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Does Alcohol Affect Your Liver

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Does Alcohol Affect Your Liver

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Grayson W. Way Grayson W. Way Scilit Preprints.org Google Scholar 1 , Kaitlyn G. Jackson Kaitlyn G. Jackson Scilit Preprints.org Google Scholar 2 , Shreya R. Muscu Shreya R. Muscu Scilit Preprints.org Google Scholar 2 and Huip Zhou Huiping Zhou Scilit Preprints.org Google Scholar 2, 3, *

Received: March 3, 2022 / Revised: April 11, 2022 / Accepted: April 14, 2022 / Published: April 18, 2022

Effects Of Alcohol On The Body

Alcohol-related liver disease (ALD) is a spectrum of diseases whose onset and progression is caused by chronic alcohol use. ALD ranges in severity from hepatic steatosis to alcoholic hepatitis (AH) and alcohol-related cirrhosis (AC), and in some cases may lead to the development of hepatocellular carcinoma (HCC). ALD continues to be a significant health burden and is now the leading cause of liver transplantation in the United States. ALD causes biological, microbial, physiological, metabolic and inflammatory changes in patients that depend on the severity of the disease. Mortality from ALD has increased in recent years and is predicted to continue to increase. Current treatment focuses on abstinence and symptom management, with little in the way of addressing disease progression. As a result of metabolic disturbances and gut dysbiosis in ALD, bile acid (BA) signaling and metabolism are also specifically affected, which play a major role in disease progression in ALD, as well as in other liver diseases such as non-alcoholic fatty liver disease. (NAFLD). In this review, we summarize recent advances in understanding the mechanisms by which alcohol consumption induces liver injury and the role of BA-mediated signaling in the pathogenesis of ALD.

Alcohol use is estimated to date back to 8000 BC, with the earliest evidence in the form of chemical analysis dating from 7000 to 6600 BC [1]. Alcohol has been used as a medicine, salve, and cleanser and has been indulged in for centuries. Alcohol-related liver disease (ALD), formerly known as alcoholic liver disease, is a clinical disease caused by excessive and/or chronic alcohol use that has significant health and economic consequences. ALD is associated with a significant increase in lipid droplets in hepatocytes. It is classified as alcoholic fatty liver or steatosis once more than 5% of hepatocytes develop this fat phenotype [2]. These accumulations of lipid droplets can be classified as macrovesicular, large lipid droplets that displace the nucleus and organelles, or microvesicular, small lipid droplets that do not displace the nucleus, which are more common in ALD [2]. The amount of fat in the liver can be measured with a special ultrasound device FirboScan [3]. However, alcoholic steatosis is rarely diagnosed because it is largely asymptomatic. Lack of early detection often allows further progression into the spectrum of ALD, which includes simple steatosis, alcoholic hepatitis (AH), alcoholic liver fibrosis and alcoholic cirrhosis (AC), and may eventually develop into hepatocellular carcinoma (HCC) (Figure 1). The current standard treatment for ALD is (and has been for decades) abstinence, as well as dietary and lifestyle modification [4, 5, 6] for definitive treatment prior to cirrhosis and liver transplantation. ALD is closely associated with metabolic, physiological and inflammatory changes; gastric dysbiosis; and altered bile acid (BA) synthesis, recycling, and signaling [ 6 , 7 , 8 , 9 , 10 , 11 ]. Lipid and lipoprotein profiles have been shown to be significantly different in patients with AH compared to heavy drinkers and can be used in diagnosis [12]. Patients with AH have worse liver function than patients with never-declining ALD, AH is associated with bilirubin stasis, severe fibrosis, ductular reactivity and aberrant gene expression [13]. Gut dysbiosis increases inflammation as well as altered BA signaling due to changes in gut microbial modifications of BA and is associated with ALD, non-alcoholic fatty liver disease (NAFLD) and autoimmune liver disease [14]. Recently, not only bacterial intestinal dysbiosis has become important, but it has been shown that fungal changes in the intestinal microbiome are also related to ALD [15]. BAs are not only important in the absorption of cholesterol and lipids, but also act as important signaling molecules that regulate lipid and glucose metabolism as well as the immune response. Disruption of BA homeostasis is associated with ALD and cirrhosis [16, 17, 18, 19, 20].

ALD occurs with chronic and excessive alcohol consumption, with an initial exposure to a dose of 10 g of pure ethanol per day [21]. Previous reports have shown that ALD is the leading cause of liver disease worldwide and has become the leading cause of liver transplantation in the United States, surpassing hepatitis C virus due to advances in treatment [22]. ALD accounts for 30% of all HCC cases and HCC-specific mortality worldwide [ 23 , 24 ]. A recent predictive modeling study published in the journal Lancet Public Health estimates that age-adjusted deaths from ALD are expected to increase from 8.23 ​​per 100,000 person-years in 2019 to 15.20 per 100,000 person-years in 2040 and that to 1,128,400 deaths. to occur between 2019 and 2040 [25]. ALD is the leading chronic cause of alcohol-related death, accounting for 18,164 deaths annually in the United States [26].

Many of the toxic effects of ethanol are related and tied to the site of its metabolism. Ethanol is readily absorbed in the gastrointestinal tract, with only 2 to 10% of the absorbed amount being excreted via the lungs, urine, and sweat, while the remainder is oxidized mainly in the liver [27]. Ethanol metabolism is carried out by several enzymes. Ethanol is oxidized to acetaldehyde in hepatocytes mainly by alcohol dehydrogenase (ADH). Acetaldehyde loses hydrogen through the action of aldehyde dehydrogenase (ALDH) and NAD

Precision Digestive Care » How Exactly Does Alcohol Cause Liver Problems?

Forming acetate and NADH [1]. Substitution of lysine for glutamate at position 504 of ALDH2 leads to an almost completely inactive form called ALDH2*2 [1]. ALDH2*2 causes a response to alcohol and is relatively common in people of Chinese, Japanese, and Korean descent, but essentially absent in people of European or African descent [1]. Acetate can be converted to acetyl-CoA, which can be oxidized in the tricarboxylic acid cycle. ADH and ALDH require the coenzyme nicotinamide adenine dinucleotide (NAD).

) for oxygen transfer, its reduction to NADH [28, 29, 30, 31]. There are several forms of ADH and ALDH that are encoded by different genes. Genetic variations of ADH and ALDH can affect ethanol metabolism [28, 31]. Previous research has focused on identifying genes that may be associated with alcoholism, with Edenberg summarizing that ALDH2*2 may be protective against alcohol dependence [28]. Although ADH is the key enzyme in ethanol metabolism, there are two other well-known enzymes: cytochrome P450 2E1 (CYP2E1), part of the microsomal ethanol oxidation system (MEOS); and catalase [27, 31, 32]. CYP2E1 is involved in the metabolism of acetone and fatty acids and is usually found in microsomes or vesicles in the endoplasmic reticulum [29, 31, 32, 33]. Although CYP2E1 is normally found in the liver, it can be found in many organs and its expression is inducible [ 29 , 31 , 32 , 33 ]. Found in all major organs, catalase is an antioxidant enzyme commonly known for its role in the conversion of hydrogen peroxide to water and molecular oxygen [ 27 , 31 , 32 ]. Recently, activation of peroxisome proliferator-activated receptor α (PPARα) has been shown to completely switch ethanol metabolism from the reactive oxygen species (ROS)-induced CYP2E1 pathway to the ROS-scavenging catalase pathway and accelerated alcohol clearance [34]. Ethanol also induces cytochrome P450 2A5 (CYP2A5) and this induction is regulated by nuclear factor-erythroid 2-related factor 2 (NRF2) [35]. While the primary site of alcohol metabolism is the liver, some metabolism may occur elsewhere and some tissue damage may occur at other sites.

Excessive alcohol consumption is the leading preventable cause of death in the United States, with chronic alcoholism responsible for 51,078 deaths.

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