approach, a single nucleotide polymorphism of the patatin-like phos-pholipase domain containing three
genes (rs738409) was found to be
significantly associated with steatosis and the more progressive forms
of NAFLD. Other polymorphisms of
various genes have also been shown
to be associated with increased risk
of NAFLD, such as glucokinase regu-latory protein and neurocan. In the
last decade, family and twin studies
have suggested that NAFLD may be
heritable and we suspect that future
studies will likewise uncover the
genetic roots of NAFLD. 17 With advancements in genomics, proteomics,
and metabolomics technologies, and
the application of these platforms in
the field of NAFLD, new noninvasive
prognostic and diagnostic biomarkers are likely to be discovered in the
near future. 18 Utilization of these
platforms can not only help scientists
identify biomarkers for the early
diagnosis of NASH, but also identify
potential targets for therapeutic interventions.
Although development of fibrosis
in patients with NAFLD and NASH
was historically believed to be an
irreversible step in the path to cirrhosis, recent studies revealed that
cirrhosis is a dynamic and reversible disease stage. 19 Scientists are
now searching for novel therapeutic
strategies that target specific steps
in the process of fibrogenesis with
the aim of reversing advanced fibrosis and cirrhosis.
Today, the cornerstones of the
treatment of NAFLD are lifestyle interventions, which are effective not
only for improving NAFLD, but also
for the risk factors of metabolic syndrome and cardiovascular diseases.
Nevertheless, lifestyle modifications
are difficult to achieve and sustain.
In addition to the above-mentioned
pharmacologic agents, current
studies are focusing on caspase
inhibitors, PPAR alpha and delta,
farnesoid-X-receptor agonists, and
modulation of certain enzymes that
play a role in preventing the in-
flammation that is associated with
metabolic syndrome.20 Although
promising results have been carried
out, more research is necessary for
developing new regimens for pa-
tients with NASH. n
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