Leptin in the treatment of lipodystrophy-associated nonalcoholic fatty liver disease: are we there already?

Evaluation of: In general, nonalcoholic fatty liver disease (NAFLD) consists of ectopic fat accumulation in the liver, when the ability to store fat in inert reservoirs is overcome. That occurs either when we have an excess of energy/fat such as in obesity, or when adipose tissue is defective, not being able to store even regular amounts of energy, such as in lipodystrophies (LDs). LD associates with metabolic deregulation: insulin resistance/diabetes mellitus and dyslipidemia. Several small studies have shown a beneficial effect of leptin replacement, an adipocyte-derived hormone, in the metabolic profile of patients with LD. The paper under evaluation studied 50 patients with LD-associated NAFLD treated with leptin, suggesting a beneficial effect in liver histology and in decreasing not only steatosis, but also nonalcoholic steatohepatitis, although with no effect on fibrosis after 2 years of treatment.