26 More recent work describes a protective effect of HIF1α stabilization on hepatocyte apoptosis in IR injury by way of an interaction between the Wnt signaling pathway Panobinostat solubility dmso and HIF, presenting data that suggests that a stabilizing interaction between beta-catenin and HIF1α promotes hepatocyte

survival in IR injury.8 Much of the work on HIFs in IR injury relies on HIF1α, and further work may clarify the role of other isoforms, such as HIF2α. An association described between obstructive sleep apnea (OSA) and nonalcoholic fatty liver disease and/or nonalcoholic steatohepatitis (NASH) remains controversial.27 Several studies have linked OSA, and in particular the incidence of apneic-hypopneic episodes, to elevation of liver enzymes and the histologic appearance of NASH.28, 29 A major confounding factor is the frequent comorbidity of obesity and/or the metabolic syndrome; however, one recent study suggested that even among obese patients, nocturnal oxygen desaturation contributed Selleckchem AZD3965 to insulin resistance and liver injury,

including fibrosis, inflammation, and ballooning necrosis, but not the appearance of steatosis.30 A study of 83 patients with OSA and matched controls suggested that there was a relationship between OSA and progression of steatosis to steatohepatitis, based on serum levels of type III procollagen.31 In a larger study of 218 patients with OSA, severe OSA (defined as greater than 50 apneic/hypopneic episodes/hour [AHI]) was associated with increased liver enzymes (odds ratio [OR] 5.9, P < 0.02). Patients with AHI greater

than 50/hour were also much more likely to have steatosis, lobular necrosis, and fibrosis by liver biopsy.32 Several studies in mouse models have offered some data to corroborate these observations. In one study, chow-fed mice were exposed to either room air or 12 hours of room air and 12 hours of chronic, intermittent hypoxia (CIH; approximately 5% oxygen for periods of 30 seconds followed by 21% oxygen for periods of 30 seconds). After 12 weeks on the CIH regimen, mice developed increased serum alanine aminotransferase (ALT), serum acetylcholine triglycerides, and serum cholesterol, as well as increased nuclear factor kappaB (NF-κB) DNA-binding activity in liver nuclear extracts.33 In mice genetically predisposed to obesity, CIH increased liver triglycerides and phospholipids, as well genes of lipid biosynthesis, including sterol regulatory element binding protein 1-c (SREBP1c), acetyl-coenzyme A carboxylase, and steroyl-CoA desaturases 1 and 2.34 In a third study, wildtype (WT) mice were maintained on a high-fat diet and exposed to either room air (21% oxygen) or room air with periods of intermittent hypoxia (as described above) for 6 months.