Wang Xinxue, Luo Jia, Lu Zhuoheng, Fang Shenzhe, Sun Mengxia, Luo Wenjing, Shen Jianwei, Liu Aiming, Ye Hua
Department of Gastroenterology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
Zhejiang Key Laboratory of Pathophysiology, Department of Pharmacology, Health Science Center, Ningbo University, Ningbo, China.
Front Pharmacol. 2023 May 12;14:1190458. doi: 10.3389/fphar.2023.1190458. eCollection 2023.
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver diseases. In most cases, NAFLD progresses from benign steatosis to steatohepatitis (NASH), and then to cirrhosis. No treatment is currently approved for NAFLD/NASH in the clinic. Fenofibrate (FENO) has been clinically used to treat dyslipidemia for more than a half century, but its effects on NASH are not established. FENO's half-life is quite different between rodent and human. The aim of this study was to investigate the potential of pharmacokinetic-based FENO regime for NASH treatment and the underlying mechanisms. Two typical mouse NASH models, methionine-choline deficient (MCD) diet-fed mice and choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD)-fed mice, were used. MCD model was designed as therapeutic evaluation in experiment 1 and CDAHFD model was designed as preventive in experiment 2. Three doses of FENO (5, 25, 125 mg/kg), two times a day (BID), were administered to the above models. Serum markers of liver injury, cholestasis, and the histology of liver tissues were investigated. Normal mice were used as a model in experiment 3 for toxicity evaluation, Quantitative-PCR and Western Blot assays were used to investigate the inflammatory responses, bile acid synthesis as well as lipid catabolism. Mice on the MCD and CDAHFD diets developed steatohepatitis as expected. Treatment with FENO (25 mg/kg·BID) significantly decreased hepatic steatosis, inflammation and fibrosis in both therapeutic and preventive models. In the MCD model, the therapeutic action of FENO (25 mg/kg·BID) and 125 mg/kg·BID on histopathology and the expression of inflammatory cytokines were comparable. In reducing macrophage infiltration and bile acid load, FENO (25 mg/kg·BID) was superior to 125 mg/kg·BID. In all the aspects mentioned above, FENO (25 mg/kg·BID) was the best among the 3 doses in the CDAHFD model. In a third experiment, the effects of FENO (25 mg/kg·BID) and 125 mg/kg·BID on lipid catabolism were comparable, but 125 mg/kg·BID increased the expression of inflammatory factors and bile acid load. In both models, FENO (5 mg/kg·BID) showed little effect in hepatic steatosis and inflammation, neither the adverse effects. FENO (125 mg/kg·BID) aggravated liver inflammation, increased bile acid synthesis, and promoted the potential of liver proliferation. In toxicity risk assay, FENO (25 mg/kg·BID) treatment showed low potential to trigger bile acid synthesis, inflammation and hepatocyte proliferation. A new regime, FENO (25 mg/kg·BID) is potentially a therapeutic strategy for the NASH treatment. Translational medicine is warranted to prove its effectiveness in the clinic.
非酒精性脂肪性肝病(NAFLD)是慢性肝病的主要病因。在大多数情况下,NAFLD从良性脂肪变性发展为脂肪性肝炎(NASH),进而发展为肝硬化。目前临床上尚无获批用于治疗NAFLD/NASH的药物。非诺贝特(FENO)已在临床上用于治疗血脂异常半个多世纪,但它对NASH的作用尚未明确。FENO在啮齿动物和人类中的半衰期差异很大。本研究的目的是探讨基于药代动力学的FENO方案治疗NASH的潜力及其潜在机制。使用了两种典型的小鼠NASH模型,即喂食蛋氨酸-胆碱缺乏(MCD)饮食的小鼠和喂食胆碱缺乏、L-氨基酸定义的高脂饮食(CDAHFD)的小鼠。MCD模型在实验1中设计为治疗性评估,CDAHFD模型在实验2中设计为预防性评估。将三剂FENO(5、25、125mg/kg),每日两次(BID),给予上述模型。研究了肝损伤、胆汁淤积的血清标志物以及肝组织的组织学。正常小鼠在实验3中用作毒性评估模型,采用定量PCR和蛋白质免疫印迹分析来研究炎症反应、胆汁酸合成以及脂质分解代谢。喂食MCD和CDAHFD饮食的小鼠如预期发展为脂肪性肝炎。用FENO(25mg/kg·BID)治疗在治疗性和预防性模型中均显著降低了肝脂肪变性、炎症和纤维化。在MCD模型中,FENO(25mg/kg·BID)和125mg/kg·BID对组织病理学和炎症细胞因子表达的治疗作用相当。在减少巨噬细胞浸润和胆汁酸负荷方面,FENO(25mg/kg·BID)优于125mg/kg·BID。在上述所有方面,FENO(25mg/kg·BID)在CDAHFD模型中是三剂中效果最佳的。在第三个实验中,FENO(25mg/kg·BID)和125mg/kg·BID对脂质分解代谢的作用相当,但125mg/kg·BID增加了炎症因子的表达和胆汁酸负荷。在两个模型中,FENO(5mg/kg·BID)对肝脂肪变性和炎症几乎没有作用,也没有不良反应。FENO(125mg/kg·BID)加重了肝脏炎症,增加了胆汁酸合成,并促进了肝脏增殖的可能性。在毒性风险试验中,FENO(25mg/kg·BID)治疗引发胆汁酸合成、炎症和肝细胞增殖的可能性较低。一种新的方案,FENO(25mg/kg·BID)可能是治疗NASH的一种治疗策略。转化医学有必要在临床上证明其有效性。