Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 28, 2015; 7(27): 2749-2756
Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2749
Vitamin E reduces liver stiffness in nonalcoholic fatty liver disease
Aiko Fukui, Naoto Kawabe, Senju Hashimoto, Michihito Murao, Takuji Nakano, Hiroaki Shimazaki, Toshiki Kan, Kazunori Nakaoka, Masashi Ohki, Yuka Takagawa, Tomoki Takamura, Hiroyuki Kamei, Kentaro Yoshioka
Aiko Fukui, Naoto Kawabe, Senju Hashimoto, Michihito Murao, Takuji Nakano, Hiroaki Shimazaki, Toshiki Kan, Kazunori Nakaoka, Masashi Ohki, Yuka Takagawa, Tomoki Takamura, Kentaro Yoshioka, Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, Aichi 470-1192, Japan
Aiko Fukui, Hiroyuki Kamei, Department of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Aichi 468-8503, Japan
Author contributions: Fukui A proposed the study; Kawabe N, Hashimoto S, Murao M, Nakano T, Shimazaki H, Kan T, Nakaoka M, Ohki M, Takagawa Y, Takamura T and Yoshioka K performed the research; Fukui A collected and analyzed the data; Fukui A, Kawabe N, Kamei H and Yoshioka K contributed to the design and interpretation of the study and to further drafts; Yoshioka K is the guarantor; all authors contributed equally to this work.
Institutional review board statement: This study conformed to the Japanese Good Clinical Practice and the Declaration of Helsinki, and was reviewed and approved by the Ethics Committee of the Fujita Health University Hospital (IRB number: 14-020).
Informed consent statement: Each patient gave a written informed consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kentaro Yoshioka, MD, Department of Liver, Biliary Tract and Pancreas Diseases, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan. kyoshiok@fujita-hu.ac.jp
Telephone: +81-562-932324 Fax: +81-562-938601
Received: July 3, 2015
Peer-review started: July 6, 2015
First decision: September 8, 2015
Revised: September 20, 2015
Accepted: November 10, 2015
Article in press: November 11, 2015
Published online: November 28, 2015
Processing time: 147 Days and 6.6 Hours
Abstract

AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease (NAFLD).

METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin E were 150, 300, or 600 mg; three times per day after each meal. Responses were assessed by liver enzyme levels [aspartate aminotransferase (AST), alanine aminotranferease (ALT), and γ-glutamyl transpeptidase (γ-GTP)], noninvasive scoring systems of hepatic fibrosis-4 [FIB-4 index and aspartate aminotransferase-to-platelet index (APRI)], and liver stiffness [velocity of shear wave (Vs)] measured by acoustic radiation force impulse elastography. Vs measurements were performed at baseline and 12 mo after baseline. The patients were genotyped for the patatin-like phospholipase domain containing 3 (PNPLA3) polymorphisms and then divided into either the CC/CG or GG group to examine each group’s responses to vitamin E treatment.

RESULTS: We found marked differences in the platelet count, serum albumin levels, alkaline phosphatase levels, FIB-4 index, APRI, and Vs at baseline depending on the PNPLA3 polymorphism. AST, ALT, and γ-GTP levels (all P < 0.001); FIB-4 index (P = 0.035); APRI (P < 0.001); and Vs (P < 0.001) significantly decreased from baseline to 12 mo in the analysis of all patients. In the subset analyses of PNPLA3 genotypes, AST levels (P = 0.011), ALT levels (P < 0.001), γ-GTP levels (P = 0.005), APRI (P = 0.036), and Vs (P = 0.029) in genotype GG patients significantly improved, and AST and ALT levels (both P < 0.001), γ-GTP levels (P = 0.003), FIB-4 index (P = 0.017), and APRI (P < 0.001) in genotype CC/CG patients.

CONCLUSION: One year of vitamin E treatment improved noninvasive fibrosis scores and liver stiffness in NAFLD patients. The responses were similar between different PNPLA3 genotypes.

Keywords: Vitamin E, Acoustic radiation force impulse, Nonalcoholic fatty liver disease, Velocity of shear wave, Patatin-like phospholipase domain containing 3

Core tip: Responses to vitamin E treatment in nonalcoholic fatty liver disease patients were assessed by noninvasive scoring systems of hepatic fibrosis, and liver stiffness (velocity of shear wave) was measured by acoustic radiation force impulse elastography. Vitamin E treatment for 1 year improved not only liver enzyme levels but also noninvasive fibrosis scores and liver stiffness. Subsequently, the patients were divided into two groups according to patatin-like phospholipase domain containing 3 (PNPLA3) genotype (CC/CG or GG) to examine whether either group responded differently to the treatment. The responses were similar between different PNPLA3 genotypes.