Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10851
Revised: February 11, 2014
Accepted: April 21, 2014
Published online: August 21, 2014
The development of non invasive biomarkers of disease has become a major focus of interest in nonalcoholic fatty liver disease (NAFLD). The large prevalence of the disease and the invasive nature of the investigation means that screening with liver biopsy is impractical. In addition to screening, the differentiation of those with simple steatosis vs steatohepatitis and fibrosis is clinically important as the prognosis of each differs. Serum biomarkers may be a combination of simple markers derived from large data sets or direct markers of disease activity. Serum markers of inflammation, apoptosis and oxidative stress in addition to fibrosis have been extensively studied in patients with NAFLD. Other techniques such as transient elastography, magnetic resonance elastography and acoustic radiation force imaging are becoming more established as noninvasive methods of detecting fibrosis in a variety of chronic liver conditions in addition to NAFLD. Newer high throughput methods such as proteomics and glycomics allow the nonhypothesis-driven identification of novel markers and may also potentially contribute to our understanding of the pathogenesis of the condition. This review addresses some of the methodological issues which need to be considered in the search for the ideal biomarker. It is likely that a combination of serum biomarkers and techniques such as transient elastography may provide the optimal diagnostic discrimination however this remains to be proven in large studies.
Core tip: The search for non invasive biomarkers is a major focus of interest in the field of nonalcoholic fatty liver disease (NAFLD). Though the diagnosis of NAFLD is still a histological one, the dramatic rise in prevalence and the spectrum of severity mean that liver biopsy has become impractical for all. Both serum biomarkers of inflammation and fibrosis and assessment of fibrosis using techniques such as transient elastography may have a role to play. Newer techniques (the “omics”) may not only lead to novel biomarkers but also allow better understanding of the pathophysiology of the condition.