Therapeutic options in pediatric non alcoholic fatty liver disease: current status and future directions

Abstract

The epidemics of overweight and obesity has resulted in a significant increase of non alcoholic fatty liver disease (NAFLD), a potentially progressive condition. Currently, obesity related hepatopathy represents therefore the main cause of pediatric chronic liver disease. The first choice treatment at all ages is weight loss and/or lifestyle changes, however compliance is very poor and a pharmacological approach has become necessary. In the present article we present a systematic literature review focusing on established pediatric NALFD drugs (ursodeoxycholic acid, insulin sensitizers, and antioxidants) and on innovative therapeutic options as well.Regarding the former ones, a pediatric pilot study highlighted that ursodeoxycholic acid is not efficient on transaminases levels and bright liver. Similarly, a recent large scale, multicenter randomized clinical trial (TONIC study) showed that also insulin sensitizers and antioxidant vitamin E have scarce effects on serum transaminase levels. Among a large series of novel therapeutic approaches acting on recently proposed different pathomechanisms, probiotics seem hitherto the most interesting and reasonable option for their safety and tolerability. Toll-like receptors modifiers, Pentoxifylline, and Farnesoid X receptors agonists have been still poorly investigated, and will need further studies before becoming possible promising innovative therapeutic strategies.

ω-3 Fatty acids reverse lipotoxity through induction of autophagy in nonalcoholic fatty liver disease

“…Farnesoid X receptors agonists) have been still poorly investigated, and need further studies before becoming possible promising innovative therapeutic strategies [6,7].…”

The effect of pentoxifylline on IL-6 and PDGF expression in human keloid fibroblasts

“…[6] In addition, studies show that PTX appears to be beneficial in anti fibrosisarterial diseases, it can effectively inhibit the keloid of liver, lung, kidney fibrosis and skin scar. [4][5][6][7] Feng HY et al [10] reported that levels of I/III procollagen in keloids were higher than those in normal skin, while PTX could reduce the proliferation of fibroblasts and gene transcription of I/III procollagen, as well as TGF-βl levels obviously. In clinical research, PTX has been used in the treatment of keloid, but relevant basic research has been less reported.…”

“…Pentoxifylline (PTX) has been reported to have a wide range of anti-fibrosis capacity, it can effectively retain the fibrosis of liver, lung, renal and skin scar. [4][5][6][7] We use an in-vitro model of human NF and KF cultured with different dose of PTX, and study the effect on IL-6 and PDGF expression and further explore the potential pathogenesis of keloids.…”

Non Alkolik Yağlı Karaciğer Hastalığında Güncel Medikal Tedavi

“…Fiziksel aktivite, glukoz dengesi ve artmış insülin duyarlılığı gibi kilo kaybından bağımsız faydalı etkilerinden dolayı NAYKH'nın tedavisine entegre olmuştur. Ayrıca; fiziksel aktivite, hepatik trigliserid toplanmasını azaltır ve vücutta lipid oksidasyonunu düzeltir (11). Sonuç olarak, hepatosteatozdan kronik karaciğer hastalığına kadar NAYKH'nın her döneminde medikal tedaviden önce mutlaka yaşam tarzı değişikli-ği ön plana çıkarılmalıdır.…”