Nonalcoholic fatty liver disease (NAFLD) is now recognized as both an important component of the metabolic syndrome and the most prevalent liver disease in the United States. Although the mechanisms for development of steatosis and chronic liver injury in NAFLD remain unclear, recent investigations have indicated that overactivation of c-Jun N-terminal kinase (JNK) is critical to this process. These findings, together with evidence for the involvement of JNK signaling in other manifestations of the metabolic syndrome such as obesity and insulin resistance, have suggested that JNK may be a novel therapeutic target in this disorder. This review details findings that JNK mediates lipid accumulation and cell injury in fatty liver disease and discusses the possible cellular mechanisms of JNK actions.
Nonalcoholic fatty liver disease is an important component of the metabolic syndromeThe metabolic syndrome has been defined classically by the clinical features of obesity, glucose intolerance, dyslipidemia and hypertension [1]. This disorder is highly prevalent, affecting 50 million people in the United States alone, and its incidence is increasing with the rising rates of obesity and diabetes. The metabolic syndrome is a significant cause of morbidity and an independent predictor of mortality in older adults [2]. Although interest has largely focused on cardiovascular complications resulting from accelerated atherosclerosis [3], the importance of increased lipid accumulation in other organs that characterizes the metabolic syndrome is now being recognized. One such manifestation is nonalcoholic fatty liver disease (NAFLD) [4]. NAFLD contributes to the morbidity and mortality of the metabolic syndrome, and one long-term study demonstrated a higher mortality rate in type 2 diabetics from liver disease than cardiovascular disease [5]. In addition to effects from the actual liver disease, fatty liver and the associated hepatic insulin resistance contribute to the metabolic syndrome because of the liver's central role in glucose and lipid homeostasis. The presence of liver injury predicts the development of cardiovascular disease [6,7], suggesting a central function for NAFLD in clinical manifestations of the metabolic syndrome.