Metabolic Research Laboratories, Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK; Department of Medical Physiology, Chiba University, Graduate School of Medicine, Chiba, Japan.
Laboratory of Hepatology, CHROMETA Department, KU Leuven, Leuven, Belgium.
J Hepatol. 2023 May;78(5):1048-1062. doi: 10.1016/j.jhep.2023.01.024. Epub 2023 Feb 3.
Alongside the liver, white adipose tissue (WAT) is critical in regulating systemic energy homeostasis. Although each organ has its specialised functions, they must work coordinately to regulate whole-body metabolism. Adipose tissues and the liver are relatively resilient and can adapt to an energy surplus by facilitating triglyceride (TG) storage up to a certain threshold level without significant metabolic disturbances. However, lipid storage in WAT beyond a "personalised" adiposity threshold becomes dysfunctional, leading to metabolic inflexibility, progressive inflammation, and aberrant adipokine secretion. Moreover, the failure of adipose tissue to store and mobilise lipids results in systemic knock-on lipid overload, particularly in the liver. Factors contributing to hepatic lipid overload include lipids released from WAT, dietary fat intake, and enhanced de novo lipogenesis. In contrast, extrahepatic mechanisms counteracting toxic hepatic lipid overload entail coordinated compensation through oxidation of surplus fatty acids in brown adipose tissue and storage of fatty acids as TGs in WAT. Failure of these integrated homeostatic mechanisms leads to quantitative increases and qualitative alterations to the lipidome of the liver. Initially, hepatocytes preferentially accumulate TG species leading to a relatively "benign" non-alcoholic fatty liver. However, with time, inflammatory responses ensue, progressing into more severe conditions such as non-alcoholic steatohepatitis, cirrhosis, and hepatocellular carcinoma, in some individuals (often without an early prognostic clue). Herein, we highlight the pathogenic importance of obesity-induced "adipose tissue failure", resulting in decreased adipose tissue functionality (i.e. fat storage capacity and metabolic flexibility), in the development and progression of NAFL/NASH.
除了肝脏,白色脂肪组织(WAT)在调节全身能量稳态方面至关重要。虽然每个器官都有其专门的功能,但它们必须协调工作以调节全身代谢。脂肪组织和肝脏具有相对的弹性,可以通过促进甘油三酯(TG)储存来适应能量过剩,直到达到一定的阈值水平而不会引起明显的代谢紊乱。然而,WAT 中的脂质储存超过了“个性化”的肥胖阈值就会变得功能失调,导致代谢灵活性降低、炎症进展和异常的脂肪细胞因子分泌。此外,脂肪组织储存和动员脂质的能力下降会导致全身脂质过载,特别是在肝脏中。导致肝脂质过载的因素包括从 WAT 释放的脂质、饮食脂肪摄入和增强的从头合成。相比之下,对抗毒性肝脂质过载的肝外机制需要通过棕色脂肪组织中过剩脂肪酸的氧化和 WAT 中脂肪酸作为 TG 的储存来进行协调补偿。这些综合的稳态机制的失败导致肝脏脂质组的数量增加和质量改变。最初,肝细胞优先积累 TG 物种,导致相对“良性”的非酒精性脂肪肝。然而,随着时间的推移,炎症反应随之而来,进展为更严重的情况,如非酒精性脂肪性肝炎、肝硬化和肝细胞癌,在某些人中(通常没有早期预后线索)。在此,我们强调了肥胖引起的“脂肪组织功能障碍”导致脂肪组织功能下降(即脂肪储存能力和代谢灵活性)在非酒精性脂肪性肝病/非酒精性脂肪性肝炎的发生和发展中的致病重要性。
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