Effect of pioglitazone in a patient with impaired glucose tolerance and nonalcoholic steatohepatitis

SUMMARY A man 55 years of age with impaired glucose tolerance, central obesity, atherogenic dyslipidemia and biopsy-proven nonalcoholic steatohepatitis was treated with the thiazolidinedione pioglitazone for 18 months in an attempt to reverse his severe steatohepatitis. Initial evaluation revealed marked insulin resistance, low plasma adiponectin and increased plasma biomarkers of subclinical inflammation (i.e., IL-6, TNF-α, TGF-β and hsCRP). After pioglitazone treatment insulin sensitivity was restored significantly, as well as plasma adiponectin and biomarkers of subclinical inflammation. Liver adiposity decreased together with a marked improvement of histological abnormalities. Histological markers of inflammation, hepatic stellate cell activation and apoptosis were reversed to near-normal levels. Practitioners should be aware that abnormal glucose metabolism is common in nonalcoholic steatohepatitis and thiazolidinediones may be valuble in the management of such patients.