Cited by 228Liver Disease Diagnosis and TreatmentLiver physiology and pathologyLipid metabolism and disorders

The DOI matches its Crossref record; 43 of the 45 references it cites were found in a registry or an index; none of the 13 sources its claims cite is checked for support yet.

Leptin reverses nonalcoholic steatohepatitis in patients with severe lipodystrophy†

Open access

Javor, Edward D., Ghany, Marc G., Cochran, Elaine K., Oral, Elif Arioglu, DePaoli, Alex M., Premkumar, Ahalya, Kleiner, David E., Gorden, Phillip·2005·Hepatology

DOI 10.1002/hep.20672

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Abstract

Severe lipodystrophy is characterized by diminished adipose tissue and hypoleptinemia, leading to ectopic triglyceride accumulation. In the liver, this is associated with steatosis, potentially leading to nonalcoholic steatohepatitis (NASH). We investigated the prevalence of NASH and the effect of leptin replacement in these patients. Ten patients with either generalized lipodystrophy (8 patients) or Dunnigan's partial lipodystrophy (2 patients) were included in this analysis. Paired liver biopsy specimens were obtained at baseline and after treatment with recombinant methionyl human leptin (r-metHuLeptin), mean duration 6.6 months. The extents of portal and parenchymal inflammation, steatosis, ballooning, presence of Mallory bodies, and fibrosis in liver biopsy specimens were scored using a previously validated system developed to assess NASH activity. Histological disease activity was defined as the sum of ballooning, steatosis, and parenchymal inflammation scores. We concurrently tested serum triglycerides and aminotransferases and estimations of liver volume and fat content by magnetic resonance imaging. Eight of 10 patients met histological criteria for NASH at baseline. After treatment with r-metHuLeptin, repeat histological examinations showed significant improvements in steatosis (P = .006) and ballooning injury (P = .005), with a reduction of mean NASH activity by 60% (P = .002). Fibrosis was unchanged. Significant reductions were seen in mean serum triglycerides (1206-->226 mg/dL, P = .002), glucose (220-->144 mg/dL, P = .02), insulin (46.4-->24.8 muIU/mL, P = .004), ALT (54-->24 U/L, P = .02), AST (47-->22 U/L, P = .046), liver volume (3209-->2391 cm(3), P = .007), and liver fat content (31-->11%, P = .006). In conclusion, r-metHuLeptin therapy significantly reduced triglycerides, transaminases, hepatomegaly, and liver fat content. These reductions were associated with significant reductions in steatosis and the hepatocellular ballooning injury seen in NASH.

AI snapshot

Written from the paper’s full text.

TL;DR

In 10 patients with severe lipodystrophy and hypoleptinemia, recombinant methionyl human leptin (r-metHuLeptin) treatment was associated with significant histological improvement in nonalcoholic steatohepatitis (NASH), alongside reductions in liver fat, liver volume, triglycerides, and aminotransferases. Fibrosis did not change over the mean 6.6-month treatment period.

Key findings

Eight of 10 patients met histological criteria for NASH at baseline; after r-metHuLeptin, 6 of the 8 (75%) no longer met those criteria, and the group prevalence of NASH fell from 80% to 20% (P = .03).
Mean NASH activity score decreased by 60%, from 5.3 ± 0.8 to 2.1 ± 0.4 (P = .002), with significant improvements in steatosis (1.7 ± 0.4 to 0.4 ± 0.2; P = .006) and ballooning injury (1.5 ± 0.4 to 0.3 ± 0.2; P = .005); fibrosis was unchanged (1.9 ± 0.4 to 1.9 ± 0.5; P = .1).
Mean serum triglycerides fell from 1,206 ± 590 to 226 ± 57 mg/dL (P = .002), fasting glucose from 220 ± 27 to 144 ± 13 mg/dL (P = .02), fasting insulin from 46.4 ± 13.0 to 24.8 ± 7.4 IU/mL (P = .004), ALT from 54 ± 13 to 24 ± 4 U/L (P = .02), and AST from 47 ± 11 to 22 ± 2 U/L (P = .046).
Mean liver volume decreased from 3,209 ± 348 to 2,391 ± 254 cm³ (P = .007), and mean liver fat by MRI decreased from 31% ± 7% to 11% ± 6% (P = .006).

Methods

Open-label pilot study of r-metHuLeptin in 10 patients with severe lipodystrophy: 4 congenital generalized lipodystrophy, 4 acquired generalized lipodystrophy, and 2 Dunnigan’s partial lipodystrophy; 8 female and 2 male, age range 17–67 years.
Paired liver biopsies were obtained before and after treatment (mean duration 6.6 ± 1.4 months); biopsies were scored by a single hepatopathologist blinded to clinical data and biopsy sequence using a previously validated NASH scoring system.
Concurrent laboratory testing and MRI assessments of liver volume and liver fat were performed; paired t tests or Wilcoxon signed-rank tests compared baseline and post-treatment means, and Spearman rank correlation assessed relationships between NASH score and metabolic/imaging variables.

Limitations

The paper states limitations including relatively small sample size, variable interval between liver biopsies, study of a rare disease with uncertain general relationship to NASH, lack of placebo control, and no evidence that results in hypoleptinemic patients apply to broader NASH patients with higher serum leptin concentrations.
The authors also state that the short interval between biopsies was the primary factor limiting observed change in fibrosis.
Evident from the text: this was an open-label, single-arm pilot study without a placebo or untreated comparator, and the sample was predominantly female, which may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/hep.20672

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The reductions in NASH scores were strongly correlated with reductions in liver volumes, liver fat measured by MRI, serum transami-nases, triglycerides, fasting insulin, and fasting glucose values (Table 3).”
- Also stated in: § Discussion · plain
  “There were significant correlations between the NASH activity scores and MRI estimations of liver volume and fat content, serum transaminases, triglycerides, fasting insulin, and fasting glucose values.”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > r-metHuLeptin Therapy
Strength:boosted· not yet calibratedCausal:correlational· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After treatment with r-metHuLeptin, repeat histological examinations showed significant improvements in steatosis (P ‫؍‬ .006)and ballooning injury (P ‫؍‬ .005),with a reduction of mean NASH activity by 60% (P ‫؍‬ .002).”
- Also stated in: § Discussion · plain
  “Steatosis 1.7 Ϯ 0.4 0.4 Ϯ 0.2 .006”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibratedn = 10
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eight of 10 patients met histological criteria for NASH at baseline.”
- Also stated in: § Baseline Liver Data · plain
  “Eight patients had histological evidence of NASH.”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
Load-bearingStrength:plain· not yet calibratedn = 10
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After treatment with r-metHuLeptin, repeat histological examinations showed significant improvements in steatosis (P ‫؍‬ .006)and ballooning injury (P ‫؍‬ .005),with a reduction of mean NASH activity by 60% (P ‫؍‬ .002).”
- Also stated in: § Discussion · plain
  “Ballooning injury 1.5 Ϯ 0.4 0.3 Ϯ 0.2 .005”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
Load-bearingStrength:plain· not yet calibratedCausal:direct· not yet calibratedn = 10
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes

Show all 26 claims

It may state two separate claims as one. 3
Probably not a substantial claim. 18

None of the sources cited for this claim have been checked yet.
In the paper
“The modified Dixon method was used to assess the hepatic fat fraction.”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Liver Fat Measurements.
What the sources say
- Not checked yetcites [12] source
- Not checked yetcites [13] source
Strength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The extents of portal and parenchymal inflammation, steatosis, ballooning, presence of Mallory bodies, and fibrosis in liver biopsy specimens were scored using a previously validated system developed to assess NASH activity.”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
What the sources say
- Not checked yetcites [14] source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Steatosis is believed to sensitize the liver to metabolic injury, leading to inflammation, necrosis, and fibrosis.2,[5][6][7]”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
What the sources say
- Not checked yetcites [2] source
- Not checked yetcites [5] source
- Not checked yetcites [6] source
Strength:hedged· not yet calibratedCausal:direct· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The assessment and severity of NASH is made histologically based on the patterns and degrees of hepatic steatosis, inflammation, and injury, in the absence of significant alcohol consumption.8”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Abstract
What the sources say
- Not checked yetcites [8] source
Load-bearingStrength:plain· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Recent rodent studies suggest that this can be potentially overcome with a high enough dose, 22,24 a theory similar to insulin resistance.”
§ Leptin Reverses Nonalcoholic Steatohepatitis in Patients With Severe Lipodystrophy > Discussion
What the sources say
- Not checked yetcites [22] source
- Not checked yetcites [24] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibrated
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passes
Probably not a substantial claim. The paper’s conclusions may not depend on it.

21 of 21

The paper relies on this without support.
Severe lipodystrophy is characterized by diminished adipose tissue and hypoleptinemia, leading to ectopic triglyceride accumulation.
“Severe lipodystrophy is characterized by diminished adipose tissue and hypoleptinemia, leading to ectopic triglyceride accumulation.”
The paper relies on this without support.
In the absence of adequate adipose tissue, combined with leptin deficiency, the liver becomes a major repository for triglycerides in lipodystrophic patients, often expanding far beyond the normal size.
“In the absence of adequate adipose tissue, combined with leptin deficiency, the liver becomes a major repository for triglycerides in lipodystrophic patients, often expanding far beyond the normal size.”

2 of 2

Claims other papers make about this one

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

Baseline liver-fat mean does not match individual MRI values
Major
The ten baseline liver-fat percentages in Table 1 average 57.1%, not the reported group mean of 31%. This changes a reported value used to describe the treatment effect.
Reported 31 · recomputed 57.1
Stated age range excludes a listed patient
Minor
The stated maximum age is 67 years, but Table 1 lists a patient aged 68.

2 of 2

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Self-citation

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Cholic Acid for Hepatic Steatosis in Patients with Lipodystrophy: A Randomized, 1
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Leptin replacement therapy for the treatment of non-HAART associated lipodystrophy syndromes: a meta- analysis into the effects of leptin on metabolic and hepatic endpoints Terapia de reposição de leptina para o tratamento de síndromes lipodistróficas não associadas ao uso de antirretrovirais: uma metanálise dos efeitos da leptina em parâmetros metabólicos e hepáticos
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Vatier, C. (2017) · theses.fr (ABES) · doi:10.70675/c838779bzf530z488eza1b7z3f0e1185a357
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Authors: Javor, E. D., Ghany, M. G., Cochran, E. K., Oral, E. A., DePaoli, A. M., Premkumar, A., Kleiner, D. E., & Gorden, P.
Affiliations: National Institutes of Health (US)
Amgen (United States) (US)
Corresponding author: Javor, Edward D.
ORCID: Ghany, Marc G.
Oral, Elif Arioglu
DePaoli, Alex M.
Kleiner, David E.
Venue: Hepatology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2005-04
Volume: 41
Issue: 4
Pages: 753-760
ISSN: 0270-9139 (ISSN-L)
DOI: 10.1002/hep.20672
OpenAlex: W2064309380
Semantic Scholar: ed56502ccbe96c2f2b6ef8670f3ba0436824e56d
Cited by: 228
References: 45
Citations by year: 2025: 10 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 12 · 2020: 9 · 2019: 8 · 2018: 10 · 2017: 9 · 2016: 7 · 2015: 12 · 2014: 19 · 2013: 14 · 2012: 16
FWCI: 11.71
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 3805 d)
Locations: Hepatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
Health Sciences › Medicine › Hepatology › Liver physiology and pathology
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords: nonalcoholic steatohepatitis, generalized lipodystrophy, hepatic steatosis, hepatocyte ballooning, liver fibrosis, serum triglycerides, transaminases, liver fat, hepatomegaly, hypoleptinemia
MeSH terms: Adolescent, Adult, Aged, Transaminases, Fatty Liver, Female, Hepatitis, Humans, Lipodystrophy, Liver, Magnetic Resonance Imaging, Male, Middle Aged, Pilot Projects, Triglycerides, Hormone Replacement Therapy, Leptin

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Leptin reverses nonalcoholic steatohepatitis in patients with severe lipodystrophy†

Abstract

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TL;DR

Key findings

Methods

Limitations

Integrity signals

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