Leukotriene Receptor Antagonist Montelukast Shows Therapeutic Promise Against Non-Alcoholic Steatohepatitis
Non-alcoholic steatohepatitis (NASH) is a kind of liver inflammation and damage resulting from fat accumulation in the liver. It's an umbrella term for liver disorders that affect people who drink little to no alcohol but are diagnosed with a "fatty liver." Nonalcoholic fatty liver disease (NAFLD) patients often suffer from no symptoms, but once NAFLD promotes inflammation and destroys liver cells, making the liver malfunction, the condition has developed into a more aggressive form of fatty liver disease, NASH, which can scar the liver or even lead to cirrhosis and liver cancer. Studies have found that dyslipidemia, particularly hypertriglyceridemia, oxidative stress, and insulin resistance exert a key influence on the development of NASH. Moreover, the production of different atherogenic factors, including pro-inflammatory cytokines, is also considered to be related to the development of NAHS. However, currently, there is no specific treatment strategy for NASH, though some approaches, including insulin-sensitizers, lipid-lowering drugs, antioxidants, L-carnitine, and probiotics, have been proposed to treat NAFLD.
On this condition, researchers from Egypt have recently published an article investigating the efficacy and safety of the leukotriene receptor antagonist montelukast in treating NASH. Cysteinyl leukotrienes (CysLTs) are generated by inflammatory cells that contain LTC4 synthases, such as eosinophils, basophils, mast cells, and erythrocyte endothelial cells, while the liver is essential for leukotriene production and metabolism (LTs). There is a bunch of research evidence that leukotriene plays a significant role in obesity, insulin resistance, and fatty liver disease, and leukotriene produced by the 5-lipoxygenase pathway is important in inflammation and chemotaxis.
Based on these studies, researchers further noted that montelukast, an approved CysLT1 receptor antagonist for the maintenance treatment of asthma and to relieve symptoms of seasonal allergies, can block the pro-inflammatory action of leukotriene D4 (LTD4). Furthermore, montelukast can ease insulin resistance, an important part of the pathogenesis of NAFLD. And later research has demonstrated that montelukast can protect against hepatotoxicity caused by acetaminophen in a rat model.
These study results encourage researchers from Egypt to evaluate the efficacy and safety of montelukast as a potential therapy to treat patients with NASH. Experiments by this research team aim at evaluating the effect of montelukast on liver stiffness, serum levels of liver fibrosis biomarkers (hyaluronic acid (HA) and transforming growth factor beta1 (TGF-β1), insulin resistance, and metabolic and inflammatory parameters.
By recruiting 52 qualified patients from the National Liver Institute, Menoufia University, Egypt, scientists screened and measured the efficacy of montelukast on liver stiffness, liver panel, serum levels of liver fibrosis biomarkers (HA and TGF-β1), insulin resistance, metabolic and inflammatory parameters.
It turned out that montelukast has a promising therapeutic effect on overweight and obese patients with non-alcoholic steatohepatitis by improving liver stiffness, hepatic fibrosis biomarkers, and metabolic parameters, as well as significantly decreasing the inflammatory and oxidative stress biomarkers in these NASH patients. In conclusion, the leukotriene receptor antagonist montelukast may be a potential therapy for non-alcoholic steatohepatitis patients with good tolerance and without provoking depression compared with existing treatments.











