Transmembrane 6 superfamily member 2 gene variant disentangles nonalcoholic steatohepatitis from cardiovascular disease
Open accessAbstract
Excess hepatic storage of triglycerides is considered a benign condition, but nonalcoholic steatohepatitis (NASH) may progress to fibrosis and promote atherosclerosis. Carriers of the TM6SF2 E167K variant have fatty liver as a result of reduced secretion of very‐low‐density lipoproteins (VLDLs). As a result, they have lower circulating lipids and reduced risk of myocardial infarction. In this study, we aimed to assess whether TM6SF2 E167K affects liver damage and cardiovascular outcomes in subjects at risk of NASH. Liver damage was evaluated in 1,201 patients who underwent liver biopsy for suspected NASH; 427 were evaluated for carotid atherosclerosis. Cardiovascular outcomes were assessed in 1,819 controls from the Swedish Obese Subjects (SOS) cohort. Presence of the inherited TM6SF2 E167K variant was determined by TaqMan assays. In the liver biopsy cohort, 188 subjects (13%) were carriers of the E167K variant. They had lower serum lipid levels than noncarriers (P < 0.05), had more‐severe steatosis, necroinflammation, ballooning, and fibrosis (P < 0.05), and were more likely to have NASH (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.23‐2.79) and advanced fibrosis (OR, 2.08; 95% CI: 1.20‐3.55), after adjustment for age, sex, body mass index, fasting hyperglycemia, and the I148M PNPLA3 risk variant. However, E167K carriers had lower risk of developing carotid plaques (OR, 0.49; 95% CI: 0.25‐0.94). In the SOS cohort, E167K carriers had higher alanine aminotransferase ALT and lower lipid levels (P < 0.05), as well as a lower incidence of cardiovascular events (hazard ratio: 0.61; 95% CI: 0.39‐0.95). Conclusions: Carriers of the TM6SF2 E167K variant are more susceptible to progressive NASH, but are protected against cardiovascular disease. Our findings suggest that reduced ability to export VLDLs is deleterious for the liver. (H epatology 2015;61:506‐514)
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The TM6SF2 rs58542926 minor allele is reportedly associated with MASLD and sometimes MASH.
“The rs58542926 minor allele of transmembrane 6 superfamily member 2 (TM6SF2) is also reportedly associated with MASLD and sometimes MASH (134, 140-142).”
From Found in translation—Fibrosis in metabolic dysfunction–associated steatohepatitis (MASH) (2023) · cites this paper as [141]
The HSD17B13 splice variant rs72613567 is protective against MASH, and HSD17B13 may contribute to MASH fibrosis by promoting pyrimidine catabolism.
“Furthermore, the splice variant rs72613567 in the Hydroxysteroid 17-beta Dehydrogenase 13 (HSD17B13) gene has been identified as protective against MASH, with HSD17B13 potentially contributing to MASH fibrosis by promoting pyrimidine catabolism (134, 140-142).”
From Found in translation—Fibrosis in metabolic dysfunction–associated steatohepatitis (MASH) (2023) · cites this paper as [141]
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Self-citation
- Authors
- Dongiovanni, P., Petta, S., Maglio, C., Fracanzani, A. L., Pipitone, R., Mozzi, E., Motta, B. M., Kaminska, D., Rametta, R., Grimaudo, S., Pelusi, S., Montalcini, T., Alisi, A., Maggioni, M., Kärjä, V., Borén, J., Käkelä, P., Di Marco, V., Xing, C., Nobili, V., Dallapiccola, B., Craxi, A., Pihlajamäki, J., Fargion, S., Sjöström, L., Carlsson, L. M., Romeo, S., & Valenti, L.
- Affiliations
- University of Milan (IT)
- University of Palermo (IT)
- University of Gothenburg (SE)
- Department of Public Health and Clinical Nutrition, Surgery and Pathology,University of Eastern Finland,Kuopio,Finland
- Magna Graecia University (IT)
- Bambino Gesù Children's Hospital (IT)
- University of Eastern Finland (FI)
- Department of Gastroenterology,Università di Palermo,Palermo,Italy
- The University of Texas Southwestern Medical Center (US)
- Hepato‐Metabolic Unit and Scientific Direction,Ospedale Bambin Gesù,Roma,Italy
- Corresponding author
- Romeo, Stefano
- Valenti, Luca
- ORCID
- Dongiovanni, Paola
- Petta, Salvatore
- Maglio, Cristina
- Fracanzani, Anna Ludovica
- Pipitone, Rosaria
- Mozzi, Enrico
- Motta, Benedetta Maria
- Rametta, Raffaela
- Grimaudo, Stefania
- Pelusi, Serena
- Montalcini, Tiziana
- Alisi, Anna
- Maggioni, Marco
- Borén, Jan
- Käkelä, Pirjo
- Xing, Chao
- Dallapiccola, Bruno
- Pihlajamäki, Jussi
- Fargion, Silvia
- Carlsson, Lena M.
- Romeo, Stefano
- Valenti, Luca
- Venue
- Hepatology
- Published
- 2015-01-20
- Volume
- 61
- Issue
- 2
- Pages
- 506-514
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2030379010
- Cited by
- 533
- References
- 37
- Citations by year
- 2026: 15 · 2025: 27 · 2024: 37 · 2023: 45 · 2022: 42 · 2021: 66 · 2020: 73 · 2019: 47 · 2018: 30 · 2017: 44 · 2016: 46 · 2015: 53 · 2014: 5 · 2012: 1
- FWCI
- 37.37
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Academy of Finland
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano
- Kuopio University Hospital
- Novonordisk Foundation
- Università degli studi di milano
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- TM6SF2, nonalcoholic steatohepatitis, cardiovascular disease, carotid atherosclerosis, very low density lipoprotein secretion, hepatic steatosis, liver fibrosis, PNPLA3 I148M, serum lipids, myocardial infarction, genetic risk variants, liver biopsy
- MeSH terms
- Adult, Biopsy, Carotid Artery Diseases, Cross-Sectional Studies, Female, Humans, Lipoproteins, VLDL, Liver, Liver Cirrhosis, Male, Membrane Proteins, Middle Aged, Obesity, Cohort Studies, Hepatocytes, Non-alcoholic Fatty Liver Disease
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