Presence and extent of estrogen receptor-alpha expression in patients with simple steatosis and NASH
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Loss of estrogen receptor-alpha (ER- ) in the liver is associated with hepatic steatosis and inflammation.We conducted a study in order to investigate the presence and extent of ER- expression in NASH, andits relationship with histological findings. Fifty-four patients with histologically confirmed NASH, 12patients with simple steatosis (SS), and 6 patients with normal liver tissue (NLT) were included. NASHactivity score and fibrosis score were calculated according to biopsy findings. Liver biopsy specimenswere immunohistochemically stained for ER- expression. Nuclear ER- expression percentage (stainingindex) was calculated. Mean staining index was significantly different across the NASH, SS, and NLT groups(6.3±9.9 vs. 22.1±26.4 vs. 44.2±24.8, respectively, p < 0.001 for all comparisons). Staining index wassignificantly higher in women than in men (19.4±22.2 vs. 7.9±15.3, respectively, p = 0.003). Stainingindex negatively correlated with serum ALT (r =-0.240; p = 0.04), fasting plasma glucose (r =-0.261;p = 0.027), and fibrosis score (r =-0.312; p = 0.011). As a conclusion, hepatic nuclear ER- expressionpercentage (staining index) is lower in patients with NASH when compared to SS and NLT groups. Stainingindex is negatively correlated with serum ALT levels, plasma glucose, and fibrosis score. Further studiesare required to clarify the significance of ER- expression in NASH.