Alcoholic Steatohepatitis

About ASH

Alcoholic Steatohepatitis (ASH, or AH) is a liver condition under Alcoholic Liver Disease (ALD), caused by chronic alcohol abuse. ASH is typically found in individuals with a history of heavy drinking for two or more decades, although there are examples of patients with ASH with history of less than 10 years of alcohol abuse.

Studies have shown that a dose-dependent relationship has been observed between alcohol intake and the risk of developing ALD. In fact, 90-100% of heavy drinkers suffer from steatosis and around 10 -35% are reported to have ASH. In the U.S. up to around 5 million people suffer from ASH, a disease that may be completely asymptomatic and therefore often remains undiagnosed.


Regional differences around the world

Alcohol intake tends to vary greatly in different regions around the world, with the highest amount of alcohol intake per adult reported in Europe, especially in Russia and the surrounding countries, and the lowest amount reported in the regions of the Eastern Mediterranean and some regions of Southeast Asia. Naturally, higher per capita alcohol intake has been shown to be tightly correlated to higher incidence of liver diseases.

The role of Keratin 18 in ASH

Excessive hepatocyte cell death by apoptosis is a prominent feature of most acute and chronic liver diseases, also in ASH. Early on in the apoptosis of hepatocytes, caspases (a form of proteases) are activated and cleave the protein keratin 18 (K18), a major intermediate filament protein in liver cells, and the resulting fragments are subsequently released into the blood or the extracellular space.

The levels of caspase cleaved keratin 18 (ccK18) have been shown to be elevated among heavy drinkers and among patients with ASH.  The K18 fragments can be efficiently quantified by the unique M30 Apoptosense® ELISA, and are useful indicators of hepatocyte apoptosis during the diagnosis and monitoring of liver damage in adult patients with possible ASH.    

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