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Hypoxia in MASLD: a spatial determinant of the pathogenesis
Isabel Fuster-Martínez1, Vanesa Bernal-Monterde2, Guillaume Bidault1
1Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Metabolic dysfunction-associated steatotic liver disease (MASLD) disrupts liver architecture, causing hypoxia. This review explores how oxygen levels and obstructive sleep apnoea (OSA) impact MASLD progression and liver injury.
Area of Science:
- Hepatology
- Physiology
- Pathology
Background:
- The liver's microarchitecture creates an oxygen gradient essential for zonation.
- Metabolic dysfunction-associated steatotic liver disease (MASLD) impairs this architecture, leading to hypoxia.
- Hypoxia and obstructive sleep apnoea (OSA) are increasingly linked to MASLD.
Purpose of the Study:
- To review intrahepatic oxygen dynamics in MASLD.
- To examine the interplay between OSA and MASLD.
- To elucidate the role of hypoxia in liver injury.
Main Methods:
- Literature review of intrahepatic oxygen gradients.
- Analysis of molecular responses to hypoxia in MASLD.
- Examination of epidemiological and mechanistic links between OSA and MASLD.
Main Results:
- Hypoxia is a key feature of MASLD, driven by architectural disruption.
- Hypoxia-inducible factors are activated in response to low oxygen.
- Chronic intermittent hypoxia from OSA is associated with MASLD progression.
Conclusions:
- Intrahepatic hypoxia is a critical factor in MASLD pathogenesis.
- Oxygen dynamics play a spatial role in determining liver injury severity.
- Understanding hypoxia's role may reveal new therapeutic targets for MASLD.
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