Toward Genetic Prediction of Nonalcoholic Fatty Liver Disease Trajectories: PNPLA3 and Beyond

Gastroenterology. 2020 May;158(7):1865-1880.e1. doi: 10.1053/j.gastro.2020.01.053. Epub 2020 Feb 15.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is on the verge of becoming the leading cause of liver disease. NAFLD develops at the interface between environmental factors and inherited predisposition. Genome-wide association studies, followed by exome-wide analyses, led to identification of genetic risk variants (eg, PNPLA3, TM6SF2, and SERPINA1) and key pathways involved in fatty liver disease pathobiology. Functional studies improved our understanding of these genetic factors and the molecular mechanisms underlying the trajectories from fat accumulation to fibrosis, cirrhosis, and cancer over time. Here, we summarize key NAFLD risk genes and illustrate their interactions in a 3-dimensional "risk space." Although NAFLD genomics sometimes appears to be "lost in translation," we envision clinical utility in trial design, outcome prediction, and NAFLD surveillance.

Keywords: Adiponutrin; Genetic Risk Score; Genomics; Nonalcoholic Steatohepatitis; Risk Factor; Risk Prediction.

Publication types

  • Review

MeSH terms

  • Animals
  • Genetic Predisposition to Disease
  • Genetic Variation*
  • Genome-Wide Association Study
  • Humans
  • Lipase / genetics*
  • Membrane Proteins / genetics*
  • Non-alcoholic Fatty Liver Disease / diagnosis
  • Non-alcoholic Fatty Liver Disease / genetics*
  • Phenotype
  • Risk Assessment
  • Risk Factors

Substances

  • Membrane Proteins
  • Lipase
  • adiponutrin, human