Ratio of IL 10 over IL 12 is a Novel Surrogate to Evaluate the Severity of Non Alcoholic Steatohepatitis (NASH) - A Prospective Clinical Pilot Study

Abstract

Purpose: Non alcoholic steatohepatitis (NASH) is a growing global epidemic progressing to cirrhosis, liver failure, HCC, warrants liver transplant. The natural history is still not well defined, inflammatory cytokines, intrahepatic immune traffic, degree of apoptosis and path of fibrogenesis are the sequel of the disease process. This study evaluates a novel inflammatory cytokine (IL 10 and IL 12) ratio to predict NAFLD to NASH and its severity index. Methods: Ninety (n=90) patients, mean age of 45 (28-54) were divided into Group A (n=30) BMI (mean) <25% with normal lipids, healthy control. Group B with NAFLD (n=30) BMI >29% with NAFLD (hepatic steatosis, Waist/Hip ratio > 0.9, high lipids, HOMA>1.8, mean normal ALT, AST, RBP4,2.5, Leptin, Adiponectin, TNF alpha, serum NASH score <0.8, mean fibrotic score < 0.1, mean IL 10/IL 12 ratio < 1.0. Group C with NASH (n=30), BMI>30, W/H ratio > 1.1, high lipids, HOMA> 2.2, high AST, ALT, RBP>4.5, high leptin, low adiponectin, high TNF alpha, IL10/IL12 ratio> 4.5. Serums NASH score > 0.6, fibrotic score over 0.2. Liver biopsy in NASH group, macrovascular fat 18/30(60%), balloning 12/30(40%), Mallory body 7/30(23%), METAVIR score F2 12/30(40%), F3 9/30(30%), F4 3/30(10%). Exclusion Criteria: Diabetes, viral hepatitis, autoimmune liver disease, alcoholic liver disease with daily alcohol consumption over 20 gm, steatogenic medications including herbs and HIV. Results: See Table.Table: ResultsConclusion: IL 10/12 ratio correlated with the progression of NAFLD to NASH.IL 10/12 ratio >4.5 has NASH with high steatosis, fibrotic score. Larger study will establish the predictive index of IL10/IL 12 NASH in the severity and prognosis. Alcoholic hepatitis should be considered in the multivariate analysis.