A Nutraceutical Rich in Docosahexaenoic Acid Improves Portal Hypertension in a Preclinical Model of Advanced Chronic Liver Disease

Inflammation and oxidative stress play a key role in the pathophysiology of advanced chronic liver disease (ACLD) and portal hypertension (PH). Considering the current lack of effective treatments, we evaluated an anti-inflammatory and antioxidant nutraceutical rich in docosahexaenoic acid (DHA) as a possible therapy for ACLD. We investigated the effects of two-week DHA supplementation (500 mg/kg) on hepatic fatty acids, PH, oxidative stress, inflammation, and hepatic stellate cell (HSC) phenotype in rats with ACLD. Additionally, the effects of DHA were evaluated in murine macrophages and human HSC. In contrast to vehicle-treated animals, cirrhotic rats receiving DHA reestablished a healthy hepatic fatty acid profile, which was associated with an improvement in PH. The mechanisms underlying this hemodynamic improvement included a reduction in oxidative stress and inflammation, as well as a marked HSC deactivation, confirmed in human HSC. Experiments with cultured macrophages showed that treatment with DHA protects against pro-inflammatory insults. The present preclinical study demonstrates that a nutraceutical rich in DHA significantly improves PH in chronic liver disease mainly by suppressing inflammation and oxidative stress-driven HSC activation, encouraging its evaluation as a new treatment for PH and cirrhosis

Oxidative Stress in Chronic Liver Disease and Portal Hypertension: Potential of DHA as Nutraceutical.

Chronic liver disease constitutes a growing public health issue worldwide, with no safe and effective enough treatment clinical scenarios. The present review provides an overview of the current knowledge regarding advanced chronic liver disease (ACLD), focusing on the major contributors of its pathophysiology: inflammation, oxidative stress, fibrosis and portal hypertension. We present the benefits of supplementation with docosahexaenoic acid triglycerides (TG-DHA) in other health areas as demonstrated experimentally, and explore its potential as a novel nutraceutical approach for the treatment of ACLD and portal hypertension based on published pre-clinical data

Pan-PPAR agonist lanifibranor improves portal hypertension and hepatic fibrosis in experimental advanced chronic liver disease.

BACKGROUND AIMS In advanced chronic liver disease (ACLD), de-regulated hepatic necroinflammatory processes play a key role in the development of liver microvascular dysfunction, fibrogenesis, and increased hepatic vascular tone, resulting in progression of ACLD and portal hypertension. Given the current lack of an effective treatment, we aimed at characterizing the effects of the pan-peroxisome proliferator-activated receptors (pan-PPAR) agonist lanifibranor in two pre-clinical models of ACLD, as well as in liver cells from patients with ACLD. METHODS Cirrhotic rats (thioacetamide or common bile duct ligation; TAA or cBDL) randomly received lanifibranor (100mg/kg/day, po) or vehicle for 14 days (n=12/group). PPAR expression, systemic and hepatic hemodynamics, presence of ascites, liver sinusoidal endothelial cells (LSEC) phenotype, hepatic stellate cells (HSC) activation, serum transaminases and albumin, hepatic macrophage infiltration, cytokine expression, and liver fibrosis were determined. Hepatic cells were isolated from livers from cirrhotic patients and their phenotype was evaluated after treatment with lanifibranor or vehicle. RESULTS TAA-cirrhotic rats receiving lanifibranor showed significantly lower portal pressure than vehicle-treated animals (-15%) without decreasing portal blood flow, indicating improved hepatic vascular resistance. Moreover, lanifibranor-treated TAA-rats showed decreased ascites, improved phenotype of LSEC and HSC, ameliorated hepatic microvascular function, reduced hepatic inflammation, and significant fibrosis regression (-32%). These findings were confirmed in the cBDL rat model, as well as in human liver cells from cirrhotic patients, which exhibited a phenotypic improvement upon treatment with lanifibranor. CONCLUSIONS This study demonstrates that lanifibranor exerts clear beneficial effects in pre-clinical models of decompensated cirrhosis, which lead to amelioration in fibrosis and portal hypertension. Our results in human hepatic cells isolated from cirrhotic patients further encourage its clinical evaluation for the treatment of ACLD