The role of PCSK9 in metabolic dysfunction-associated steatotic liver disease and its impact on bariatric surgery outcomes

Daniel Castellano-Castillo; María Ángeles Núñez-Sánchez; Andrés Balaguer-Román; María Antonia Martínez-Sánchez; Virginia Esperanza Fernández-Ruiz; Mercedes Ferrer-Gómez; Carlos Manuel Martínez; María Dolores Frutos; María Isabel Queipo-Ortuño; Fernando Cardona; Bruno Ramos-Molina

doi:10.1016/j.soard.2024.01.017

The role of PCSK9 in metabolic dysfunction-associated steatotic liver disease and its impact on bariatric surgery outcomes

Surg Obes Relat Dis. 2024 Feb 6:S1550-7289(24)00042-X. doi: 10.1016/j.soard.2024.01.017. Online ahead of print.

Affiliations

¹ Intercenter Medical Oncology Clinical Management Unit, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES/University of Malaga (UMA), Malaga, Spain. Electronic address: daniecas22@gmail.com.
² Obesity, Diabetes, and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.
³ Obesity, Diabetes, and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁴ Obesity, Diabetes, and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁵ Experimental Pathology Platform, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain.
⁶ Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁷ Intercenter Medical Oncology Clinical Management Unit, Regional and Virgen de la Victoria University Hospitals, Biomedical Research Institute of Malaga (IBIMA)-CIMES/University of Malaga (UMA), Malaga, Spain.
⁸ Department of Surgical Specialties, Biochemistry, and Immunology, School of Medicine, University of Malaga (UMA), Malaga, Spain.

PMID: 38490825
DOI: 10.1016/j.soard.2024.01.017

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely tied to obesity. The degree ranges from steatosis (MASL) and steatohepatitis (MASH) to liver cirrhosis. PCSK9 controls cholesterol and lipid particle transport to the liver. PCSK9 might interfere with the pathophysiology of MASLD and bariatric surgery (BS) outcomes of patients with MASLD.

Objectives: Evaluate the relationship between serum and hepatic PCSK9 levels with the degree of MASLD and the metabolic outcome of BS.

Setting: University Hospital, Spain.

Methods: A total of 110 patients with obesity undergoing BS were classified according to liver histology as controls, MAS, and MASH. PCSK9 levels in serum were measured before and 6 months after BS using enzyme-linked immunosorbent assay. PCSK9 protein and mRNA levels in liver tissue were analyzed by immunohistochemistry and reverse transcriptase-polymerase chain reaction, respectively.

Results: Hepatic PCSK9 protein levels were diminished in MASL and MASH compared with patients without MASLD and showed a strong negative association with MASLD severity scores. Liver PCSK9 mRNA was higher in MASH compared with controls and MASL and showed positive associations with MASLD severity scores. There were no differences in serum PCSK9 pre or postBS between the groups. Pre- and postsurgery serum PCSK9 positively correlated with cholesterol fold-changes and body mass index (BMI), cholesterol, and low-density lipoprotein -cholesterol fold-changes, respectively. PCSK9 fold-change positively correlated with BMI changes and was the sole variable explaining BMI fold changes in a regression model.

Conclusions: PCSK9 mRNA and protein in the liver might be associated with the degree of MASLD. Serum PCSK9 may be associated with cholesterol and/or BMI fold changes. Serum changes of PCSK9 after BS could explain BMI loss outcome.

Keywords: Bariatric surgery; MASLD; Obesity; PCSK9.