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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : BC01 - BC04 Full Version

Quantification of Microsomal Triglyceride Transfer Protein in Non Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56386.16811
Mayuri Shukla, Mamatha Kunder, Prabhakar Kamarthy, Sharath Balakrishna

1. PhD Scholar, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 2. Assistant Professor, Department of Biochemistry, Sri Devaraj Urs Medical College, Kolar, Karnataka, India. 3. Professor, Department of Medicine, Sri Devaraj Urs Medical College, Kolar, Karnataka, India. 4. Associate Professor and Head, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India.

Correspondence Address :
Dr. Mamatha Kunder,
Department of Biochemistry, Sri Devaraj Urs Medical College, Tamaka, Kolar-563101, Karnataka, India.
E-mail: kundermamatha1@gmail.com

Abstract

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) is one of the common liver disease characterised by fat accumulation in hepatocytes. NAFLD is a broad spectrum of simple steatosis, Non Alcoholic Steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Triglycerides (TG) are exported in the form of Very Low Density Lipoprotein (VLDL). VLDL are formed by incorporation of TG into apo-B by Microsomal Triglyceride transfer Protein (MTP). Therefore, MTP is a key protein for lipid transport. Estimation of MTP protein levels and its correlation with simple steatosis and steatohepatitis can be helpful in understanding its role in NAFLD progression.

Aim: To estimate the serum levels of MTP in simple steatosis and steatohepatitis and also to check its correlation with TG and VLDL in NAFLD patients with and without co-morbidities.

Materials and Methods: The present cross-sectional study was carried out in Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India, between November 2019 to January 2021. Study participants included 60 NAFLD subjects which were divided into simple steatosis (group 1, n=10) and steatohepatitis (group 2, n=50). These subjects were further subdivided into cases with co-morbidities and cases without co-morbidities. Serum levels of MTP, high sensitivity C Reactive Protein (hs-CRP), Fasting Blood Sugar (FBS), liver enzymes, lipid profile were assessed. Statistical analysis was done by using unpaired Student’s t-test and Pearson’s correlation.

Results: The mean age was 46.5 years in steatosis group and 48.85 years in steatohepatitis group. In steatosis group, there were 5 (50%) males and 5 (50%) females, whereas in steatohepatitis group 32 (64%) were females and 18 (36%) were males. The serum levels of MTP were significantly decreased in simple steatosis cases with co-morbidities as compared to cases without co-morbidities (p=0.006). A significant negative correlation was observed between MTP v/s TG and MTP v/s VLDL (r=-0.665, p=0.036) in simple steatosis cases with and without co-morbidities. Same trend was observed in steatohepatitis cases but the correlation was insignificant (r=-0.08, p=0.563).

Conclusion: The serum levels of MTP decreases as the NAFLD progresses. A significant decrease in serum levels of MTP was also observed in cases with co-morbidities as compared to cases without co-morbidities. Serum levels of MTP showed negative correlation with TG and VLDL in simple steatosis cases.

Keywords

Co-morbidities, Hyperlipidaemia, Lipid transportation, Non alcoholic steatohepatitis, Very low density lipoprotein

NAFLD is the most common liver disease with a prevalence of 9-32% in India and 25% of global adult population (1). NAFLD is characterised by the accumulation of excessive fat in the liver in absence of alcohol intake (2). NAFLD includes different stages, where simple fat accumulation without any inflammation of hepatocytes is termed as Simple steatosis or Non Alcoholic Fatty Liver (NAFL). Simple steatosis if left untreated further progresses to inflammation of hepatocytes and this stage is termed as NASH, followed by fibrosis and hepatocellular carcinoma (3).

Fat accumulation in liver can be a result of either lack of breakdown of fatty acids or lack of fatty acid export from liver to peripheral tissues (4),(5). TG are exported from liver in the form of VLDL particles. TG rich VLDL particles represent the mechanism by which fatty acids are exported from the liver and delivered to muscle for oxidation and adipose tissue for storage, respectively (6).

VLDL are formed by incorporation of TG into apolipoprotein B (apoB) by MTP (7),(8),(9). MTP was identified as a major cellular protein capable of transferring neutral lipids and is localised to endoplasmic reticulum in hepatocytes. MTP is a heterodimer with two distinct subunits. A unique large α-subunit (97kDa) and a multifunctional Protein Disulfide Isomerase (PDI) β-subunit (55kDa). The 97kDa subunit confers all of the lipid transfer activity to the heterodimer (10). VLDL assembly is a two-step process that begins in the endoplasmic reticulum lumen. In the first step, MTP acts to incorporate a small amount of TG in apoB100 as it is being translated by ribosomes and translocated across the endoplasmic reticulum membrane (6). In the second step, additional TG is packaged into the nascent apoB100-containing particles as they traverse from the endoplasmic reticulum to the golgi apparatus to form VLDL particles (11).

In-vitro studies have shown that lipid transfer by the MTP is most efficient with TG and cholesterol although MTP transfers polar lipids also along with the neutral lipids (8),(12). According to several lines of evidence, MTP polymorphisms have been linked to lipid homeostasis and, in turn, to a higher risk of NAFLD (13),(14). Lower hepatic expression of MTP plays a crucial role in NAFLD development and is one of the potential gene found to be associated with NAFLD susceptibility (15). The most common and widely investigated polymorphism in MTP gene is -493 G>T (rs1800591) (16),(17).

Therefore, aim was to study MTP in simple steatosis and steatohepatitis, which can be helpful in assessing the disease progression. Simple steatosis is asymptomatic and steatohepatitis is an advanced stage which further progresses to irreversible conditions like fibrosis and cirrhosis. Usually many patients are diagnosed only at advanced stage of NAFLD (18). Therefore, assessment of NAFLD is essential at early stages to prevent the further complications and progression of the disease. Hence, simple steatosis and steatohepatitis were selected in this study, to stratify before NAFLD progresses to advanced stages. However, to the best of our knowledge, till date no study measured the serum levels of MTP. Thus, this study was aimed to measure the serum levels of MTP and also to check its correlation with the stages of NAFLD in patients with or without co-morbidities in order to understand its role in disease progression.

Material and Methods

The present-cross sectional study was carried out in Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India between November 2019 to January 2021. Study was approved by the Institutional Ethics Committee (IEC) of Sri Devaraj Urs Medical College (DMC/KLR/IEC/657/2021-22). The written informed consent was obtained prior to the recruitment of the subjects.

Inclusion criteria: NAFLD patients, aged between 25-60 years and with or without complications (diagnosed by laboratory tests, Ultrasonography) such as obesity, hyperlipidaemia, hypertension, diabetes and cardiovascular diseases, were included in the study.

Exclusion criteria: Subjects with other chronic liver diseases like hepatitis, chronic obstructive pulmonary disease, alcohol consumption, smoking history were excluded from the study.


Sample size calculation: Total 60 patients were enrolled in present study by convenient sampling.

Subjects and Study Design

The study participants included 60 NAFLD patients. The patients were broadly categorised into two groups; group 1 (simple steatosis) and group 2 (steatohepatitis). National Cholesterol Education Program Adult Treatment Panel (NCEP ATPIII) guidelines (19) and ultrasonography were followed to differentiate the stages. Cases with high serum levels of liver enzymes like Alanine transaminase (ALT) (<35 mg/dL), Aspartate aminotransferase (AST) (<45 mg/dL) and TG (>150 mg/dL) along with impression of hepatomegaly with fatty infiltration were considered as steatohepatitis or NASH. In addition to above, cases without inflammation (hs-CRP within the normal range: <10 mg/L) were considered as simple steatosis and with inflammation (hs-CRP >10 mg/L) were considered as steatohepatitis in the present study (19).

Simple steatosis (Group 1): Characterised by increased fat accumulation without inflammation included 10 patients. Further patients with simple steatosis were subdivided based on co-morbidities into- 1A (cases with co-morbidities- five patients) and 1B (cases without co-morbidities-five patients).

Steatohepatitis (Group 2): Characterised by increased fat accumulation with inflammation included 50 patients. Patients with steatohepatitis were subdivided based on co-morbidities into- 2A (cases with co-morbidities- 25 patients) and 2B (cases without co-morbidities- 25 patients).

The co-morbidities like obesity, hyperlipidaemia, hypertension, diabetes and cardiovascular diseases were considered. Body Mass Index (BMI) was calculated to confirm obesity, FBS was measured for diabetic patients, and blood pressure for hypertension. Patients with any three of the above mentioned co-morbidities were considered in cases with co-morbidities group.

Sample Collection

Five mL venous blood was collected from all the subjects in tubes containing sodium fluoride for FBS estimation. For investigations like hs-CRP, Liver Function Tests (LFT) and lipid profile blood was collected in tube without anticoagulant. Blood samples were centrifuged at 3000rpm for 10 minutes at room temperature within 2 hours. of collection. Basic parameters were analysed immediately and serum for MTP estimation was aliquoted and stored at -70°C until further analysis.

Biochemical Evaluation

The biochemical parameters were analysed by standard methods using Vitros 5.1 FS clinical chemistry analyser (Table/Fig 1). VLDL was calculated using Friedwald’s formula. Serum levels of MTP were estimated by Enzyme Linked Immunosorbent Assay (ELISA) using a commercial kit. (Catalogue no. SEC641Hu, Cloud clone corp., USA).

Statistical Analysis

Statistical analysis was carried out using Graph Pad Prism V.9. Shapiro-Wilk test was used to assess the normality of data. Statistical difference between the two groups were analysed using unpaired t-test. Results are represented as Mean±Standard Deviation (SD). Pearson’s correlation was used to determine the relationship between variables. The p-value <0.05 was considered statistically signi?cant and p-value <0.0001 as highly significant.

Results

Simple steatosis had 5 (50%) females and 5 (50%) males and there were 32 (64%) females and 18 (36%) males in steatohepatitis. No statistical differences (p<0.05) were observed between Simple steatosis and Steatohepatitis, with respect to age, BMI, FBS and Lipid profile. The hs-CRP levels showed a significant increase in Steatohepatitis (group 2) as compared to Simple steatosis (group 1) (p<0.0001). Steatohepatitis subjects had higher serum levels of TG and VLDL (217.71±97.16) (43.54±19.43) respectively as compared to serum levels of triglyceride and VLDL Simple steatosis subjects (193.2±80.30) (38.64±16.06) respectively, but did not show any statistically significant difference (p=0.071).Serum MTP levels were measured and analysed in Simple steatosis (1.93±0.61) and Steatohepatitis (1.48±1.02) patients of NAFLD subjects and no statistical significant difference was observed (p=0.995) (Table/Fig 2).

Mean VLDL and TG levels were significantly higher in NAFLD patient with co-morbidities as compared to NAFLD without co-morbidities in Steatohepatitis patients and this difference was significant (p<0.0001), but non-significant in Simple steatosis patients (p=0.107). Mean MTP levels were significantly lower in NAFLD cases with co-morbidities as compared to NAFLD cases without co-morbidities in Simple steatosis patients (p=0.006), but non-significant in Steatohepatitis patients (p=0.532) (Table/Fig 3).

Correlation analysis was done between serum levels of MTP versus TG and MTP versus VLDL. A negative correlation was observed in both the cases with co-morbidities (group 1A and 2A), suggesting inverse relation between MTP and TG as well as VLDL. However, a significant negative correlation was observed between MTP and TG, VLDL in simple steatosis cases with and without co-morbidities (1A+1B) (r=-0.665, p=0.036) (Table/Fig 4).

Discussion

MTP as the name suggests is involved in transfer of TG from hepatocytes to the peripheral tissues. Therefore, if MTP is dysfunctional it may contribute to TG accumulation in hepatocytes which eventually results in fatty liver (20),(21). Present study measured and compared the serum levels of MTP in NAFLD subjects with Simple steatosis (Group 1) and Steatohepatitis (Group 2). Present study results showed that levels of MTP were decreased in Steatohepatitis as compared to Simple steatosis. As Steatohepatitis of NAFLD is associated with inflammation and is the advanced stage of NAFLD, decreased levels of MTP in Steatohepatitis indicates impact of its association with NAFLD and its stages.

Studies have associated NAFLD with co-morbidities like obesity, diabetes mellitus, cardiovascular disease and hyperlipidaemia (22),(23),(24),(25),(26). These co-morbidities with NAFLD carries an increased risk of liver related morbidity and mortality (27). Therefore, in this study authors wanted to investigate whether MTP levels are affected by the presence of co-morbidities in NAFLD patients. In the present study, when MTP levels were compared between cases with co-morbidities and cases without co-morbidities in both the stages, subjects with co-morbidities had decreased levels of MTP as compare to subjects without co-morbidities. This further supports the role of MTP in pathogenesis and progression of NAFLD stages.

NAFLD is a multifactorial disease that results from complicated interactions among dietary components, lifestyle choices and genetic determinants (28). Several research have been looked into gene-expression based NAFLD staging in order to better understand disease progression and find the effective treatment (29),(30),(31). An interaction between MTP and NAFLD is also been identified with the help of genetic studies. A polymorphism at promoter region (-493G/T) of MTP is associated in NASH with type 2 Diabetes Mellitus. The G allele is associated with decreased MTP transcription and is prone to increased TG content in hepatocytes (30),(32),(33). Transversion of base guanine to thymine at 493 position in the promoter region of MTP is found to be associated with decreased transcription level of MTP and failure in TG secretion from hepatocytes which increases the susceptibility to NAFLD (17),(20). The -493 allele is also considered as a risk factor in pathogenesis of metabolic syndromes (34). The polymorphism in MTP gene is also been suggested to be a useful and practical biomarker for early diagnosis of NAFLD (35). Therefore, decreased serum levels of MTP observed in advanced stage of NAFLD in present study thus could be linked to altered gene expression.

Limitation(s)

The study was limited firstly by small sample size due to inadequate number of patients who met the inclusion criteria and secondly due to lack of genetic analysis.

Conclusion

The decreased serum levels of MTP in advanced NAFLD stage suggests that MTP can be a complementary marker in differentiating simple steatosis from steatohepatitis. As MTP also shows a negative correlation with TG and VLDL when compared between cases with co-morbidities and cases without co-morbidities, therefore MTP can be considered as complementary marker in subjects with co-morbidities as well. For further prospects, studies involving all stages of NAFLD in a larger population are required. The genetic analysis and increased sample size might show significant results which can be helpful in identifying MTP as a complementary marker for differentiating the simple steatosis from steatohepatitis and assessing the disease progression.

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DOI and Others

DOI: 10.7860/JCDR/2022/56386.16811

Date of Submission: Mar 15, 2022
Date of Peer Review: Apr 08, 2022
Date of Acceptance: May 27, 2022
Date of Publishing: Sep 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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