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Relationship Between Methylome and Transcriptome in Patients With Nonalcoholic Fatty Liver Disease
Open accessAbstract
Background & aims Cirrhosis and liver cancer are potential outcomes of advanced nonalcoholic fatty liver disease (NAFLD). It is not clear what factors determine whether patients will develop advanced or mild NAFLD, limiting noninvasive diagnosis and treatment before clinical sequelae emerge. We investigated whether DNA methylation profiles can distinguish patients with mild disease from those with advanced NAFLD, and how these patterns are functionally related to hepatic gene expression.Methods We collected frozen liver biopsies and clinical data from patients with biopsy-proven NAFLD (56 in the discovery cohort and 34 in the replication cohort). Samples were divided into groups based on histologic severity of fibrosis: F0-1 (mild) and F3-4 (advanced). DNA methylation profiles were determined and coupled with gene expression data from the same biopsies; differential methylation was validated in subsets of the discovery and replication cohorts. We then analyzed interactions between the methylome and transcriptome.Results Clinical features did not differ between patients known to have mild or advanced fibrosis based on biopsy analysis. There were 69,247 differentially methylated CpG sites (76% hypomethylated, 24% hypermethylated) in patients with advanced vs mild NAFLD (P < .05). Methylation at fibroblast growth factor receptor 2, methionine adenosyl methyltransferase 1A, and caspase 1 was validated by bisulfite pyrosequencing and the findings were reproduced in the replication cohort. Methylation correlated with gene transcript levels for 7% of differentially methylated CpG sites, indicating that differential methylation contributes to differences in expression. In samples with advanced NAFLD, many tissue repair genes were hypomethylated and overexpressed, and genes in certain metabolic pathways, including 1-carbon metabolism, were hypermethylated and underexpressed.Conclusions Functionally relevant differences in methylation can distinguish patients with advanced vs mild NAFLD. Altered methylation of genes that regulate processes such as steatohepatitis, fibrosis, and carcinogenesis indicate the role of DNA methylation in progression of NAFLD.
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“Moreover, certain patterns of DNA methylation at fibrosis-related genes, such as those encoding TGFβ1, COL1A1, PDGFα, peroxisome proliferator-activated receptor alpha (PPARα), and peroxisome proliferator-activated receptor delta (PPARδ), can not only distinguish between patients with mild versus advanced MASLD, but also predict future fibrosis progression (169-172).”
From Found in translation—Fibrosis in metabolic dysfunction–associated steatohepatitis (MASH) (2023) · cites this paper as [169]
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“In contrast, promoter hypomethylation is often associated with a euchromatic state and transcriptional permissiveness [37].”
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“…hypermethylation and decreased expression levels, while numerous genes involved in tissue repair displayed hypomethylation and increased expression levels, indicating a potential dysregulation in lipid metabolism, oxidative stress response, fibrogenesis, and possibly even carcinogenesis [156].”
BackgroundRIPK1 senses S-adenosylmethionine scarcity to drive cell death and inflammation
Chen, Z., Gu, X., Chen, H., Zhang, H., Liu, J., Yang, X., Cai, Y. A., Zhang, M., Yan, L., Yang, Y., et al. (2025) · Cell Metabolism · doi:10.1016/j.cmet.2025.05.014 · Cited by 30
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Rinella, M. E., & Sookoian, S. C. (2026) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-026-01187-8 · Cited by 31
“Transcriptomic and epigenomic studies complemented these findings, showing that DNA methylation profiles discriminate mild from advanced disease 137 , that methylation of the PPARGC1A promoter links insulin resistance with mitochondrial dysfunction 138 , and that circulating methylation at the…”
Dreval, K., Tryndyak, V., de Conti, A., Beland, F. A., & Pogribny, I. P. (2019) · Frontiers in Genetics · doi:10.3389/fgene.2019.00486 · Cited by 27
Fuchs, C. D., Krivanec, S., Steinacher, D., Mlitz, V., Wahlstrom, A. M., Ståhlman, M., Claudel, T., Scharnagl, H., Stojaković, T., Marschall, H., et al. (2020) · Liver International · doi:10.1111/liv.14423 · Cited by 26
Genetics, Immunity and Nutrition Boost the Switching from NASH to HCC
Dongiovanni, P., Meroni, M., Longo, M., Fargion, S. R., & Fracanzani, A. L. (2021) · Biomedicines · doi:10.3390/biomedicines9111524 · Cited by 27
“During the development of NAFLD, both nuclear DNA and mitochondrial DNA (mtDNA) are progressively affected by aberrancies in the process of DNA methylation, differentially describing disease stages [73].”
BackgroundZeybel, M., Vatansever, S., Hardy, T., Sarı, A., Çakalağaoğlu, F., Avcı, A., Zeybel, G. L., Karahüseyinoğlu, S., Bashton, M., Mathers, J. C., et al. (2016) · Clinical Epigenetics · doi:10.1186/s13148-016-0218-1 · Cited by 27
“CpG methylation-mediated transcriptional control and epigenetic dysregulation have also been implicated as an important contributing factor in liver diseases including non-alcoholic fatty liver disease and alcoholic liver disease [15, 16].”
BackgroundDysfunctional VLDL metabolism in MASLD
Marigorta, U. M., Millet, Ó., Lu, S. C.-L., & Mato, J. M. (2024) · npj Metabolic Health and Disease · doi:10.1038/s44324-024-00018-1 · Cited by 29
Genome-wide hepatic DNA methylation changes in high-fat diet-induced obese mice
Yoon, A., Tammen, S. A., Park, S., Han, S. N., & Choi, S. (2017) · Nutrition Research and Practice · doi:10.4162/nrp.2017.11.2.105 · Cited by 26
“CD comparison was selected to examine its gene expression because CpG sites within the promoter region of human CASP1 gene was reported to be hypomethylated in the livers of advanced NAFLD patients compared with that of the mild NAFLD patients and CASP1 mRNA level were inversely related to methylation status of its Cp…”
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Deciphering the role of epigenetic modifications in fatty liver disease: A systematic review
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Self-citationS-Adenosylmethionine: A Multifaceted Regulator in Cancer Pathogenesis and Therapy
Fernández‐Ramos, D., Lopitz‐Otsoa, F., Lu, S. C.-L., & Mato, J. M. (2025) · Cancers · doi:10.3390/cancers17030535 · Cited by 28
“Importantly, DNA hypomethylation has been found in this animal model suggesting an epigenetic regulation, which also correlates with advanced forms of MASLD in patients [101], and may generate genomic instability throughout carcinogenic processes.”
EZH2 as a Potential Target for NAFLD Therapy
Lim, H. J., & Kim, M. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21228617 · Cited by 24
“Advanced NAFLD is associated with decreased methylation of tissue repair genes and increased methylation of metabolic pathway genes [27].”
BackgroundComparative Proteomic Analysis of Liver Tissues and Serum in db/db Mice
Zhang, Y., Wu, X., Xu, M., Yue, T., Ling, P., Fang, T., Luo, S., Xu, S., & Weng, J. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23179687 · Cited by 24
Mwinyi, J., Boström, A. E. D., Pisanu, C., Murphy, S. K., Erhart, W., Schafmayer, C., Hampe, J., Moylan, C. A., & Schiöth, H. B. (2016) · Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids · doi:10.1016/j.bbalip.2016.12.005 · Cited by 24
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“Hypomethylation also serves as the epigenetic characteristics of alcohol-related fatty liver disease (10).”
InfluentialLiu, H., Yin, G., Franco Leonardi, B., Lan, T., Ait Ahmed, Y., Berger, H., Kohlhepp, M. S., Amiridze, N., Martagón Calderón, N., Frau, C., et al. (2025) · Gut · doi:10.1136/gutjnl-2024-334425 · Cited by 23
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Epigenetics: An emerging field in the pathogenesis of nonalcoholic fatty liver disease
Ashraf, N. U., & Altaf, M. (2018) · Mutation Research/Reviews in Mutation Research · doi:10.1016/j.mrrev.2018.07.002 · Cited by 22
Liver fibrogenesis: un update on established and emerging basic concepts
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“suggesting the involvement of epigenetic changes in CLD progression [152].”
BackgroundModulation of Oxidative Stress-Induced Senescence during Non-Alcoholic Fatty Liver Disease
Pedroza-Díaz, J., Arroyave-Ospina, J. C., Salas, S. S., & Moshage, H. J. (2022) · Antioxidants · doi:10.3390/antiox11050975 · Cited by 27
“Differential DNA methylation patterns are associated with different stages of NAFLD: tissue-repair genes have been hypomethylated and overexpressed, whereas metabolismassociated genes have been hypermethylated and consequently downregulated [167].”
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FXR controls CHOP expression in steatohepatitis
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NASH-inducing Diets in Göttingen Minipigs
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Comprehensive analysis of epigenetic and epitranscriptomic genes’ expression in human NAFLD
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“fatty liver disease (NAFLD) [36] and Gnmt deficiency and/or hypermethioninemia, and elevated SAM levels could play a role in the pathogenesis of NAFLD by inhibiting lipophagy through PP2A methylation in an mTORC1-independent mechanism [37].”
BackgroundEpigenome modifiers and metabolic rewiring: New frontiers in therapeutics
Ferrari, A., Longo, R., Silva, R., Mitro, N., Caruso, D., De Fabiani, E., & Crestani, M. (2019) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2018.08.008 · Cited by 19
Metadata
- Authors
- Murphy, S. K., Yang, H., Moylan, C. A., Pang, H., Dellinger, A., Abdelmalek, M. F., Garrett, M. E., Ashley–Koch, A., Suzuki, A., Tillmann, H. L., Hauser, M. A., & Diehl, A. M.
- Affiliations
- Duke University (US)
- Corresponding author
- Diehl, Anna Mae
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2013-11
- Volume
- 145
- Issue
- 5
- Pages
- 1076-1087
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC3805742
- OpenAlex
- W2150020322
- Cited by
- 391
- References
- 48
- Citations by year
- 2026: 14 · 2025: 23 · 2024: 36 · 2023: 37 · 2022: 31 · 2021: 35 · 2020: 31 · 2019: 38 · 2018: 40 · 2017: 32 · 2016: 26 · 2015: 28 · 2014: 17 · 2013: 2
- FWCI
- 10.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Funders
- National Institutes of Health (5rc2aa019399-02)
- National Institute on Alcohol Abuse and Alcoholism (5RC2-AA019399, RC2-AA019399)
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007568)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- non-alcoholic fatty liver disease, DNA methylation, transcriptome, liver fibrosis, disease severity, differentially methylated CpG sites, gene expression, FGF2, MAT1A, caspase-1, one-carbon metabolism, NAFLD progression, non-invasive diagnosis
- MeSH terms
- Adult, Biopsy, Diagnosis, Differential, Fatty Liver, Female, Gene Expression Regulation, Humans, Liver, Male, Methionine Adenosyltransferase, Middle Aged, Severity of Illness Index, Cohort Studies, Disease Progression, CpG Islands, DNA Methylation, Caspase 1, Receptor, Fibroblast Growth Factor, Type 2, Transcriptome, Non-alcoholic Fatty Liver Disease
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