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Exosomal miRNAs as biomarkers in the diagnosis of liver disease

    Sheng Wang

    School of Pharmacy, Anhui Medical University, Hefei 230032, China

    Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei 230032, China

    The Key Laboratory of Anti-inflammatory and Immune medicines, Ministry of Education, Anhui Medical University, Hefei 230032, China

    ,
    Jian-Qing Wang

    Department of Pharmacology, The Second Hospital of Anhui Medical University, Hefei 230601, China

    &
    Xiong-Wen Lv

    *Author for correspondence:

    E-mail Address: lxw31288@aliyun.com

    School of Pharmacy, Anhui Medical University, Hefei 230032, China

    Institute for Liver Disease of Anhui Medical University, Anhui Medical University, Hefei 230032, China

    The Key Laboratory of Anti-inflammatory and Immune medicines, Ministry of Education, Anhui Medical University, Hefei 230032, China

    Published Online:https://doi.org/10.2217/bmm-2017-0011

    Liver disease is a primary cause of liver-related morbidity and mortality worldwide. Currently, histological examination is the gold standard for diagnosis and classification of liver disease; however, due to its several drawbacks, including the risk of complications and sampling variability, noninvasive diagnostic options are favorable. Exosomal miRNAs have recently been considered as an important source of medical biomarkers due to being widely distributed in body fluids. This review summarizes existing concepts related to the origin, mode of transportation and possible functions of exosomal miRNAs, and recent findings on the role of exosomal miRNAs in liver diseases and development of exosomal miRNA-based diagnostic biomarkers in the primary forms of liver diseases.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1 Muddu AK, Guha IN, Elsharkawy AM, Mann DA. Resolving fibrosis in the diseased liver: translating the scientific promise to the clinic. Int. J. Biochem. Cell Biol. 39(4), 695–714 (2007).Crossref, Medline, CASGoogle Scholar
    • 2 Alswat KA, Mumtaz K, Jafri W. Liver biopsy for histological assessment: the case in favor. Saudi J. Gastroenterol. 16(2), 133–139 (2010).Crossref, MedlineGoogle Scholar
    • 3 Kobayashi K, Nakao H, Nishiyama T et al. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis: a meta-analysis. Eur. Radiol. 25, 230–238 (2015).Crossref, MedlineGoogle Scholar
    • 4 Filingeri V, Sforza D, Tisone G. Complications and risk factors of a large series of percutaneous liver biopsies in patients with liver transplantation or liver disease. Eur. Rev. Med. Pharmacol. Sci. 19, 1621–1629 (2015). • Described the complications of liver biopsy, and analyzed its indications, advantages and disadvantages in different liver diseases.Medline, CASGoogle Scholar
    • 5 Enache LS, Enache EL, Ramiere C et al. Circulating RNA molecules as biomarkers in liver disease. Int. J. Mol. Sci. 15(10), 17644–17666 (2014).Crossref, Medline, CASGoogle Scholar
    • 6 Ble M, Procopet B, Miquel R, Hernandez-Gea V, Garcia-Pagan JC. Transjugular liver biopsy. Clin. Liver Dis. 18(4), 767–778 (2014).Crossref, MedlineGoogle Scholar
    • 7 Alisi A, De Vito R, Monti L, Nobili V. Liver fibrosis in paediatric liver diseases. Best Pract. Res. Clin. Gastroenterol. 25(2), 259–268 (2011).Crossref, Medline, CASGoogle Scholar
    • 8 Papagianni M, Sofogianni A, Tziomalos K. Non-invasive methods for the diagnosis of nonalcoholic fatty liver disease. World J. Hepatol. 7(4), 638–648 (2015).Crossref, MedlineGoogle Scholar
    • 9 Liga A, Vliegenthart AD, Oosthuyzen W, Dear JW, Kersaudy-Kerhoas M. Exosome isolation: a microfluidic road-map. Lab Chip 15(11), 2388–2394 (2015).Crossref, Medline, CASGoogle Scholar
    • 10 Fu H, Yang H, Zhang X, Xu W. The emerging roles of exosomes in tumor-stroma interaction. J. Cancer Res. Clin. Oncol. 142(9), 1897–1907 (2016).Crossref, Medline, CASGoogle Scholar
    • 11 Wang Y, Yi J, Chen X, Zhang Y, Xu M, Yang Z. The regulation of cancer cell migration by lung cancer cell-derived exosomes through TGF-beta and IL-10. Oncol. Lett. 11(2), 1527–1530 (2016).Crossref, Medline, CASGoogle Scholar
    • 12 Chahar HS, Bao X, Casola A. Exosomes and their role in the life cycle and pathogenesis of RNA viruses. Viruses 7(6), 3204–3225 (2015).Crossref, Medline, CASGoogle Scholar
    • 13 Nojima H, Freeman CM, Schuster RM et al. Hepatocyte exosomes mediate liver repair and regeneration via sphingosine-1-phosphate. J. Hepatol. 64(1), 60–68 (2016).Crossref, Medline, CASGoogle Scholar
    • 14 Van Giau V, An SS. Emergence of exosomal miRNAs as a diagnostic biomarker for Alzheimer's disease. J. Neurol. Sci. 360, 141–152 (2016).Crossref, Medline, CASGoogle Scholar
    • 15 Ge Q, Zhou Y, Lu J, Bai Y, Xie X, Lu Z. miRNA in plasma exosome is stable under different storage conditions. Molecules 19(2), 1568–1575 (2014).Crossref, MedlineGoogle Scholar
    • 16 Zhang J, Li S, Li L et al. Exosome and exosomal microRNA: trafficking, sorting, and function. Genomics Proteomics Bioinformatics 13(1), 17–24 (2015).Crossref, Medline, CASGoogle Scholar
    • 17 Gallo A, Tandon M, Alevizos I, Illei GG. The majority of microRNAs detectable in serum and saliva is concentrated in exosomes. PLoS ONE 7(3), e30679 (2012). •• Demonstrated that all of these miRNAs are primarily in exosomes and can be used as a reliable carrier of miRNA research.Crossref, Medline, CASGoogle Scholar
    • 18 Li Y, Zhang L, Liu F, Xiang G, Jiang D, Pu X. Identification of endogenous controls for analyzing serum exosomal miRNA in patients with hepatitis B or hepatocellular carcinoma. Dis. Markers 2015, 893594 (2015).Crossref, MedlineGoogle Scholar
    • 19 Caby MP, Lankar D, Vincendeau-Scherrer C, Raposo G, Bonnerot C. Exosomal-like vesicles are present in human blood plasma. Int. Immunol. 17(7), 879–887 (2005).Crossref, Medline, CASGoogle Scholar
    • 20 Masyuk AI, Huang BQ, Ward CJ et al. Biliary exosomes influence cholangiocyte regulatory mechanisms and proliferation through interaction with primary cilia. Am. J. Physiol. Gastrointest. Liver Physiol. 299, G990–G999 (2010).Crossref, Medline, CASGoogle Scholar
    • 21 Andre F, Schartz NEC, Movassagh M et al. Malignant effusions and immunogenic tumour-derived exosomes. Lancet 360(9329), 295–305 (2002).Crossref, Medline, CASGoogle Scholar
    • 22 Ogawa Y, Miura Y, Harazono A et al. Proteomic analysis of two types of exosomes in human whole saliva. Biol. Pharm. Bull. 34(1), 13–23 (2011).Crossref, Medline, CASGoogle Scholar
    • 23 Lasser C, Alikhani VS, Ekstrom K et al. Human saliva, plasma and breast milk exosomes contain RNA: uptake by macrophages. J. Transl. Med. 9, 9 (2011).Crossref, MedlineGoogle Scholar
    • 24 Vella LJ, Sharples RA, Lawson VA, Masters CL, Cappai R, Hill AF. Packaging of prions into exosomes is associated with a novel pathway of PrP processing. J. Pathol. 211(5), 582–590 (2007).Crossref, Medline, CASGoogle Scholar
    • 25 Pisitkun T, Shen RF, Knepper MA. Identification and proteomic profiling of exosomes in human urine. Proc. Natl Acad. Sci. USA 101(36), 13368–13373 (2004).Crossref, Medline, CASGoogle Scholar
    • 26 Asea A, Jean-Pierre C, Kaur P et al. Heat shock protein-containing exosomes in mid-trimester amniotic fluids. J. Reprod. Immunol. 79(1), 12–17 (2008).Crossref, Medline, CASGoogle Scholar
    • 27 Aalberts M, Van Dissel-Emiliani FM, Van Adrichem NP et al. Identification of distinct populations of prostasomes that differentially express prostate stem cell antigen, annexin A1, and GLIPR2 in humans. Biol. Reprod. 86(3), 82 (2012).Crossref, MedlineGoogle Scholar
    • 28 Falcone G, Felsani A, D'Agnano I. Signaling by exosomal microRNAs in cancer. J. Exp. Clin. Cancer Res. 34, 32 (2015).Crossref, MedlineGoogle Scholar
    • 29 Kalluri R. The biology and function of exosomes in cancer. J. Clin. Invest. 126(4), 1208–1215 (2016).Crossref, MedlineGoogle Scholar
    • 30 Brinton LT, Sloane HS, Kester M, Kelly KA. Formation and role of exosomes in cancer. Cell Mol. Life Sci. 72(4), 659–671 (2015).Crossref, Medline, CASGoogle Scholar
    • 31 Emanueli C, Shearn AI, Angelini GD, Sahoo S. Exosomes and exosomal miRNAs in cardiovascular protection and repair. Vascul. Pharmacol. 71, 24–30 (2015).Crossref, Medline, CASGoogle Scholar
    • 32 Bang C, Thum T. Exosomes: new players in cell-cell communication. Int. J. Biochem. Cell Biol. 44(11), 2060–2064 (2012).Crossref, Medline, CASGoogle Scholar
    • 33 Cai S, Cheng X, Pan X, Li J. Emerging role of exosomes in liver physiology and pathology. Hepatol. Res. doi:10.1111/hepr.12794 (2016) (Epub ahead of print).Google Scholar
    • 34 Cannell IG, Kong YW, Bushell M. How do microRNAs regulate gene expression? Biochem. Soc. Trans. 36(Pt 6), 1224–1231 (2008).Crossref, Medline, CASGoogle Scholar
    • 35 Pan B-T, Johnstone RM. Fate of the transferrin receptor during maturation of sheep reticulocytes in vitro: selective externalization of the receptor. Cell 33, 967–977 (1983). • Exosomes were first discovered, and the function of exosomes was regarded as ‘garbage bags’ that remove waste products out from donor cells.Crossref, Medline, CASGoogle Scholar
    • 36 Schneider A, Simons M. Exosomes: vesicular carriers for intercellular communication in neurodegenerative disorders. Cell Tissue Res. 352(1), 33–47 (2013).Crossref, Medline, CASGoogle Scholar
    • 37 Vlassov AV, Magdaleno S, Setterquist R, Conrad R. Exosomes: current knowledge of their composition, biological functions, and diagnostic and therapeutic potentials. Biochim. Biophys. Acta 1820(7), 940–948 (2012).Crossref, Medline, CASGoogle Scholar
    • 38 Isola AL, Chen S. Exosomes: the link between GPCR activation and metastatic potential? Front. Genet. 7, 56 (2016).Crossref, MedlineGoogle Scholar
    • 39 Zhao W, Zheng XL, Zhao SP. Exosome and its roles in cardiovascular diseases. Heart Fail Rev. 20(3), 337–348 (2015).Crossref, Medline, CASGoogle Scholar
    • 40 Ailawadi S, Wang X, Gu H, Fan GC. Pathologic function and therapeutic potential of exosomes in cardiovascular disease. Biochim. Biophys. Acta 1852(1), 1–11 (2015).Crossref, Medline, CASGoogle Scholar
    • 41 Mittelbrunn M, Vicente-Manzanares M, Sanchez-Madrid F. Organizing polarized delivery of exosomes at synapses. Traffic 16(4), 327–337 (2015).Crossref, Medline, CASGoogle Scholar
    • 42 Arscott WT, Tandle AT, Zhao S et al. Ionizing radiation and glioblastoma exosomes: implications in tumor biology and cell migration. Transl. Oncol. 6(6), 638–IN636 (2013).Crossref, MedlineGoogle Scholar
    • 43 Sato K, Meng F, Glaser S, Alpini G. Exosomes in liver pathology. J. Hepatol. 65(1), 213–221 (2016).Crossref, Medline, CASGoogle Scholar
    • 44 Khalyfa A, Gozal D. Exosomal miRNAs as potential biomarkers of cardiovascular risk in children. J. Transl. Med. 12, 162 (2014).Crossref, MedlineGoogle Scholar
    • 45 Tian T, Zhu YL, Zhou YY et al. Exosome uptake through clathrin-mediated endocytosis and macropinocytosis and mediating miR-21 delivery. J. Biol. Chem. 289(32), 22258–22267 (2014).Crossref, Medline, CASGoogle Scholar
    • 46 Di Bonito P, Ridolfi B, Columba-Cabezas S et al. HPV-E7 delivered by engineered exosomes elicits a protective CD8(+) T cell-mediated immune response. Viruses 7(3), 1079–1099 (2015).Crossref, Medline, CASGoogle Scholar
    • 47 Braicu C, Tomuleasa C, Monroig P, Cucuianu A, Berindan-Neagoe I, Calin GA. Exosomes as divine messengers: are they the Hermes of modern molecular oncology? Cell Death Differ. 22(1), 34–45 (2015).Crossref, Medline, CASGoogle Scholar
    • 48 Bala S, Petrasek J, Mundkur S et al. Circulating microRNAs in exosomes indicate hepatocyte injury and inflammation in alcoholic, drug-induced, and inflammatory liver diseases. Hepatology 56(5), 1946–1957 (2012). •• This study showed that exosomes participate in liver disease through mediating cellular communication.Crossref, Medline, CASGoogle Scholar
    • 49 Masyuk AI, Masyuk TV, Larusso NF. Exosomes in the pathogenesis, diagnostics and therapeutics of liver diseases. J. Hepatol. 59(3), 621–625 (2013).Crossref, Medline, CASGoogle Scholar
    • 50 Zhao L, Liu W, Xiao J, Cao B. The role of exosomes and ‘exosomal shuttle microRNA’ in tumorigenesis and drug resistance. Cancer Lett. 356(2 Pt B), 339–346 (2015).Crossref, Medline, CASGoogle Scholar
    • 51 Hu G, Gong AY, Roth AL et al. Release of luminal exosomes contributes to TLR4-mediated epithelial antimicrobial defense. PLoS Pathog. 9(4), e1003261 (2013).Crossref, Medline, CASGoogle Scholar
    • 52 Yoon YJ, Kim OY, Gho YS. Extracellular vesicles as emerging intercellular communicasomes. BMB Reports 47(10), 531–539 (2014).Crossref, Medline, CASGoogle Scholar
    • 53 Chen C, Luo F, Liu X et al. NF-kB-regulated exosomal miR-155 promotes the inflammation associated with arsenite carcinogenesis. Cancer Lett. 388, 21–33 (2016).Crossref, MedlineGoogle Scholar
    • 54 Royo F, Falcon-Perez JM. Liver extracellular vesicles in health and disease. J. Extracell. Vesicles (2012). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760641/.Crossref, MedlineGoogle Scholar
    • 55 Wei J-X, Lv L-H, Wan Y-L et al. Vps4A functions as a tumor suppressor by regulating the secretion and uptake of exosomal micrornas in human hepatoma cells. Hepatology 61, 1284–1294 (2015). •• It is suggested that exosome-mediated miRNAs transmit is a critical mechanism of hepatocellular carcinoma occurrence, progression and metastasis.Crossref, Medline, CASGoogle Scholar
    • 56 Fonsato V, Collino F, Herrera MB et al. Human liver stem cell-derived microvesicles inhibit hepatoma growth in SCID mice by delivering antitumor microRNAs. Stem Cells 30(9), 1985–1998 (2012).Crossref, Medline, CASGoogle Scholar
    • 57 Kogure T, Lin WL, Yan IK, Braconi C, Patel T. Intercellular nanovesicle-mediated microRNA transfer: a mechanism of environmental modulation of hepatocellular cancer cell growth. Hepatology 54(4), 1237–1248 (2011).Crossref, Medline, CASGoogle Scholar
    • 58 Bukong TN, Momen-Heravi F, Kodys K, Bala S, Szabo G. Exosomes from hepatitis C infected patients transmit HCV infection and contain replication competent viral RNA in complex with Ago2-miR122-HSP90. PLoS Pathog. 10(10), e1004424 (2014).Crossref, MedlineGoogle Scholar
    • 59 Tan CY, Lai RC, Wong W, Dan YY, Lim S-K, Ho HK. Mesenchymal stem cell-derived exosomes promote hepatic regeneration in drug-induced liver injury models. Stem Cell Res. Ther. 5(3), 76 (2014).Crossref, MedlineGoogle Scholar
    • 60 Li T, Yan Y, Wang B et al. Exosomes derived from human umbilical cord mesenchymal stem cells alleviate liver fibrosis. Stem Cells Dev. 22(6), 845–854 (2013).Crossref, Medline, CASGoogle Scholar
    • 61 Deng ZB, Zhuang X, Ju S et al. Exosome-like nanoparticles from intestinal mucosal cells carry prostaglandin E2 and suppress activation of liver NKT cells. J. Immunol. 190(7), 3579–3589 (2013).Crossref, Medline, CASGoogle Scholar
    • 62 Qian X, Xu C, Fang S et al. Exosomal microRNAs derived from umbilical mesenchymal stem cells inhibit hepatitis C virus infection. Stem Cells Transl. Med. 5(9), 1190–1203 (2016).Crossref, Medline, CASGoogle Scholar
    • 63 Murakami Y, Toyoda H, Tanahashi T et al. Comprehensive miRNA expression analysis in peripheral blood can diagnose liver disease. PLoS ONE 7(10), e48366 (2012).Crossref, Medline, CASGoogle Scholar
    • 64 Gitto S, Micco L, Conti F, Andreone P, Bernardi M. Alcohol and viral hepatitis: a mini-review. Dig. Liver Dis. 41(1), 67–70 (2009).Crossref, Medline, CASGoogle Scholar
    • 65 Momen-Heravi F, Saha B, Kodys K, Catalano D, Satishchandran A, Szabo G. Increased number of circulating exosomes and their microRNA cargos are potential novel biomarkers in alcoholic hepatitis. J. Transl. Med. 13, 261 (2015).Crossref, MedlineGoogle Scholar
    • 66 Bi J, Ge S. Potential roles of BMP9 in liver fibrosis. Int. J. Mol. Sci. 15(11), 20656–20667 (2014).Crossref, Medline, CASGoogle Scholar
    • 67 Yao Y, Bao J, Lu Y et al. Biomarkers of liver fibrosis detecting with electrochemical immunosensor on clinical serum. Sensors Actuators B Chem. 222, 127–132 (2016).Crossref, CASGoogle Scholar
    • 68 Chen L, Charrier A, Zhou Y et al. Epigenetic regulation of connective tissue growth factor by microRNA-214 delivery in exosomes from mouse or human hepatic stellate cells. Hepatology 59(3), 1118–1129 (2014).Crossref, Medline, CASGoogle Scholar
    • 69 Charrier A, Chen R, Chen L et al. Exosomes mediate intercellular transfer of pro-fibrogenic connective tissue growth factor (CCN2) between hepatic stellate cells, the principal fibrotic cells in the liver. Surgery 156(3), 548–555 (2014).Crossref, MedlineGoogle Scholar
    • 70 Chen L, Brigstock D. Exosomal microRNA modulates pathways of liver fibrosis by regulating connective tissue growth factor (CTGF) expression in fibrogenic cells during chronic injury. FASEB J. 27, lb440 (2013).Google Scholar
    • 71 Gäbele E, Brenner DA, Rippe RA. Liver fibrosis: signals leading to the amplification of the fibrogenic hepatic stellate cell. Front. Biosci. 8, d69–d77 (2003).Crossref, Medline, CASGoogle Scholar
    • 72 Wang H, Hou L, Li A, Duan Y, Gao H, Song X. Expression of serum exosomal microRNA-21 in human hepatocellular carcinoma. Biomed. Res. Int. 2014, 864894 (2014). •• The correlations of patient clinicopathologic characteristics with serum exosomal miR-21 expression levels revealed that high level of exosomal miR-21 expression positively related to cirrhosis (p = 0.024). In terms of the analysis results, exosome miRNAs show good prospects as biomarkers for detection of cirrhosis.Google Scholar
    • 73 Csak T, Bala S, Lippai D et al. microRNA-122 regulates hypoxia-inducible factor-1 and vimentin in hepatocytes and correlates with fibrosis in diet-induced steatohepatitis. Liver Int. 35(2), 532–541 (2015).Crossref, Medline, CASGoogle Scholar
    • 74 Tomiyama T, Yang GX, Zhao M et al. The modulation of co-stimulatory molecules by circulating exosomes in primary biliary cirrhosis. Cell Mol. Immunol. 14(3), 276–284 (2015).Crossref, MedlineGoogle Scholar
    • 75 Bolondi L, Sofia S, Siringo S et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 48, 251–259 (2001).Crossref, Medline, CASGoogle Scholar
    • 76 Silvaa M, Meloa SA. Non-coding RNAs in exosomes: new players in cancer biology. Curr. Genomics 16, 295–303 (2015).Crossref, MedlineGoogle Scholar
    • 77 Basu S, Bhattacharyya SN. Insulin-like growth factor-1 prevents miR-122 production in neighbouring cells to curtail its intercellular transfer to ensure proliferation of human hepatoma cells. Nucleic Acids Res. 42(11), 7170–7185 (2014).Crossref, Medline, CASGoogle Scholar
    • 78 Moll A, Krenauer A, Bierbach U et al. Mixed hepatoblastoma and teratoma of the liver in a 3-year-old child: a unique combination and clinical challenge. Diagn. Pathol. 4, 37 (2009).Crossref, MedlineGoogle Scholar
    • 79 Hiyama E. Pediatric hepatoblastoma: diagnosis and treatment. Transl. Pediatr. 3(4), 293–299 (2014).MedlineGoogle Scholar
    • 80 Jiao C, Jiao X, Zhu A, Ge J, Xu X. Exosomal miR-34s panel as potential novel diagnostic and prognostic biomarker in patients with hepatoblastoma. J. Pediatr. Surg. 52(4), 618–624 (2016).Crossref, MedlineGoogle Scholar
    • 81 Liu W, Chen S, Liu B. Diagnostic and prognostic values of serum exosomal microRNA-21 in children with hepatoblastoma: a Chinese population-based study. Pediatr. Surg. Int. 32(11), 1059–1065 (2016). •• Looks at the area under receiver operator curve of plasmatic miR-21, exosomal miR-21 and AFP were 0.729, 0.861 and 0.675, respectively. The results suggest that exosomal miR-21 could be defined as a diagnostic and prognostic biomarker for patients with hepatitis B.Crossref, MedlineGoogle Scholar
    • 82 Y L, Gm X, Ll L et al. Assessment of endogenous reference gene suitability for serum exosomal microRNA expression analysis in liver carcinoma resection studies. Mol. Med. Rep. 12(3), 4683–4691 (2015).Crossref, MedlineGoogle Scholar
    • 83 Sohn W, Kim J, Kang SH et al. Serum exosomal microRNAs as novel biomarkers for hepatocellular carcinoma. Exp. Mol. Med. 47, e184 (2015).Crossref, Medline, CASGoogle Scholar
    • 84 Chiba M, Kimura M, Asari S. Exosomes secreted from human colorectal cancer cell lines contain mRNAs, microRNAs and natural antisense RNAs, that can transfer into the human hepatoma HepG2 and lung cancer A549 cell lines. Oncol. Rep. 28(5), 1551–1558 (2012).Crossref, Medline, CASGoogle Scholar
    • 85 Sugimachi K, Matsumura T, Hirata H et al. Identification of a bona fide microRNA biomarker in serum exosomes that predicts hepatocellular carcinoma recurrence after liver transplantation. Br. J. Cancer 112(3), 532–538 (2015).Crossref, Medline, CASGoogle Scholar
    • 86 Cano A, Alonso C. Deciphering non-alcoholic fatty liver disease through metabolomics. Biochem. Soc. Trans. 42(5), 1447–1452 (2014).Crossref, Medline, CASGoogle Scholar
    • 87 David K, Kowdley KV, Unalp A et al. Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology 49(6), 1904–1912 (2009).Crossref, MedlineGoogle Scholar
    • 88 Saadeh S, Younossi ZM, Remer EM et al. The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123(3), 745–750 (2002).Crossref, MedlineGoogle Scholar
    • 89 Wong VW, Wong GL, Yeung DK et al. Incidence of non-alcoholic fatty liver disease in Hong Kong: a population study with paired proton-magnetic resonance spectroscopy. J. Hepatol. 62(1), 182–189 (2015).Crossref, MedlineGoogle Scholar
    • 90 Benhamouche-Trouillet S, Postic C. Emerging role of miR-21 in non-alcoholic fatty liver disease. Gut 65(11), 1781–1783 (2016).Crossref, Medline, CASGoogle Scholar