Vitamins such as B12 and folate may be able to reverse some liver damage, new research suggests.
Fatty liver, or non-alcoholic steatohepatitis (NASH) is an aggressive form of fatty liver disease that can cause severe liver damage and have a huge impact on overall health.
There is currently no effective treatment for NASH, but a recent study found that vitamin B12 and folate may help reduce inflammation and scarring in human subjects and animal models. Future studies are needed to better understand why NASH develops so that treatments can help counteract the underlying mechanisms. Liver problems can occur for a variety of reasons but are not always caused by alcohol consumption.
Non-alcoholic fatty liver disease (NAFLD) is a term that describes a series of conditions caused by an accumulation of fat in the liver. Not related to alcohol consumption, NAFLD is caused by other factors and usually results in inflammation and liver damage. In more severe or aggressive cases, NAFLD can be diagnosed as non-alcoholic steatohepatitis (NASH).
Currently, there is no medication to treat non-alcoholic steatohepatitis. But a recent study published in the Journal of Hepatology looked at the mechanisms of NASH and found that a specific protein, syntaxin 17, was prevented from doing its job of removing dead, unhealthy cells. Additionally, researchers found that vitamin B12 and folate increased levels of syntaxin 17 and helped reverse fibrosis (thickening or scarring) and inflammation of the liver.
Impact of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis
Fat accumulation in the liver as a defining feature of non-alcoholic fatty liver disease (NAFLD). Certain health conditions increase the risk of developing NAFLD, including the following:
overweight and obesity
type 2 diabetes
insulin resistance
metabolic syndrome
high blood pressure
high cholesterol
Some people with NAFLD can develop liver damage and inflammation, leading to nonalcoholic steatohepatitis (NASH).
NASH can cause scarring and permanent liver damage, increasing the risk of liver cancer. Currently, there are no drugs that can effectively treat NASH.
Indeed, non-alcoholic fatty liver disease [NAFLD] is a condition that affects approximately 25% of the world’s population. It is mainly associated with obesity. Its most serious stage, non-alcoholic fatty steatohepatitis (NASH), affects around 5% of the world’s population. NASH can lead to liver cirrhosis, the need for liver transplantation and liver cancer.
B vitamins reverse liver inflammation and fibrosis in NASH
The authors of the current study examined the actions that occur in the development of NASH using human subjects, mouse models and primates. They found that the increase in the amino acid homocysteine (Hcy) was present alongside liver inflammation and fibrosis. They also found that high levels of homocysteine in the liver induced and worsened NASH. Homocysteine also impacted a specific protein, Syntaxin 17, which is essential for removing damaged cells from the body, a process called autophagy. The researchers used mice and cell cultures to examine how vitamin B12 and folate might help.
They found that vitamin B12 and folate helped restore syntaxin 17 expression and the autophagy process. Ultimately, vitamin B12 and folate helped reduce NASH inflammation and fibrosis.
The detailed experimental article published in the Journal of Hepatology, July 2022 brings a new vision of these diseases. Using non-human models, the researchers clearly showed that vitamin B12 and folate reduced liver inflammation and liver scarring (fibrosis) in NASH. These agents appear to act by affecting the homocysteine pathway. This is not a well-studied path. Homocysteine appears to be elevated in NASH and its metabolism reduced in NASH. Remarkably, vitamin therapy appears to prevent and reverse fat accumulation, inflammation and fibrosis in two different mouse models of NASH. Preclinical results suggest that vitamin therapy might be a first-line treatment, especially in patients with low serum B12 and folate levels and high serum homocysteine levels.
Future Research Areas
The study provided excellent data in an area of research where information is limited. However, since much of the research has been in mouse models, more studies are needed to confirm the findings and determine how best to treat people diagnosed with NASH. The researchers suggest that vitamin B12 and folate might be useful, especially as a preventive treatment or first-line treatment for NASH.
