Nonalcoholic fatty liver disease (NAFLD) is characterized by increased lipid deposition within hepatocytes attributable to metabolic causes in the absence of viral hepatitis or liver disorders caused by excessive alcohol or toxic drug consumption or other liver disorders. In the majority of patients, NAFLD manifests histologically as "simple steatosis" defi ned as hepatic steatosis without substantial infl ammation or fi brosis. Simple steatosis carries a very low risk of progression to cirrhosis and liver dysfunction ( 1 ). However, 10-30% of patients with NAFLD have or develop nonalcoholic steatohepatitis (NASH), characterized by hepatic lobular infl ammation and fi brosis in addition to steatosis. Progression to cirrhosis occurs in a proportion of patients ( 1, 2 ). The factor(s) responsible for the development of progressive NASH, as opposed to simple steatosis, remain unclear. A prominent concept that has been invoked to explain the development of NASH is that of lipotoxicity. Hepatic lipotoxicity implies that exposure to, or accumulation of, certain lipid species within hepatic cells may directly cause cellular toxicity or act in a proinfl ammatory or profi brotic manner. According to the hypothesis of hepatic lipotoxicity, NASH develops when the liver is exposed to lipotoxic lipid species, whereas simple steatosis develops in response to over-nutrition when the liver is not signifi cantly exposed to lipotoxic lipid species. It is generally accepted that triglycerides, which constitute the majority of hepatic lipids in NASH and simple steatosis, are a "safe" storage lipid with little or no lipotoxic potential. Relatively small quantities of other lipotoxic lipid species may exert a disproportionate impact in the development of NASH.Lipidomic analyses of human livers with NAFLD reported that levels of free (unesterifi ed) cholesterol (FC) were increased in NASH but not in simple steatosis, whereas levels of
Abstract Cholesterol crystals form within hepatocyte lipid droplets in human and experimental nonalcoholic steatohepatitis (NASH) and are the focus of crown-like structures (CLSs) of activated Kupffer cells (KCs). Obese, diabetic