Transmembrane 6 superfamily member 2 gene variant disentangles nonalcoholic steatohepatitis from cardiovascular disease

Paola Dongiovanni, Salvatore Petta, Cristina Maglio, Anna Ludovica Fracanzani, Rosaria Pipitone, Enrico Mozzi, Benedetta Maria Motta, Dorota Kaminska, Raffaela Rametta, Stefania Grimaudo, Serena Pelusi, Tiziana Montalcini, Anna Alisi, Marco Maggioni, Vesa Kärjä, Jan Borén, Pirjo Käkelä, Vito Di Marco, Chao Xing, Valerio NobiliBruno Dallapiccola, Antonio Craxi, Jussi Pihlajamäki, Silvia Fargion, Lars Sjöström, Lena M. Carlsson, Stefano Romeo, Luca Valenti

Research output: Contribution to journalArticlepeer-review

384 Scopus citations


Excess hepatic storage of triglycerides is considered a benign condition, but nonalcoholic steatohepatitis (NASH) may progress to fibrosis and promote atherosclerosis. Carriers of the TM6SF2 E167K variant have fatty liver as a result of reduced secretion of very-low-density lipoproteins (VLDLs). As a result, they have lower circulating lipids and reduced risk of myocardial infarction. In this study, we aimed to assess whether TM6SF2 E167K affects liver damage and cardiovascular outcomes in subjects at risk of NASH. Liver damage was evaluated in 1,201 patients who underwent liver biopsy for suspected NASH; 427 were evaluated for carotid atherosclerosis. Cardiovascular outcomes were assessed in 1,819 controls from the Swedish Obese Subjects (SOS) cohort. Presence of the inherited TM6SF2 E167K variant was determined by TaqMan assays. In the liver biopsy cohort, 188 subjects (13%) were carriers of the E167K variant. They had lower serum lipid levels than noncarriers (P<0.05), had more-severe steatosis, necroinflammation, ballooning, and fibrosis (P<0.05), and were more likely to have NASH (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.23-2.79) and advanced fibrosis (OR, 2.08; 95% CI: 1.20-3.55), after adjustment for age, sex, body mass index, fasting hyperglycemia, and the I148M PNPLA3 risk variant. However, E167K carriers had lower risk of developing carotid plaques (OR, 0.49; 95% CI: 0.25-0.94). In the SOS cohort, E167K carriers had higher alanine aminotransferase ALT and lower lipid levels (P<0.05), as well as a lower incidence of cardiovascular events (hazard ratio: 0.61; 95% CI: 0.39-0.95). Conclusions: Carriers of the TM6SF2 E167K variant are more susceptible to progressive NASH, but are protected against cardiovascular disease. Our findings suggest that reduced ability to export VLDLs is deleterious for the liver.

Original languageEnglish (US)
Pages (from-to)506-514
Number of pages9
Issue number2
StatePublished - Feb 1 2015

ASJC Scopus subject areas

  • Hepatology


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