Reduced lysosomal acid lipase activity: A new marker of liver disease severity across the clinical continuum of non-alcoholic fatty liver disease?

• Published in: World journal of gastroenterology : WJG Vol. 25; no. 30; pp. 4172 - 4180
• Main Authors: Francesco, Baratta, Daniele, Pastori, Domenico, Ferro, Giovanna, Carluccio, Giulia, Tozzi, Francesco, Angelico, Francesco, Violi, Maria, Del Ben
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.08.2019
• Subjects: Biomarkers - blood; Biomarkers - metabolism; Cholesterol Esters - metabolism; Disease Progression; Dried Blood Spot Testing; Enzyme Replacement Therapy - methods; Humans; Lipid Metabolism - genetics; Liver - pathology; Liver Cirrhosis - pathology; Liver Cirrhosis - prevention & control; Liver Function Tests - methods; Lysosomes - metabolism; Minireviews; Non-alcoholic Fatty Liver Disease - diagnosis; Non-alcoholic Fatty Liver Disease - drug therapy; Non-alcoholic Fatty Liver Disease - pathology; Severity of Illness Index; Sterol Esterase - blood; Sterol Esterase - deficiency; Sterol Esterase - genetics; Sterol Esterase - therapeutic use; Triglycerides - metabolism; Wolman Disease; Wolman Disease - drug therapy; Wolman Disease - genetics; Wolman Disease - pathology; Wolman disease; Cirrhosis; Lysosomal acid lipase; Cholesterol ester storage disease; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v25.i30.4172

Lysosomal acid lipase (LAL) plays a key role in intracellular lipid metabolism. Reduced LAL activity promotes increased multi-organ lysosomal cholesterol ester storage, as observed in two recessive autosomal genetic diseases, Wolman disease and Cholesterol ester storage disease. Severe liver steatosis and accelerated liver fibrosis are common features in patients with genetic LAL deficiency. By contrast, few reliable data are available on the modulation of LAL activity and on the epigenetic and metabolic factors capable of regulating its activity in subjects without homozygous mutations of the Lipase A gene. In the last few years, a less severe and non-genetic reduction of LAL activity was reported in children and adults with non-alcoholic fatty liver disease (NAFLD), suggesting a possible role of LAL reduction in the pathogenesis and progression of the disease. Patients with NAFLD show a significant, progressive reduction of LAL activity from simple steatosis to non-alcoholic steatohepatitis and cryptogenic cirrhosis. Among cirrhosis of different etiologies, those with cryptogenic cirrhosis show the most significant reductions of LAL activity. These findings suggest that the modulation of LAL activity may become a possible new therapeutic target for patients with more advanced forms of NAFLD. Moreover, the measurement of LAL activity may represent a possible new marker of disease severity in this clinical setting.