CHRONIC LIVER DISEASE CHARACTERIZED BY EXTREMELY COMPLEX PATHOGENIC MECHANISMS AND MULTIFACTORIAL ETIOLOGY, WHICH OFTEN DEVELOPS AS A CONSEQUENCE OF OBESITY, METABOLIC SYNDROME. PATHOPHYSIOLOGICAL MECHANISMS INVOLVED IN THE DEVELOPMENT OF NAFLD INCLUDE DIET, OBESITY, INSULIN RESISTANCE (IR), GENETIC AND EPIGENETIC DETERMINANTS, INTESTINAL DYSBIOSIS, OXIDATIVE/NITROSATIVE STRESS, AUTOPHAGY DYSREGULATION, HEPATIC INFLAMMATION, GUT-LIVER AXIS, GUT MICROBES, IMPAIRED MITOCHONDRIAL METABOLISM AND REGULATION OF HEPATIC LIPID METABOLISM. SOME OF THE NEW DRUGS FOR THE TREATMENT OF NAFLD ARE INTRODUCED HERE. ALL OF THEM ACHIEVE THERAPEUTIC OBJECTIVES BY INTERFERING WITH CERTAIN PATHOPHYSIOLOGICAL PATHWAYS OF NAFLD, INCLUDING FIBROBLAST GROWTH FACTORS (FGF) ANALOGUES, PEROXISOME PROLIFERATOR-ACTIVATED RECEPTORS (PPARS) AGONISTS, GLUCAGON-LIKE PEPTIDE-1 (GLP-1) AGONISTS, G PROTEIN-COUPLED RECEPTORS (GPCRS), SODIUM-GLUCOSE COTRANSPORTER-2 INHIBITORS (SGLT-2I), FARNESOID X RECEPTOR (FXR), FATTY ACID SYNTHASE INHIBITOR (FASNI), ANTIOXIDANTS, ETC. THIS REVIEW DESCRIBES SOME PATHOPHYSIOLOGICAL MECHANISMS OF NAFLD AND ESTABLISHED TARGETS AND DRUGS. 2023 2 2795 45 FATTY LIVER AND CHRONIC KIDNEY DISEASE: NOVEL MECHANISTIC INSIGHTS AND THERAPEUTIC OPPORTUNITIES. CHRONIC KIDNEY DISEASE (CKD) IS A RISK FACTOR FOR END-STAGE RENAL DISEASE (ESRD) AND CARDIOVASCULAR DISEASE (CVD). ESRD OR CVD DEVELOP IN A SUBSTANTIAL PROPORTION OF PATIENTS WITH CKD RECEIVING STANDARD-OF-CARE THERAPY, AND MORTALITY IN CKD REMAINS UNCHANGED. THESE DATA SUGGEST THAT KEY PATHOGENETIC MECHANISMS UNDERLYING CKD PROGRESSION GO UNAFFECTED BY CURRENT TREATMENTS. GROWING EVIDENCE SUGGESTS THAT NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND CKD SHARE COMMON PATHOGENETIC MECHANISMS AND POTENTIAL THERAPEUTIC TARGETS. COMMON NUTRITIONAL CONDITIONS PREDISPOSING TO BOTH NAFLD AND CKD INCLUDE EXCESSIVE FRUCTOSE INTAKE AND VITAMIN D DEFICIENCY. MODULATION OF NUCLEAR TRANSCRIPTION FACTORS REGULATING KEY PATHWAYS OF LIPID METABOLISM, INFLAMMATION, AND FIBROSIS, INCLUDING PEROXISOME PROLIFERATOR-ACTIVATED RECEPTORS AND FARNESOID X RECEPTOR, IS ADVANCING TO STAGE III CLINICAL DEVELOPMENT. THE RELEVANCE OF EPIGENETIC REGULATION IN THE PATHOGENESIS OF NAFLD AND CKD IS ALSO EMERGING, AND MODULATION OF MICRORNA21 IS A PROMISING THERAPEUTIC TARGET. ALTHOUGH SINGLE ANTIOXIDANT SUPPLEMENTATION HAS YIELDED VARIABLE RESULTS, MODULATION OF KEY EFFECTORS OF REDOX REGULATION AND MOLECULAR SENSORS OF INTRACELLULAR ENERGY, NUTRIENT, OR OXYGEN STATUS SHOW PROMISING PRECLINICAL RESULTS. OTHER EMERGING THERAPEUTIC APPROACHES TARGET KEY MEDIATORS OF INFLAMMATION, SUCH AS CHEMOKINES; FIBROGENESIS, SUCH AS GALECTIN-3; OR GUT DYSFUNCTION THROUGH GUT MICROBIOTA MANIPULATION AND INCRETIN-BASED THERAPIES. FURTHERMORE, NAFLD PER SE AFFECTS CKD THROUGH LIPOPROTEIN METABOLISM AND HEPATOKINE SECRETION, AND CONVERSELY, TARGETING THE RENAL TUBULE BY SODIUM-GLUCOSE COTRANSPORTER 2 INHIBITORS CAN IMPROVE BOTH CKD AND NAFLD. IMPLICATIONS FOR THE TREATMENT OF NAFLD AND CKD ARE DISCUSSED IN LIGHT OF THIS NEW THERAPEUTIC ARMAMENTARIUM. 2016 3 1721 38 DYSREGULATION OF AUTOPHAGY ACTS AS A PATHOGENIC MECHANISM OF NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) INDUCED BY COMMON ENVIRONMENTAL POLLUTANTS. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) HAS BEEN THE MOST COMMON CHRONIC LIVER DISEASE IN THE WORLD, INCLUDING THE DEVELOPING COUNTRIES. NAFLD IS METABOLIC DISEASE WITH SIGNIFICANT LIPID DEPOSITION IN THE HEPATOCYTES OF THE LIVER, WHICH IS USUALLY ASSOCIATED WITH OXIDATIVE STRESS, INFLAMMATION AND FIBROGENESIS, AND INSULIN RESISTANCE. PROGRESSIVE NAFLD CAN DEVELOP INTO NON-ALCOHOLIC STEATOHEPATITIS (NASH) OR HEPATOCELLULAR CARCINOMA. THE CURRENT EVIDENCE PROPOSES THAT ENVIRONMENTAL POLLUTANTS PROMOTE DEVELOPMENT AND PROGRESSION OF NAFLD, AND AUTOPHAGY PLAYS A VITAL ROLE BUT IS MULTIFACTORIAL AFFECTED IN NAFLD. IN THIS REVIEW, WE ANALYZED ON THE REGULATIONS OF COMMON ENVIRONMENTAL POLLUTANTS ON AUTOPHAGY IN NAFLD. TO CLARIFY THE INVOLVED ROLES OF AUTOPHAGY, WE DISCUSSED THE DYSREGULATION OF AUTOPHAGY BY ENVIRONMENTAL POLLUTANTS IN ADIPOSE TISSUE AND GUT, AND THEIR INTERACTIONS WITH LIVER, AS WELL AS EPIGENETIC REGULATION ON AUTOPHAGY BY ENVIRONMENTAL POLLUTANTS. FURTHERMORE, PROTECTIVE ROLES OF POTENTIAL THERAPEUTIC TREATMENTS ON THE MULTIPLE-HITS OF AUTOPHAGY IN NAFLD WERE DESCRIPTED. 2021 4 4326 36 MICRORNAS IN THE PATHOGENESIS OF NONALCOHOLIC FATTY LIVER DISEASE. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD), OR, MORE ACCURATELY, METABOLIC ASSOCIATED FATTY LIVER DISEASE, ACCOUNTS FOR A LARGE PROPORTION OF CHRONIC LIVER DISORDERS WORLDWIDE AND IS CLOSELY ASSOCIATED WITH OTHER CONDITIONS SUCH AS CARDIOVASCULAR DISEASE, OBESITY, AND TYPE 2 DIABETES MELLITUS. NAFLD RANGES FROM SIMPLE STEATOSIS TO NONALCOHOLIC STEATOHEPATITIS (NASH) AND CAN PROGRESS TO CIRRHOSIS AND, EVENTUALLY, ALSO HEPATOCELLULAR CARCINOMA. THE MORBIDITY AND MORTALITY ASSOCIATED WITH NAFLD ARE INCREASING RAPIDLY YEAR ON YEAR. CONSEQUENTLY, THERE IS AN URGENT NEED TO UNDERSTAND THE ETIOLOGY AND PATHOGENESIS OF NAFLD AND IDENTIFY EFFECTIVE THERAPEUTIC TARGETS. MICRORNAS (MIRNAS), IMPORTANT EPIGENETIC FACTORS, HAVE RECENTLY BEEN PROPOSED TO PARTICIPATE IN NAFLD PATHOGENESIS. HERE, WE REVIEW THE ROLES OF MIRNAS IN LIPID METABOLISM, INFLAMMATION, APOPTOSIS, FIBROSIS, HEPATIC STELLATE CELL ACTIVATION, INSULIN RESISTANCE, AND OXIDATIVE STRESS, KEY FACTORS THAT CONTRIBUTE TO THE OCCURRENCE AND PROGRESSION OF NAFLD. ADDITIONALLY, WE SUMMARIZE THE ROLE OF MIRNA-ENRICHED EXTRACELLULAR VESICLES IN NAFLD. THESE MIRNAS MAY COMPRISE SUITABLE THERAPEUTIC TARGETS FOR THE TREATMENT OF THIS CONDITION. 2021 5 5079 35 PHYSIOPATHOLOGY OF NONALCOHOLIC FATTY LIVER DISEASE: FROM DIET TO NUTRIGENOMICS. PURPOSE OF REVIEW: NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS THE MOST COMMON CAUSE OF CHRONIC LIVER DISEASE WORLDWIDE AND IS STRONGLY ASSOCIATED WITH METABOLIC DISORDERS, SUCH AS OBESITY, TYPE 2 DIABETES MELLITUS, AND METABOLIC SYNDROME, TO THE EXTENT THAT A NEW DEFINITION OF METABOLIC ASSOCIATED FATTY LIVER DISEASE HAS BEEN PROPOSED. RECENT FINDINGS: INSULIN RESISTANCE, WORSENED BY A HIGH-FAT AND HIGH-CARBOHYDRATE DIET, IS THE KEY TO THE PHYSIOPATHOLOGY OF HEPATIC STEATOSIS. THIS IS DRIVEN BY SEVERAL MECHANISMS THAT ARE MOSTLY ACTIVATED AT A GENETIC LEVEL, SUCH AS DE-NOVO LIPOGENESIS AND TRIGLYCERIDE SYNTHESIS. THEREFORE, MANY DIET REGIMENS HAVE BEEN STUDIED, ALTHOUGH SIGNIFICANT CONTROVERSIES REMAIN REGARDING THEIR METABOLIC EFFECTS AND LONG-TERM SUSTAINABILITY. SUMMARY: IN THIS REVIEW, WE SUMMARIZED THE ROLE AND EFFECTS OF THE MAIN MACRONUTRIENTS ON THE DEVELOPMENT OF NAFLD AND DISCUSSED THE MOLECULAR MECHANISMS INVOLVED. WE ALSO DISCUSSED THE IMPORTANCE OF GENETIC POLYMORPHISMS, EPIGENETIC ALTERATIONS, AND DYSBIOSIS TO DETERMINE IF LIFESTYLE MODIFICATION AND A SPECIFIC DIETARY REGIMEN COULD BE AN ESSENTIAL PART OF NAFLD TREATMENT. 2022 6 4314 32 MICRORNAS AS CONTROLLED SYSTEMS AND CONTROLLERS IN NON-ALCOHOLIC FATTY LIVER DISEASE. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS A MULTI-FACETED CONDITION INCLUDING SIMPLE STEATOSIS ALONE OR ASSOCIATED WITH INFLAMMATION AND BALLOONING (NON-ALCOHOLIC STEATOHEPATITIS) AND EVENTUALLY FIBROSIS. THE NAFLD INCIDENCE HAS INCREASED OVER THE LAST TWENTY YEARS BECOMING THE MOST FREQUENT CHRONIC LIVER DISEASE IN INDUSTRIALIZED COUNTRIES. OBESITY, VISCERAL ADIPOSITY, INSULIN RESISTANCE, AND MANY OTHER DISORDERS THAT CHARACTERIZE METABOLIC SYNDROME ARE THE MAJOR PREDISPOSING RISK FACTORS FOR NAFLD. FURTHERMORE, DIFFERENT FACTORS, INCLUDING GENETIC BACKGROUND, EPIGENETIC MECHANISMS AND ENVIRONMENTAL FACTORS, SUCH AS DIET AND PHYSICAL EXERCISE, CONTRIBUTE TO NAFLD DEVELOPMENT AND PROGRESSION. SEVERAL LINES OF EVIDENCE DEMONSTRATE THAT SPECIFIC MICRORNAS EXPRESSION PROFILES ARE STRONGLY ASSOCIATED WITH SEVERAL PATHOLOGICAL CONDITIONS INCLUDING NAFLD. IN NAFLD, MICRORNA DEREGULATION IN RESPONSE TO INTRINSIC GENETIC OR EPIGENETIC FACTORS OR ENVIRONMENTAL FACTORS CONTRIBUTES TO METABOLIC DYSFUNCTION. IN THIS REVIEW WE FOCUSED ON MICRORNAS ROLE BOTH AS CONTROLLED AND CONTROLLERS MOLECULES IN NAFLD DEVELOPMENT AND/OR THEIR EVENTUAL VALUE AS NON-INVASIVE BIOMARKERS OF DISEASE. 2014 7 5386 33 REDOX HOMEOSTASIS AND EPIGENETICS IN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD). NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD), AN ACCUMULATION OF INTRA-HEPATIC TRIGLYCERIDES THAT IS OFTEN CONSIDERED THE HEPATIC MANIFESTATION OF INSULIN RESISTANCE, IS THE MOST COMMON CAUSE OF CHRONIC LIVER DISEASE IN THE WESTERN COUNTRIES WITH UP TO ONE THIRD OF THE POPULATION AFFECTED. NAFLD IS A SPECTRUM OF DISTURBANCES THAT ENCOMPASSES VARIOUS DEGREES OF LIVER DAMAGE RANGING FROM SIMPLE STEATOSIS TO NON-ALCOHOLIC STEATOHEPATITIS (NASH). NASH IS CHARACTERIZED BY HEPATOCELLULAR INJURY/INFLAMMATION WITH OR WITHOUT FIBROSIS. THE INDIVIDUALS WITH NAFLD DEVELOP NASH IN 10% OF THE CASES, AND ARE ALSO AT RISK OF DEVELOPING HEPATOCELLULAR CARCINOMA (HCC). EPIGENETIC MECHANISMS OF NUCLEAR CHROMATIN REMODELING, SUCH AS DNA METHYLATION, POST-TRANSLATIONAL MODIFICATIONS OF HISTONES, AND INCORPORATION OF HISTONE VARIANTS INTO THE CHROMATIN ARE INCREASINGLY RECOGNIZED AS CRUCIAL FACTORS IN THE PATHOPHYSIOLOGY OF NAFLD. NAFLD IS OFTEN ACCOMPANIED BY OXIDATIVE STRESS: REACTIVE OXYGEN SPECIES (ROS) ARE IMPLICATED IN ALTERED REDUCTION/OXIDATION (REDOX) REACTIONS THAT ATTACK CELLULAR MACROMOLECULES AND ARE DETECTED IN THE LIVER OF PATIENTS AND ANIMAL MODELS OF NAFLD. IN THIS REVIEW, WE SUMMARIZE RECENT KNOWLEDGE ADVANCEMENTS IN THE HEPATIC EPIGENETIC AND REDOX MECHANISMS, AND THEIR POSSIBLE LINKS, INVOLVED IN THE PATHOGENESIS AND TREATMENT OF NAFLD. 2013 8 6106 27 THE EMERGING ROLE OF MICRORNAS IN NAFLD: HIGHLIGHT OF MICRORNA-29A IN MODULATING OXIDATIVE STRESS, INFLAMMATION, AND BEYOND. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS A COMMON CAUSE OF CHRONIC LIVER DISEASE AND RANGES FROM STEATOSIS TO STEATOHEPATITIS AND TO LIVER FIBROSIS. LIPOTOXICITY IN HEPATOCYTES, ELEVATED OXIDATIVE STRESS AND THE ACTIVATION OF PROINFLAMMATORY MEDIATORS OF KUPFFER CELLS, AND FIBROGENIC PATHWAYS OF ACTIVATED HEPATIC STELLATE CELLS CAN CONTRIBUTE TO THE DEVELOPMENT OF NAFLD. MICRORNAS (MIRS) PLAY A CRUCIAL ROLE IN THE DYSREGULATED METABOLISM AND INFLAMMATORY SIGNALING CONNECTED WITH NAFLD AND ITS PROGRESSION TOWARDS MORE SEVERE STAGES. OF NOTE, THE PROTECTIVE EFFECT OF NON-CODING MIR-29A ON LIVER DAMAGE AND ITS VERSATILE ACTION ON EPIGENETIC ACTIVITY, MITOCHONDRIAL HOMEOSTASIS AND IMMUNOMODULATION MAY IMPROVE OUR PERCEPTION OF THE PATHOGENESIS OF NAFLD. HEREIN, WE REVIEW THE BIOLOGICAL FUNCTIONS OF CRITICAL MIRS IN NAFLD, AS WELL AS HIGHLIGHT THE EMERGING ROLE OF MIR-29A IN THERAPEUTIC APPLICATION AND THE RECENT ADVANCES IN MOLECULAR MECHANISMS UNDERLYING ITS LIVER PROTECTIVE EFFECT. 2020 9 74 43 A MULTIDISCIPLINARY APPROACH AND CURRENT PERSPECTIVE OF NONALCOHOLIC FATTY LIVER DISEASE: A SYSTEMATIC REVIEW. IN RECENT TIMES, NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) HAS BEEN CONSIDERED ONE OF THE MAJOR CAUSES OF LIVER DISEASE ACROSS THE WORLD. NAFLD IS DEFINED AS THE DEPOSITION OF TRIGLYCERIDES IN THE LIVER AND IS ASSOCIATED WITH OBESITY AND METABOLIC SYNDROME. HYPERINSULINEMIA, INSULIN RESISTANCE (IR), FATTY LIVER, HEPATOCYTE INJURY, UNBALANCED PROINFLAMMATORY CYTOKINES, MITOCHONDRIAL DYSFUNCTION, OXIDATIVE STRESS, LIVER INFLAMMATION, AND FIBROSIS ARE THE MAIN PATHOGENESIS IN NAFLD. RECENT STUDIES SUGGEST THAT THE ACTION OF INTESTINAL MICROBIOTA THROUGH CHRONIC INFLAMMATION, INCREASED INTESTINAL PERMEABILITY, AND ENERGY UPTAKE PLAYS A VITAL ROLE IN NAFLD. MOREOVER, POLYCYSTIC OVARIAN SYNDROME ALSO CAUSES NAFLD DEVELOPMENT THROUGH IR. AGE, GENDER, RACE, ETHNICITY, SLEEP, DIET, SEDENTARY LIFESTYLE, AND GENETIC AND EPIGENETIC PATHWAYS ARE SOME CONTRIBUTING FACTORS OF NAFLD THAT CAN EXACERBATE THE RISK OF LIVER CIRRHOSIS AND HEPATOCELLULAR CARCINOMA (HCC) AND EVENTUALLY LEAD TO DEATH. NAFLD HAS VARIOUS PRESENTATIONS, INCLUDING FATIGUE, UNEXPLAINED WEIGHT LOSS, BLOATING, UPPER ABDOMINAL PAIN, DECREASED APPETITE, HEADACHE, ANXIETY, POOR SLEEP, INCREASED THIRST, PALPITATION, AND A FEELING OF WARMTH. SOME STUDIES HAVE SHOWN THAT NAFLD WITH SEVERE CORONAVIRUS DISEASE 2019 (COVID-19) HAS POOR OUTCOMES. THE GOLD STANDARD FOR NAFLD DIAGNOSIS IS LIVER BIOPSY. OTHER DIAGNOSTIC TOOLS ARE IMAGING TESTS, SERUM BIOMARKERS, MICROBIOTA MARKERS, AND TESTS FOR EXTRAHEPATIC COMPLICATIONS. THERE ARE NO SPECIFIC TREATMENTS FOR NAFLD. THEREFORE, THE MAIN CONCERN FOR NAFLD IS TREATING THE COMORBID CONDITIONS SUCH AS ANTI-DIABETIC AGENTS FOR TYPE 2 DIABETES MELLITUS, STATINS TO REDUCE HCC PROGRESSION, ANTIOXIDANTS TO PREVENT HEPATOCELLULAR DAMAGE, AND BARIATRIC SURGERY FOR PATIENTS WITH A BMI OF >40 KG/M(2) AND >35 KG/M(2) WITH COMORBIDITIES. LIFESTYLE AND DIETARY CHANGES ARE CONSIDERED PREVENTIVE STRATEGIES AGAINST NAFLD ADVANCEMENT. INADEQUATE TREATMENT OF NAFLD FURTHER LEADS TO CARDIAC CONSEQUENCES, SLEEP APNEA, CHRONIC KIDNEY DISEASE, AND INFLAMMATORY BOWEL DISEASE. IN THIS SYSTEMATIC REVIEW, WE HAVE BRIEFLY DISCUSSED THE RISK FACTORS, PATHOGENESIS, CLINICAL FEATURES, AND NUMEROUS CONSEQUENCES OF NAFLD. WE HAVE ALSO REVIEWED VARIOUS GUIDELINES FOR NAFLD DIAGNOSIS ALONG WITH EXISTING THERAPEUTIC STRATEGIES FOR THE MANAGEMENT AND PREVENTION OF THE DISEASE. 2022 10 6264 31 THE MULTIPLE-HIT PATHOGENESIS OF NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD). NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS INCREASINGLY PREVALENT AND REPRESENTS A GROWING CHALLENGE IN TERMS OF PREVENTION AND TREATMENT. DESPITE ITS HIGH PREVALENCE, ONLY A SMALL MINORITY OF AFFECTED PATIENTS DEVELOPS INFLAMMATION AND SUBSEQUENTLY FIBROSIS AND CHRONIC LIVER DISEASE, WHILE MOST OF THEM ONLY EXHIBIT SIMPLE STEATOSIS. IN THIS CONTEXT, THE FULL UNDERSTANDING OF THE MECHANISMS UNDERLYING THE DEVELOPMENT OF NAFLD AND NON-ALCOHOLIC STEATOHEPATITIS (NASH) IS OF EXTREME IMPORTANCE; DESPITE ADVANCES IN THIS FIELD, KNOWLEDGE ON THE PATHOGENESIS OF NAFLD IS STILL INCOMPLETE. THE 'TWO-HIT' HYPOTHESIS IS NOW OBSOLETE, AS IT IS INADEQUATE TO EXPLAIN THE SEVERAL MOLECULAR AND METABOLIC CHANGES THAT TAKE PLACE IN NAFLD. THE "MULTIPLE HIT" HYPOTHESIS CONSIDERS MULTIPLE INSULTS ACTING TOGETHER ON GENETICALLY PREDISPOSED SUBJECTS TO INDUCE NAFLD AND PROVIDES A MORE ACCURATE EXPLANATION OF NAFLD PATHOGENESIS. SUCH HITS INCLUDE INSULIN RESISTANCE, HORMONES SECRETED FROM THE ADIPOSE TISSUE, NUTRITIONAL FACTORS, GUT MICROBIOTA AND GENETIC AND EPIGENETIC FACTORS. IN THIS ARTICLE, WE REVIEW THE FACTORS THAT FORM THIS HYPOTHESIS. 2016 11 4712 28 NON-ALCOHOLIC FATTY LIVER DISEASE: METABOLIC, GENETIC, EPIGENETIC AND ENVIRONMENTAL RISK FACTORS. NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS ONE OF THE MOST FREQUENT CAUSES OF CHRONIC LIVER DISEASE IN THE WESTERN WORLD, PROBABLY DUE TO THE GROWING PREVALENCE OF OBESITY, METABOLIC DISEASES, AND EXPOSURE TO SOME ENVIRONMENTAL AGENTS. IN CERTAIN PATIENTS, SIMPLE HEPATIC STEATOSIS CAN PROGRESS TO NON-ALCOHOLIC STEATOHEPATITIS (NASH), WHICH CAN SOMETIMES LEAD TO LIVER CIRRHOSIS AND ITS COMPLICATIONS INCLUDING HEPATOCELLULAR CARCINOMA. UNDERSTANDING THE MECHANISMS THAT CAUSE THE PROGRESSION OF NAFLD TO NASH IS CRUCIAL TO BE ABLE TO CONTROL THE ADVANCEMENT OF THE DISEASE. THE MAIN HYPOTHESIS CONSIDERS THAT IT IS DUE TO MULTIPLE FACTORS THAT ACT TOGETHER ON GENETICALLY PREDISPOSED SUBJECTS TO SUFFER FROM NAFLD INCLUDING INSULIN RESISTANCE, NUTRITIONAL FACTORS, GUT MICROBIOTA, AND GENETIC AND EPIGENETIC FACTORS. IN THIS ARTICLE, WE WILL DISCUSS THE EPIDEMIOLOGY OF NAFLD, AND WE OVERVIEW SEVERAL TOPICS THAT INFLUENCE THE DEVELOPMENT OF THE DISEASE FROM SIMPLE STEATOSIS TO LIVER CIRRHOSIS AND ITS POSSIBLE COMPLICATIONS. 2021 12 2862 35 FRUCTOSE-MEDIATED EFFECTS ON GENE EXPRESSION AND EPIGENETIC MECHANISMS ASSOCIATED WITH NAFLD PATHOGENESIS. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS A CHRONIC, FREQUENTLY PROGRESSIVE CONDITION THAT DEVELOPS IN RESPONSE TO EXCESSIVE HEPATOCYTE FAT ACCUMULATION (I.E., STEATOSIS) IN THE ABSENCE OF SIGNIFICANT ALCOHOL CONSUMPTION. LIVER STEATOSIS DEVELOPS AS A RESULT OF IMBALANCED LIPID METABOLISM, DRIVEN LARGELY BY INCREASED RATES OF DE NOVO LIPOGENESIS AND HEPATIC FATTY ACID UPTAKE AND REDUCED FATTY ACID OXIDATION AND/OR DISPOSAL TO THE CIRCULATION. FRUCTOSE IS A NATURALLY OCCURRING SIMPLE SUGAR, WHICH IS MOST COMMONLY CONSUMED IN MODERN DIETS IN THE FORM OF SUCROSE, A DISACCHARIDE COMPRISED OF ONE MOLECULE OF FRUCTOSE COVALENTLY BONDED WITH ONE MOLECULE OF GLUCOSE. A NUMBER OF OBSERVATIONAL AND EXPERIMENTAL STUDIES HAVE DEMONSTRATED DETRIMENTAL EFFECTS OF DIETARY FRUCTOSE CONSUMPTION NOT ONLY ON DIVERSE METABOLIC OUTCOMES SUCH AS INSULIN RESISTANCE AND OBESITY, BUT ALSO ON HEPATIC STEATOSIS AND NAFLD-RELATED FIBROSIS. DESPITE THE COMPELLING EVIDENCE THAT EXCESSIVE FRUCTOSE CONSUMPTION IS ASSOCIATED WITH THE PRESENCE OF NAFLD AND MAY EVEN PROMOTE THE DEVELOPMENT AND PROGRESSION OF NAFLD TO MORE CLINICALLY SEVERE PHENOTYPES, THE MOLECULAR MECHANISMS BY WHICH FRUCTOSE ELICITS EFFECTS ON DYSREGULATED LIVER METABOLISM REMAIN UNCLEAR. EMERGING DATA SUGGEST THAT DIETARY FRUCTOSE MAY DIRECTLY ALTER THE EXPRESSION OF GENES INVOLVED IN LIPID METABOLISM, INCLUDING THOSE THAT INCREASE HEPATIC FAT ACCUMULATION OR REDUCE HEPATIC FAT REMOVAL. THE AIM OF THIS REVIEW IS TO SUMMARIZE THE CURRENT RESEARCH SUPPORTING A ROLE FOR DIETARY FRUCTOSE INTAKE IN THE MODULATION OF TRANSCRIPTOMIC AND EPIGENETIC MECHANISMS UNDERLYING THE PATHOGENESIS OF NAFLD. 2020 13 3293 36 HIGH FAT DIET-TRIGGERED NON-ALCOHOLIC FATTY LIVER DISEASE: A REVIEW OF PROPOSED MECHANISMS. OBESITY IS CHARACTERIZED BY THE DEPOSITION OF EXCESSIVE BODY FAT, AND IS CAUSED BY ENERGY IMBALANCE, ESPECIALLY WHEN CONSUMING FAT-RICH DIETS. HIGH FAT DIET (HFD)-ASSOCIATED OBESITY IS GREATLY COMMON IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) THAT IS EMERGING AS ONE OF THE MOST UNIVERSAL CAUSES OF LIVER DISEASE WORLDWIDE, ESPECIALLY IN WESTERN COUNTRIES. IN SPITE OF ITS HIGH PREVALENCE, ONLY A SMALL PROPORTION OF AFFECTED INDIVIDUALS WILL BECOME INFLAMED, FOLLOWED BY FIBROSIS AND CHRONIC LIVER DISEASES, AND MOST PATIENTS ONLY SHOW SIMPLE STEATOSIS. IN THIS CASE, THE FULL COMPREHENSION OF THE MECHANISMS UNDERLYING THE PROGRESSION OF NAFLD IS OF EXTREME SIGNIFICANCE; IN SPITE OF PROGRESS IN THIS FIELD, AWARENESS ON THE DEVELOPMENT OF NAFLD IS STILL INCOMPLETE. TRADITIONALLY, LIVER STEATOSIS IS COMMONLY CONNECTED WITH HFD, OBESITY, AND INSULIN RESISTANCE (IR). RECENTLY, VARIOUS POSSIBLE MECHANISMS HAVE BEEN PUT FORWARD FOR LIVER DAMAGE, INCLUDING ENDOPLASMIC RETICULUM STRESS, PERTURBATION OF AUTOPHAGY, MITOCHONDRIAL DYSFUNCTION, HEPATOCELLULAR APOPTOSIS, GUT MICROBIOTA IMBALANCE, DYSREGULATION OF MICRORNAS, AND GENETIC/EPIGENETIC RISK FACTORS, AS WELL AS AN INCREASE IN INFLAMMATORY RESPONSES, AMONG MANY OTHERS. COLLECTIVELY, THESE PROPOSED MECHANISMS ALLOW FOR A VARIETY OF HITS ACTING TOGETHER ON SUBJECTS TO MEDIATED NAFLD AND WILL OFFER A MORE ACCURATE EXPLANATION FOR PROGRESSION OF NAFLD. THEREFORE, THIS REVIEW SUMMARIZES THE PRESENT INFORMATION CONCERNING NAFLD AFTER HFD EXPOSURE, AS WELL AS DISCUSSES POSSIBLE MECHANISMS THROUGH WHICH IT MAY ARISE. 2020 14 5012 27 PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR-GAMMA AS A TARGET AND REGULATOR OF EPIGENETIC MECHANISMS IN NONALCOHOLIC FATTY LIVER DISEASE. PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR-GAMMA (PPARGAMMA) BELONGS TO THE SUPERFAMILY OF NUCLEAR RECEPTORS THAT CONTROL THE TRANSCRIPTION OF MULTIPLE GENES. ALTHOUGH IT IS FOUND IN MANY CELLS AND TISSUES, PPARGAMMA IS MOSTLY EXPRESSED IN THE LIVER AND ADIPOSE TISSUE. PRECLINICAL AND CLINICAL STUDIES SHOW THAT PPARGAMMA TARGETS SEVERAL GENES IMPLICATED IN VARIOUS FORMS OF CHRONIC LIVER DISEASE, INCLUDING NONALCOHOLIC FATTY LIVER DISEASE (NAFLD). CLINICAL TRIALS ARE CURRENTLY UNDERWAY TO INVESTIGATE THE BENEFICIAL EFFECTS OF PPARGAMMA AGONISTS ON NAFLD/NONALCOHOLIC STEATOHEPATITIS. UNDERSTANDING PPARGAMMA REGULATORS MAY THEREFORE AID IN UNRAVELING THE MECHANISMS GOVERNING THE DEVELOPMENT AND PROGRESSION OF NAFLD. RECENT ADVANCES IN HIGH-THROUGHPUT BIOLOGY AND GENOME SEQUENCING HAVE GREATLY FACILITATED THE IDENTIFICATION OF EPIGENETIC MODIFIERS, INCLUDING DNA METHYLATION, HISTONE MODIFIERS, AND NON-CODING RNAS AS KEY FACTORS THAT REGULATE PPARGAMMA IN NAFLD. IN CONTRAST, LITTLE IS STILL KNOWN ABOUT THE PARTICULAR MOLECULAR MECHANISMS UNDERLYING THE INTRICATE RELATIONSHIPS BETWEEN THESE EVENTS. THE PAPER THAT FOLLOWS OUTLINES OUR CURRENT UNDERSTANDING OF THE CROSSTALK BETWEEN PPARGAMMA AND EPIGENETIC REGULATORS IN NAFLD. ADVANCES IN THIS FIELD ARE LIKELY TO AID IN THE DEVELOPMENT OF EARLY NONINVASIVE DIAGNOSTICS AND FUTURE NAFLD TREATMENT STRATEGIES BASED ON PPARGAMMA EPIGENETIC CIRCUIT MODIFICATION. 2023 15 5150 36 PPARALPHA IN THE EPIGENETIC DRIVER SEAT OF NAFLD: NEW THERAPEUTIC OPPORTUNITIES FOR EPIGENETIC DRUGS? NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS A GROWING EPIDEMIC AND THE MOST COMMON CAUSE OF CHRONIC LIVER DISEASE WORLDWIDE. IT CONSISTS OF A SPECTRUM OF LIVER DISORDERS RANGING FROM SIMPLE STEATOSIS TO NASH WHICH PREDISPOSES PATIENTS TO FURTHER FIBROSIS, CIRRHOSIS AND EVEN HEPATOCARCINOMA. DESPITE MUCH RESEARCH, AN APPROVED TREATMENT IS STILL LACKING. FINDING NEW THERAPEUTIC TARGETS HAS THEREFORE BEEN A MAIN PRIORITY. KNOWN AS A MAIN REGULATOR OF THE LIPID METABOLISM AND HIGHLY EXPRESSED IN THE LIVER, THE NUCLEAR RECEPTOR PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR-ALPHA (PPARALPHA) HAS BEEN IDENTIFIED AS AN ATTRACTIVE THERAPEUTIC TARGET. SINCE ITS EXPRESSION IS SILENCED BY DNA HYPERMETHYLATION IN NAFLD PATIENTS, MANY RESEARCH STRATEGIES HAVE AIMED TO RESTORE THE EXPRESSION OF PPARALPHA AND ITS TARGET GENES INVOLVED IN LIPID METABOLISM. ALTHOUGH PREVIOUSLY TESTED PPARALPHA AGONISTS DID NOT AMELIORATE THE DISEASE, CURRENT RESEARCH HAS SHOWN THAT PPARALPHA ALSO INTERACTS AND REGULATES EPIGENETIC DNMT1, JMJD3, TET AND SIRT1 ENZYMES. MOREOVER, THERE IS A GROWING BODY OF EVIDENCE SUGGESTING THE ORCHESTRATING ROLE OF EPIGENETICS IN THE DEVELOPMENT AND PROGRESSION OF NAFLD. THEREFORE, CURRENT THERAPEUTIC STRATEGIES ARE SHIFTING MORE TOWARDS EPIGENETIC DRUGS. THIS REVIEW PROVIDES A CONCISE OVERVIEW OF THE EPIGENETIC REGULATION OF NAFLD WITH A FOCUS ON PPARALPHA REGULATION AND HIGHLIGHTS RECENTLY IDENTIFIED EPIGENETIC INTERACTION PARTNERS OF PPARALPHA. 2022 16 5151 34 PPARS IN LIVER DISEASES AND CANCER: EPIGENETIC REGULATION BY MICRORNAS. PEROXISOME-PROLIFERATOR-ACTIVATED RECEPTORS (PPARS) ARE LIGAND-ACTIVATED NUCLEAR RECEPTORS THAT EXERT IN THE LIVER A TRANSCRIPTIONAL ACTIVITY REGULATING A WHOLE SPECTRUM OF PHYSIOLOGICAL FUNCTIONS, INCLUDING CHOLESTEROL AND BILE ACID HOMEOSTASIS, LIPID/GLUCOSE METABOLISM, INFLAMMATORY RESPONSES, REGENERATIVE MECHANISMS, AND CELL DIFFERENTIATION/PROLIFERATION. DYSREGULATIONS OF THE EXPRESSION, OR ACTIVITY, OF SPECIFIC PPAR ISOFORMS IN THE LIVER ARE THEREFORE BELIEVED TO REPRESENT CRITICAL MECHANISMS CONTRIBUTING TO THE DEVELOPMENT OF HEPATIC METABOLIC DISEASES, DISORDERS INDUCED BY HEPATIC VIRAL INFECTIONS, AND HEPATOCELLULAR ADENOMA AND CARCINOMA. IN THIS REGARD, SPECIFIC PPAR AGONISTS HAVE PROVEN TO BE USEFUL TO TREAT THESE METABOLIC DISEASES, BUT FOR CANCER THERAPIES, THE USE OF PPAR AGONISTS IS STILL DEBATED. INTERESTINGLY, IN ADDITION TO PREVIOUSLY DESCRIBED MECHANISMS REGULATING PPARS EXPRESSION AND ACTIVITY, MICRORNAS ARE EMERGING AS NEW IMPORTANT REGULATORS OF PPAR EXPRESSION AND ACTIVITY IN PATHOPHYSIOLOGICAL CONDITIONS AND THEREFORE MAY REPRESENT FUTURE THERAPEUTIC TARGETS TO TREAT HEPATIC METABOLIC DISORDERS AND CANCERS. HERE, WE REVIEWED THE CURRENT KNOWLEDGE ABOUT THE GENERAL ROLES OF THE DIFFERENT PPAR ISOFORMS IN COMMON CHRONIC METABOLIC AND INFECTIOUS LIVER DISEASES, AS WELL AS IN THE DEVELOPMENT OF HEPATIC CANCERS. RECENT WORKS HIGHLIGHTING THE REGULATION OF PPARS BY MICRORNAS IN BOTH PHYSIOLOGICAL AND PATHOLOGICAL SITUATIONS WITH A FOCUS ON THE LIVER ARE ALSO DISCUSSED. 2012 17 4464 34 MOLECULAR MECHANISMS OF NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)/NONALCOHOLIC STEATOHEPATITIS (NASH). NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS ONE OF THE MOST COMMON CHRONIC LIVER DISEASES WORLDWIDE AND HAS GARNERED INCREASING ATTENTION IN RECENT DECADES. NAFLD IS CHARACTERIZED BY A WIDE RANGE OF LIVER CHANGES, FROM SIMPLE STEATOSIS TO NONALCOHOLIC STEATOHEPATITIS (NASH), CIRRHOSIS, AND HEPATOCELLULAR CARCINOMA. THE PATHOGENESIS OF NAFLD/NASH IS VERY COMPLICATED AND INVOLVES LIPID ACCUMULATION, INSULIN RESISTANCE, INFLAMMATION, AND FIBROGENESIS. IN ADDITION, NAFLD IS CLOSELY ASSOCIATED WITH COMPLICATIONS SUCH AS OBESITY, DYSLIPIDEMIA, AND TYPE 2 DIABETES. IN PARTICULAR, THE CLINICAL SPECTRUM, PATHOPHYSIOLOGY, AND THERAPEUTIC OPTIONS OF NAFLD SHARE MANY THINGS IN COMMON WITH DIABETES. INSULIN RESISTANCE IS AN UNDERLYING BASIS FOR THE PATHOGENESIS OF DIABETES AND NAFLD. THIS CHAPTER FOCUSES ON THE MOLECULAR MECHANISM INVOLVED IN THE PATHOGENESIS OF INSULIN RESISTANCE, DIABETES, AND NASH/NAFLD INCLUDING THOSE THAT DRIVE DISEASE PROGRESSION SUCH AS OXIDATIVE STRESS, GENETIC AND EPIGENETIC MECHANISMS, ADIPONECTIN, CYTOKINES, AND IMMUNE CELLS. 2021 18 2287 32 EPIGENETIC REGULATION IN LEAN NONALCOHOLIC FATTY LIVER DISEASE. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD), THE MOST PROMINENT CAUSE OF CHRONIC LIVER DISEASE WORLDWIDE, IS A RAPIDLY GROWING EPIDEMIC. IT CONSISTS OF A WIDE RANGE OF LIVER DISEASES, FROM STEATOSIS TO NONALCOHOLIC STEATOHEPATITIS, AND PREDISPOSES PATIENTS TO LIVER FIBROSIS, CIRRHOSIS, AND EVEN HEPATOCELLULAR CARCINOMA. NAFLD IS STRONGLY CORRELATED WITH OBESITY; HOWEVER, IT HAS BEEN EXTENSIVELY REPORTED AMONG LEAN/NONOBESE INDIVIDUALS IN RECENT YEARS. ALTHOUGH LEAN PATIENTS DEMONSTRATE A LOWER PREVALENCE OF DIABETES MELLITUS, CENTRAL OBESITY, DYSLIPIDEMIA, HYPERTENSION, AND METABOLIC SYNDROME, A PERCENTAGE OF THESE PATIENTS MAY DEVELOP STEATOHEPATITIS, ADVANCED LIVER FIBROSIS, AND CARDIOVASCULAR DISEASE, AND HAVE INCREASED ALL-CAUSE MORTALITY. THE PATHOPHYSIOLOGICAL MECHANISMS OF LEAN NAFLD REMAIN VAGUE. STUDIES HAVE REPORTED THAT LEAN NAFLD DEMONSTRATES A CLOSE ASSOCIATION WITH ENVIRONMENTAL FACTORS, GENETIC PREDISPOSITION, AND EPIGENETIC MODIFICATIONS. IN THIS REVIEW, WE AIM TO DISCUSS AND SUMMARIZE THE EPIGENETIC MECHANISMS INVOLVED IN LEAN NAFLD AND TO INTRODUCE THE INTERACTION BETWEEN EPIGENETIC PATTERNS AND GENETIC OR NON GENETIC FACTORS. SEVERAL EPIGENETIC MECHANISMS HAVE BEEN IMPLICATED IN THE REGULATION OF LEAN NAFLD. THESE INCLUDE DNA METHYLATION, HISTONE MODIFICATIONS, AND NONCODING-RNA-MEDIATED GENE REGULATION. EPIGENETICS IS AN AREA OF SPECIAL INTEREST IN THE SETTING OF LEAN NAFLD AS IT COULD PROVIDE NEW INSIGHTS INTO THE THERAPEUTIC OPTIONS AND NONINVASIVE BIOMARKERS THAT TARGET THIS UNDER-RECOGNIZED AND CHALLENGING DISORDER. 2023 19 4722 34 NONCODING RNAS IN NONALCOHOLIC FATTY LIVER DISEASE: POTENTIAL DIAGNOSIS AND PROGNOSIS BIOMARKERS. NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) IS CURRENTLY THE MOST COMMON CHRONIC LIVER DISEASE WORLDWIDE IN PART DUE TO THE CONCOMITANT OBESITY PANDEMIC AND INSULIN RESISTANCE (IR). IT IS INCREASINGLY BECOMING EVIDENT THAT NAFLD IS A DISEASE AFFECTING NUMEROUS EXTRAHEPATIC VITAL ORGANS AND REGULATORY PATHWAYS. THE MOLECULAR MECHANISMS UNDERLYING THE NONALCOHOLIC STEATOSIS FORMATION ARE POORLY UNDERSTOOD, AND LITTLE INFORMATION IS AVAILABLE ON THE PATHWAYS THAT ARE RESPONSIBLE FOR THE PROGRESSIVE HEPATOCELLULAR DAMAGE THAT FOLLOWS LIPID ACCUMULATION. RECENTLY, MUCH RESEARCH HAS FOCUSED ON THE IDENTIFICATION OF THE EPIGENETIC MODIFICATIONS THAT CONTRIBUTE TO NAFLD PATHOGENESIS. NONCODING RNAS (NCRNAS) ARE ONE OF SUCH EPIGENETIC FACTORS THAT COULD BE IMPLICATED IN THE NAFLD DEVELOPMENT AND PROGRESSION. IN THIS REVIEW, WE SUMMARIZE THE CURRENT KNOWLEDGE OF THE GENETIC AND EPIGENETIC FACTORS POTENTIALLY UNDERLYING THE DISEASE. PARTICULAR EMPHASIS WILL BE PUT ON THE CONTRIBUTION OF MICRORNAS (MIRNAS), LONG NONCODING RNAS (LNCRNAS), AND CIRCULAR RNAS (CIRCRNAS) TO THE PATHOPHYSIOLOGY OF NAFLD AS WELL AS THEIR POTENTIAL USE AS THERAPEUTIC TARGETS OR AS MARKERS FOR THE PREDICTION AND THE PROGRESSION OF THE DISEASE. 2020 20 1233 31 CROSSTALK BETWEEN KIDNEY AND LIVER IN NON-ALCOHOLIC FATTY LIVER DISEASE: MECHANISMS AND THERAPEUTIC APPROACHES. LIVER AND KIDNEY ARE VITAL ORGANS THAT MAINTAIN HOMEOSTASIS AND INJURY TO EITHER OF THEM TRIGGERS PATHOGENIC PATHWAYS AFFECTING THE OTHER. FOR EXAMPLE, NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) PROMOTES THE PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD), VICE VERSA ACUTE KIDNEY INJURY (AKI) ENDORSES THE INDUCTION AND PROGRESSION OF LIVER DYSFUNCTION. PROGRESS IN CLINICAL AND BASIC RESEARCH SUGGEST A ROLE OF EXCESSIVE FRUCTOSE INTAKE, INSULIN RESISTANCE, INFLAMMATORY CYTOKINES PRODUCTION, ACTIVATION OF THE RENIN-ANGIOTENSIN SYSTEM, REDOX IMBALANCE, AND THEIR IMPACT ON EPIGENETIC REGULATION OF GENE EXPRESSION IN THIS CONTEXT. RECENT DEVELOPMENTS IN EXPERIMENTAL AND CLINICAL RESEARCH HAVE IDENTIFIED SEVERAL BIOCHEMICAL AND MOLECULAR PATHWAYS FOR AKI-LIVER INTERACTION, INCLUDING ALTERED LIVER ENZYMES PROFILE, METABOLIC ACIDOSIS, OXIDATIVE STRESS, ACTIVATION OF INFLAMMATORY AND REGULATED CELL DEATH PATHWAYS. THIS REVIEW FOCUSES ON THE CURRENT PRECLINICAL AND CLINICAL FINDINGS ON KIDNEY-LIVER CROSSTALK IN NAFLD-CKD AND AKI-LIVER DYSFUNCTION SETTINGS AND HIGHLIGHTS POTENTIAL MOLECULAR MECHANISMS AND THERAPEUTIC TARGETS. 2022