S1158 Is Lysosomal Acid Lipase Activity a Reliable Marker of Non-Alcoholic Fatty Liver Disease? A Systematic Review

Abstract

INTRODUCTION: NAFLD encompasses a spectrum of liver damage varying from non-alcoholic fatty liver (NAFL) on the most clinically benign end of the spectrum to cirrhosis on the opposite extreme, where most liver-related morbidity and mortality occurs. Lysosomal acid lipase (LAL) is an enzyme that hydrolyzes cholesteryl esters and triglycerides (TG) into cholesterol, free fatty acids and glycerol. A deficiency of LAL causes build-up of TG and cholesteryl esters in the liver, spleen, intestinal mucosa, adrenal glands, lymph nodes, vascular endothelium and macrophages of the body, leading to elevation of transaminases, fatty acid infiltration of the hepatocytes and hepatomegaly, all of which are the characteristic features of NAFLD. METHODS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to June 2020. Included studies were cohort, cross sectional and review studies that investigated the correlation of the lysosomal acid lipase (LAL) activity with the severity of non-alcoholic fatty liver disease (NAFLD). End note was used to screen the articles. RESULTS: We identified 12 studies that commented upon the correlation of LAL activity with NAFLD. The total sample size was 2850 subjects. LAL activity is significantly reduced in NAFLD when compared to healthy subjects and subjects with HCV. In addition, cryptogenic cirrhosis has marked reduction in LAL activity when compared to known etiology cirrhosis. Moreover, splenomegaly was significantly associated with reduced LAL activity. Furthermore, low LAL activity was associated with increased in levels of various serological marks of liver disease (GGT, INR, Cr). We also noticed inverse correlation between the platelets and WBC count with LAL activity. Table 1 summarizes our findings. CONCLUSION: We conclude that LAL activity is inversely related to the severity of NAFLD. Further prospective multicenter studies are warranted to establish the correlation.Table 1.: Lysosomal Acid Lipase activity in patients with Non-Alcoholic Fatty Liver Disease