Pathogenetic substantiation of approaches to the treatment of non-alcoholic fatty liver disease.

Abstract

Non-alcoholic fatty liver disease (NAFLD) affected 20-40% of the adult population in high developed countries. Active form of the disease - non-alcoholic steatohepatitis (NASH) - is characterized by damaged hepatocytes, inflammation of the liver tissue, can be accompanied by liver fibrosis, and is one of the most common causes of liver cirrhosis, liver failure and hepatocellular carcinoma. Moreover, there is a close link between NASH and metabolic syndrome, thereby among this category of patients the high risk of developing diabetes mellitus, cardiovascular complications and cancer. Weight reduction of 10% by observing dietary recommendations and performing regular physical exercises contributes to the reduction or complete resolution of NASH in some patients. However, in practice, it is not always possible to eliminate inflammation in the hepatic tissue. Existing drugs such as vitamin E, pioglitazone and pentoxifylline have limited efficacy, and can cause a few side effects, including hepatotoxicity, and not to reduce the severity of liver fibrosis. However, basic and translational studies have improved our understanding of the pathogenesis of NASH, thereby opening new promising therapeutic targets. Currently, several drug agents are in Phase II and Phase III clinical trials and may enter practice in the foreseeable future. In this article, we consider modern concepts of pathogenesis, existing therapeutic approaches and new directions of pharmacy in the field of NASH treatment.