Non-alcoholic fatty liver disease is associated with bacterial translocation and a higher inflammation response in psoriatic patients

Abstract

Psoriasis and non-alcoholic fatty liver disease (NAFLD) are both inflammatory diseases. The study objective was to estimate the risk of NAFLD, non-alcoholic steatohepatitis, and liver fibrosis (by liver stiffness and liver biopsy) in patients with psoriasis and to determine the epidemiological, clinical, immunological (TNF-α, IL-2, IL-6, IL-12, IL-17, IL-23, and TGF-β) characteristics, and bacterial translocation. Of the 215 psoriatic patients included, 91 presented NAFLD (prevalence: 42.3%). Compared to patients with psoriasis alone, those with NAFLD were significantly more likely to have metabolic syndrome, diabetes, dyslipidemia, body mass index ≥ 30 kg/m2, homeostatic model assessment of insulin resistance ≥ 2.15, and greater psoriasis area severity index. NAFLD patients also had significantly higher levels of TNF-α (p = 0.002) and TGF-β (p = 0.007) and a higher prevalence of bacterial translocation (29.7% vs. 13.7%; p = 0.004). Liver stiffness measurement was over 7.8 kPa in 17.2% (15/87) of NAFLD patients; 13 of these underwent liver biopsy, and 5.7% (5/87) had liver fibrosis, while 1.1% (1/87) had advanced fibrosis or non-alcoholic steatohepatitis. In conclusion the prevalence of NAFLD in patients with psoriasis is high and associated with a higher prevalence of metabolic syndrome features, bacterial translocation and a higher pro-inflammatory state. It is worth mentioning that liver fibrosis and non-alcoholic steatohepatitis are not frequent in this population of patients.

Non-Alcoholic Fatty Liver Disease (NAFLD) in Patients with Psoriasis: A Review of the Hepatic Effects of Systemic Therapies

“…8,13,14 NAFLD has been shown to occur 1.5 to 3 times more frequently in patients with psoriasis than in the general population. 3,11,15 Prevalences of NAFLD ranging up to 65% have been reported in this patient population. 16 The increased risk of NAFLD in psoriasis patients is not surprising, as the two diseases share a common link with the metabolic syndrome.…”

“… 65 As acitretin frequently causes hyperlipidemia, use is preferably avoided in patients with or at high risk of NAFLD. 11 , 75 , 79 , 80…”

“… 9 The global prevalence of NAFLD is estimated to be 25%. 10 , 11 The presence of NASH in the general population is difficult to ascertain since it can be confirmed only by liver biopsy. However, rates between 1.5 and 6.5% have been reported.…”

The Stiffness of Cardiac Fibroblast Substrates Exerts a Regulatory Influence on Collagen Metabolism via α2β1 Integrin, FAK and Src Kinases

“…These cells also modify the physical properties of their extracellular spaces by collagen deposition. Fibrosis increases the stiffness of the extracellular space [ 24 ] and the intensity of this process may modify the rigidity of the cell environment. Similarly, Col1A1 gene expression was found to be elevated.…”

Analysis of Common Pathways and Markers From Non-Alcoholic Fatty Liver Disease to Immune-Mediated Diseases

“…A recent study has reported more than 40% prevalence of MAFLD in a cohort of more than two hundred psoriatic patients, higher than the prevalence described in the general population. This rate was found to be also associated with a higher prevalence of bacterial translocation and a higher pro-inflammatory state, evaluated by increased serum levels of TNF-α and transforming growth factor-beta (TGF-β) ( 97 ). Finally, it has been reported that psoriasis plus MAFLD confers a higher risk of developing cardiovascular disease at 10 years compared to psoriasis alone ( 98 ).…”