Lysosomal acid lipase deficiency: a form of non-obese fatty liver disease (NOFLD)

ABSTRACT

Introduction: With the growing obesity epidemic, nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the leading causes of liver disease worldwide. Although obesity is a main risk factor for the development of NAFLD, it can also develop in lean subjects and can be encountered in different clinical setting and in association with an array of genetic, metabolic, nutritional, infectious and drug-induced disorders.

Areas covered: This article discusses causes of fatty liver in non-obese subjects focusing on Lysosomal acid lipase deficiency (LAL-D), a commonly overlooked disorder reviewing its prevalence, genetics, pathogenesis, clinical features, diagnosis and treatment. It will also review other causes of non-alcoholic fatty liver disease, which can be encountered in the absence of obesity and metabolic syndrome.

Expert commentary: Although the prevalence of LAL-D has been estimated in the range of 1 in 40,000 and 1 in 300,000, this estimate is much more than the identified cases reported in the literature, which suggests that that the disease may be considerably under-diagnosed. There is a pressing need to educate clinicians about the disease, especially with the development of new promising therapeutic modalities.

KEYWORDS:

• Nonalcoholic fatty liver disease
• NASH
• NAFLD
• NOFLD
• lysosomal acid lipase deficiency
• LAL-D
• obesity
• metabolic syndrome

Acknowledgments

The author is deeply appreciative of Dr Achyut Bhaattacharrya, Professor and chief of Pathology at the University of Arizona for his kind help with the pathology slides.

He would also like to thank Dr William Balistreri, Professor of Pediatrics and Medicine at the University of Cincinnati for suggesting the term of NOFLD (Non-Obese Fatty Liver Disease).

Declaration of interest

The author is a consultant and speaker for Alexion Pharmaceuticals, a company marketing Kanuma, an enzyme replacement therapy approved for the treatment of patients with LAL-D. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.