4.7 Review

Hepatic insulin receptor: new views on the mechanisms of liver disease

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Summary: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease, affecting 70% of patients with diabetes. There are currently no specific drugs available for its treatment. GLP-1 receptor agonists (GLP-1 RAs) have shown significant impact on body weight and markers of fatty liver and fibrosis in NAFLD patients, in addition to their anti-hyperglycemic effect. This review aims to summarize the available evidence on the role of GLP-1 RAs in NAFLD treatment and propose potential future scenarios.

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Article Biochemistry & Molecular Biology

Bilirubin Levels Are Negatively Correlated with Adiposity in Obese Men and Women, and Its Catabolized Product, Urobilin, Is Positively Associated with Insulin Resistance

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Summary: This study found that bilirubin levels are lower in obese individuals compared to lean individuals. Obesity leads to an increase in the UGT1A1 enzyme, which clears bilirubin from the blood. As a result, more conjugated bilirubin enters the intestine and is converted into urobilin, which is then absorbed through the hepatic portal vein. The study also revealed a negative correlation between bilirubin levels and BMI and adiposity in obese individuals, while urobilin levels were positively associated with BMI and adiposity. Obese women were found to have higher insulin resistance, and urobilin levels showed a stronger linear correlation with insulin resistance in women compared to men. These findings suggest that plasma urobilin levels are associated with obesity and its comorbidities such as insulin resistance.

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Bilirubin Nanoparticle Treatment in Obese Mice Inhibits Hepatic Ceramide Production and Remodels Liver Fat Content

Zachary A. Kipp et al.

Summary: Studies show that increasing plasma bilirubin levels can help prevent and treat hepatic lipid accumulation in metabolic diseases like obesity and diabetes. Using mice on a high-fat diet, researchers found that bilirubin nanoparticles effectively reduce liver fat content by inhibiting the accumulation of ceramides and lowering the expression of enzymes responsible for ceramide production. These findings suggest that bilirubin nanoparticles have potential for improving metabolic health.

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Adipose-Specific PPARα Knockout Mice Have Increased Lipogenesis by PASK-SREBP1 Signaling and a Polarity Shift to Inflammatory Macrophages in White Adipose Tissue

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Summary: Metabolic-associated fatty liver disease (MAFLD) is a common chronic liver disease, but it is often underestimated due to the lack of effective diagnostic methods. Fatty acid binding protein 4 (FABP4) plays an important role in the progression of fatty liver disease and may be a potential therapeutic target.

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Metabolic-associated fatty liver disease: From simple steatosis toward liver cirrhosis and potential complications. Proceedings of the Third Translational Hepatology Meeting, organized by the Spanish Association for the Study of the Liver (AEEH)

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Summary: This is a meeting report of the 3rd Translational Hepatology Meeting held in Alicante, Spain, in October 2021. The meeting, organized by the Spanish Association for the Study of the Liver (AEEH), provided updates on recent advances in basic and translational hepatology, focusing on the molecular and cellular mechanisms and therapeutic targets involved in metabolic-associated fatty liver disease (MAFLD), metabolic-associated steatohepatitis (MASH), cirrhosis, and end-stage hepatocellular carcinoma (HCC).

GASTROENTEROLOGIA Y HEPATOLOGIA (2022)

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Hepatic kinome atlas: An in-depth identification of kinase pathways in liver fibrosis of humans and rodents

Justin F. Creeden et al.

Summary: This study explores the similarities in fibrotic signaling networks in humans and rodents, identifying potential antifibrotic effects that may improve outcomes in liver diseases. The activation of certain protein kinases, such as the insulin receptor, is found to be hyperactive in fibrotic liver disease in both species. The findings establish a comprehensive kinase atlas for liver fibrosis, identifying analogous signaling events conserved among humans and rodents.

HEPATOLOGY (2022)

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Serum Thrombospondin-2 Levels Are Closely Associated With the Severity of Metabolic Syndrome and Metabolic Associated Fatty Liver Disease

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Summary: The study found that serum thrombospondin-2 (TSP2) is closely associated with the severity and progression of obesity-related metabolic syndrome (MetS) and metabolic associated fatty liver disease (MAFLD). Serum TSP2 is a promising noninvasive biomarker for differentiating metabolic associated steatohepatitis (MASH) and identifying at-risk patients.

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Summary: This study evaluated the safety and efficacy of combining semaglutide with cilofexor and/or firsocostat in patients with NASH. The combination therapy was generally well tolerated and resulted in additional benefits over semaglutide monotherapy, including improvements in liver steatosis and biochemistry. Double-blind placebo-controlled trials with larger patient numbers are needed to further assess the efficacy and safety of these combination therapies in NASH.

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Association between use of liraglutide and liver fibrosis in patients with type 2 diabetes

Yijiong Tan et al.

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NAFLD: Mechanisms, Treatments, and Biomarkers

Fatiha Nassir

Summary: Nonalcoholic fatty liver disease (NAFLD), also known as metabolic-associated fatty liver disease (MAFLD), is a common liver disease worldwide that is closely linked to the obesity epidemic. Currently, there is no specific pharmacological treatment available for NAFLD due to incomplete understanding of its mechanisms, lack of accurate and inexpensive imaging tools, and inadequate non-invasive biomarkers. NAFLD can lead to metabolic-associated steatohepatitis (NASH), liver fibrosis, and hepatocellular carcinoma.

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Summary: Insulin stores lipid in adipocytes and prevents lipolysis and the release of NEFA. Excessive release of NEFA and increased abdominal adiposity trigger insulin resistance, leading to reduced insulin clearance in the liver. Conversely, reduced insulin clearance in the liver can cause chronic hyperinsulinemia and insulin resistance. This review discusses the impact of NEFA mobilization on the reciprocal relationship between insulin resistance and reduced hepatic insulin clearance, and its implications in the pathogenesis of non-alcoholic fatty liver disease.

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Randomised clinical trial: Semaglutide versus placebo reduced liver steatosis but not liver stiffness in subjects with non-alcoholic fatty liver disease assessed by magnetic resonance imaging

Anne Flint et al.

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Justin F. Creeden et al.

Summary: Recent research indicates that bilirubin may have a new role as a metabolic hormone, potentially leading to cardiovascular complications for patients with low levels. Protective mechanisms at mildly elevated levels of bilirubin could offer treatment possibilities for those with hypobilirubinemia.

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Hepatic Insulin Resistance Is Not Pathway Selective in Humans With Nonalcoholic Fatty Liver Disease

Kasper W. ter Horst et al.

Summary: In obese patients with NAFLD, impaired insulin-mediated suppression of glucose production and no increase in glucose-stimulated/high-insulin lipogenesis were observed, indicating a proximal block in insulin signaling pathways in hepatocytes.

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Lower insulin clearance is associated with increased risk of type 2 diabetes in Native Americans

Mujtaba H. Shah et al.

Summary: The study found that lower MCRI is associated with an unfavorable metabolic phenotype and an increased risk of incident type 2 diabetes.

DIABETOLOGIA (2021)

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Effects of antidiabetic agents on steatosis and fibrosis biomarkers in type 2 diabetes: A real-world data analysis

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Retinol from hepatic stellate cells via STRA6 induces lipogenesis on hepatocytes during fibrosis

Injoo Hwang et al.

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Summary: Severe insulin resistance syndromes are a group of rare and heterogeneous disorders with complex etiologies. While advances in medical technology have provided insights into their pathophysiological pathways, the exact cellular and molecular mechanisms of insulin resistance still need further elucidation. Early identification and personalized clinical management are crucial for these syndromes.

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Lykke Sylow et al.

Summary: Skeletal muscle is crucial for insulin-stimulated glucose disposal and overall glycemic control. Insulin regulates glucose uptake in skeletal muscle through complex signaling cascades. Understanding insulin's actions in muscle can provide insights into addressing issues with glucose uptake in conditions like diabetes and obesity.

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Bilirubin deficiency renders mice susceptible to hepatic steatosis in the absence of insulin resistance

Weiyu Chen et al.

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Loss of postprandial insulin clearance control by Insulin-degrading enzyme drives dysmetabolism traits

Diego O. Borges et al.

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Identification of Binding Regions of Bilirubin in the Ligand-Binding Pocket of the Peroxisome Proliferator-Activated Receptor-A (PPARalpha)

Darren M. Gordon et al.

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Philip N. Newsome et al.

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Is insulin the preferred treatment in persons with type 2 diabetes and liver cirrhosis?

Fu-Shun Yen et al.

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Raghd Abu Helal et al.

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