Background/Aim. The metabolic disorders that predispose patients to non-alcoholic steatohepatitis (NASH) include insulin resistance and obesity. Repeated hypoxic events, such as occur in obstructive sleep apnoea syndrome have been designated as a risk factor in the progression of liver disease in such patients, but the mechanism is unclear, in particular the role of hypoxia. Therefore we studied the influence of hypoxia on the development and progression of steatohepatitis in an experimental mouse model. Methods. Mice with hepatocellular specific deficiency in the Phosphatase and Tensin Homolog (PTEN) gene, a tumour suppressor, were exposed to a 10% O2 (hypoxic) or 21% O2 (control) atmosphere for 7 days. Hematocrit, AST, glucose, triglycerides and insulin tolerance were measured in blood. Histological lesions were quantified. Expression of genes involved in lipogenesis, mitochondrial β-oxidation, as well as Foxo1, hepcidin, and CYP2E1 were analyzed by quantitative PCR. Results. The hematocrit increased (60±3% vs 50±2%, (p<0.01) and the ratio of liver weight/body weight increased (4.7±0.3% vs 5.4±0.2%, p<0.01) in the hypoxic animals. Steatosis was more pronounced (p<0.01) and the NASH Activity Score (NAS) score (8.3±2.4 vs 2.3±10.7, p<0.01) serum AST, triglycerides and glucose were higher in hypoxic mice. Insulin sensitivity decreased in hypoxic mice relative to controls. The expression of the lipogenic genes, SREBP-1c, PPARγ, ACC1 and ACC2 increased significantly in mice exposed to hypoxia, whereas mitochondria β-oxidation genes (PPARα, CPT1) decreased significantly. Conclusion. The findings demonstrate that hypoxia alone aggravates and accelerates the progression of NASH by upregulating the expression of lipogenic genes, by down-regulating genes involved in lipid metabolism and by decreasing insulin sensitivity.

Original post:
Hypoxia aggravates nonalcoholic steatohepatitis in mice lacking hepatocellular PTEN