The Korean Journal of Hepatology 2011;17:247-249 http://dx.doi.org/10.3350/kjhep.2011.17.3.247 The Korean Journal of Hepatology Elsewhere Apoptosis and diagnosis of nonalcoholic steatohepatitis Chang Wook Kim and Chang Don Lee Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea An apoptosis panel for nonalcoholic steatohepatitis diagnosis. Tamimi TI, Elgouhari HM, Alkhouri N, Yerian LM, Berk MP, Lopez R, Schauer PR, Zein NN, Feldstein AE. J Hepatol 2011;54:1224-1229. Nonalcoholic fatty liver disease (NAFLD) is a wide-spectrum disease entity from simple hepatic steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. After Ludwig et al1 introduced the name of NASH firstly in 1980, the concerns about NASH have been explored intensively. The majority of cryptogenic cirrhosis diagnosed in the past presume the progressed state of NASH. Approximately 90% of abnormal liver function without specific causes such as virus, alcohol, toxic and genetic factor presumes NAFLD.2 For diagnosis of NAFLD, several causes which can induce hepatic steatosis should be excluded such as protein-calorie malnutrition, starvation, total parenteral nutrition, rapid weight loss, amiodarone, methotraxate, valproic acid, glucocorticoid, calcium-channel blocker, tamoxifen, tetracycline, and aspirin.2 Although the prevalence of NAFLD is different among countries and races, about 10-20% of general population may have NAFLD.2 Simple hepatic steatosis is usually thought as a non-progressive condition,3 but about 5% of hepatic steatosis can progress to NASH.4 In contrast to hepatic steatosis, approximately 30% of NASH shows the progression of fibrosis within 5 years;5 about 20% of NASH progresses to cirrhosis during lifetime.6 Once cirrhosis is developed, the risk of complications of cirrhosis is increased such as ascites, variceal bleeding, hepatic encephalopathy and development of hepatocellular carcinoma.7 NASH should be discriminated from simple hepatic steatosis because of the above reasons. Liver biopsy is still gold standard for differentiating between steatosis and NASH. The pathologic findings of NASH are macrovesicular steatosis, lobular inflammation, Mallory bodies, ballooning degeneration, and perisinusoidal/perivenular fibrosis. Using these parameters, Brunt et al8 introduced necro- inflammatory grade and fibrosis score system for NASH in 1999. Recently, NASH Clinical Research Network introduced new system in which the degrees of steatosis, lobular inflammation, hepatocyte ballooning and Mallory bodies are scored as NAFLD activity score (NAS).9 NASH can be differentiated from hepatic steatosis with NAS system. However, liver biopsy is an invasive procedure with significant complication like bleeding. Several non-invasive biomarkers for diagnosis of NASH have been investigated recently. Palekar et al10 investigated the model for predicting NASH using 8-epi-PGF2α, TGF-β, hyaluronic acid and adiponectin (sensitivity: 73.7%, specificity: 65.7%, positive predictive value: 68.2%, negative predictive value: 68.2%). Poynard et al11 introduced the model, Steatotest for predicting over 30% steatosis using alanine aminotransferase (ALT), a2-macroglobulin, apolipoprotein A-I, haptoglobin, total bilirubin, γ-glutamyl transpeptidase (GGT), cholesterol, triglycerides, glucose, age, gender and body mass index (BMI) (sensitivity: 90%, specificity: 90%, negative predictive value: 93%, positive predictive value: 63%). FibroTest was introduced for predicting Keywords: Fatty liver, Nonalcoholic; Diagnosis; Apoptosis; Fas receptor; Cytokeratin 18 Abbreviations: NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; NAS, NAFLD activity score; ALT, alanine aminotransferase; GGT, γ-glutamyl transpeptidase; BMI, body mass index; AST, aspartate aminotransferase; CK-18, cytokeratin 18; sFas, soluble Fas; AUC, area under curve Corresponding author: Chang Wook Kim Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, 65-1 Geumo-dong, Uijeongbu 480-717, Korea Tel. +82-31-820-3000, Fax. +82-31-847-2719, E-mail; cwkim@catholic.ac.kr Copyright Ⓒ 2011 by The Korean Association for the Study of the Liver The Korean Journal of Hepatology∙pISSN: 1738-222X eISSN: 2093-8047