Therapeutic potential of sodium selenite in patients with non-alcoholic fatty liver disease and hypertension disease

Abstract

Liver parenchyma damage is associated with significant activation of oxidative stress. Correction of oxidative stress can be a promising direction in the treatment of arterial hypertension. It has been established that in patients with hepatopathies, lower concentrations of selenium are found in blood and erythrocytes, which gives reason to consider selenium as a potential therapeutic agent in patients with liver pathology.
 Objective — to determine the therapeutic potential of sodium selenite in patients with non‑alcoholic fatty liver disease in combination with hypertension.
 Materials and methods. 100 patients with nonalcoholic fatty liver disease (NAFLD) were included in the study: the main group — 49 patients (67.3% women, median age is 51.0 years) with concomitant NAFLD and arterial hypertension (HTN), the comparison group — 51 patients (58.8% women, median age is 52.0 years) with NAFLD isolated course. The control group included 20 practically healthy people (55.0% women, median age is 51.0 years). Among the patients of the main group, the first degree of HTN was diagnosed in 28.6% of patients (14 people), the second degree — 71.4% (35 people). Among these patients, 32.7% (16 people) had the first stage of HTN, 67.3% (33 people) had the second stage. In the main group, 55.1% of patients had steatosis, 44.9% had steatohepatitis. In the comparison group, 58.8% had steatosis, 41.2% had steatohepatitis (χ2=0.141, p=0.707). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured according to the standard method (kinetic method). Gamma‑glutamine transpeptidase (GGTP) was measured by the enzymatic colorimetric method, alkaline phosphatase (AP) by the colorimetric method. Selenium and selenoprotein P (Sel P) levels were determined using the immunofluorescence method. Ultrasound examination of the liver was performed according to the standard method on an empty stomach.
 Results. Body mass index corresponded to normal or increased body weight: in the main group — 27.8 [26.6; 28.5] kg/ m2 and 27.3 [24.2; 28.3] kg/ m2 in the comparison group, in the control group — 24.3 [21.9; 26.0] kg/ m2. In patients of the main group was determined a significant (p <0.001) predominance of ALT levels (45 [43.0; 47.5] U/ L), AST levels (53 [51.0; 56.0] U/ L), AP levels (285.7 [217.6; 321.1] U/ L) and GGTP levels (96.2 [75.0; 108.9] U/ L) opposite to comparison group (respectively 36 [34.0; 39.0] U/ L, 41 [40.0; 45.0] U/ L, 215.5 [183.2; 246.7] U/ L and 65.5 [51.5; 76.8] U/ L) and control group levels (respectively 25.5 [24.0; 30.8] U/ L, 23 [19.3; 26.0] U/ L, 129.2 [116.9; 140.6] U/ L and 22.6 [16.1; 31.7] U/ L). A two‑fold decrease in selenoprotein P levels was obtained in patients with NAFLD and HTN compared to patients with NAFLD (19.7 [8.0; 26.7] ng/ mL and 43.1 [41.3; 45.4] ng/ mL respectively, p <0.001), and selenium in one and a half times compared to patients with NAFLD (43.5 [39.9; 49.1] g/ L and 67.2 [61.5; 77.4] g/ L respectively, p <0.001). The highest Sel P median levels (71.0 [54.3; 76.1] ng/ ml and selenium levels (108.0 [96.9; 118.8] g/ L) registered in the control group (p <0.001). Evaluating the data on selenium metabolism and liver tests depending on the intake of sodium selenite, a significant increase in the levels of Sel P (53.6 [43.1; 60.4] ng/ ml, p <0.001) and selenium (89.1 [63, 4; 99.5] g/ L, p <0.009), as well as a decrease in AST levels (41.7 [32.6; 43.2] U/ l, p <0.001) in the group with isolated NAFLD, while in the group with NAFLD and HTN comorbid course, no significant changes in the studied parameters were detected.
 Conclusions. The obtained results provide a basis for sodium selenite use in the therapy of patients with NAFLD. Further research on the duration of such therapy and sodium selenite dosing regimen in patients with a comorbid course of NAFLD and HTN is a promising and relevant direction.