270 The Genetics of Nonalcoholic Fatty Liver Disease: Spotlight on PNPLA3 and TM6SF2 Quentin M. Anstee, BSc, MBBS, PhD, MRCP(UK)1 Christopher P. Day, MD, PhD, FMedSci1 1 Liver Research Group, Institute of Cellular Medicine, The Medical Address for correspondence Quentin M. Anstee, BSc, MBBS, PhD, School, Newcastle University, Framlington Place, Newcastle-upon- MRCP(UK), Institute of Cellular Medicine, The Medical School, Tyne, United Kingdom Newcastle University, 4th Floor, William Leech Building, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, Great Britain Semin Liver Dis 2015;35:270–290. (e-mail:
[email protected]). Abstract Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum that spans simple steatosis, through nonalcoholic steatohepatitis (NASH) to fibrosis and ultimately cirrhosis. Nonalcoholic fatty liver disease is characterized by substantial interpatient variation in rate of progression and disease outcome: Although up to 25% of the general population are at risk of progressive disease, only a minority experience associated liver- related morbidity. Nonalcoholic fatty liver disease is considered a complex disease trait Keywords that occurs when environmental exposures act upon a susceptible polygenic back- ► nonalcoholic fatty ground composed of multiple independent modifiers. Recent advances include the liver disease identification of PNPLA3 as a modifier of disease outcome across the full spectrum of ► TM6SF2 NAFLD from steatosis to advanced fibrosis and hepatocellular carcinoma; and the ► PNPLA3 discovery of TM6SF2 as a potential “master regulator” of metabolic syndrome outcome, ► gene determining not only risk of advanced liver disease, but also cardiovascular disease ► steatohepatitis outcomes. In this article, the authors will review the field, discussing in detail the current ► fibrosis status of research into these important genetic modifiers of NAFLD progression.