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Minerva Endocrinology 2021 Oct 20

DOI: 10.23736/S2724-6507.21.03564-8


lingua: Inglese

Effect of spironolactone on pharmacological treatment of nonalcoholic fatty liver disease

Apostolis PAPAEFTHYMIOU 1, 2, 3 , Michael DOULBERIS 2, 3, 4, 5, Kyriaki KARAFYLLIDOU 6, Eleftherios CHATZIMICHAEL 7, Georgia DERETZI 8, Aristomenis K. EXADAKTYLOS 4, Fotios SAMPSONAS 9, Athanasios GELASAKIS 10, Spyros I. PAPAMICHOS 11, Georgios KOTRONIS 12, Dimitra GIALAMPRINOU 13, Elisabeth VARDAKA 14, Stergios A. POLYZOS 3, Jannis KOUNTOURAS 2

1 Department of Gastroenterology, University Hospital of Larisa, Larisa, Greece; 2 Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3 First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4 Department of Emergency Medicine, University Hospital Inselspital Bern, Bern, Switzerland; 5 Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland; 6 Department of Pediatrics, University Children’s Hospital of Zurich, Zurich, Switzerland; 7 Center for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland; 8 Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece; 9 Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece; 10 Laboratory of Anatomy and Physiology of Farm Animals, Department of Animal Science, Agricultural University of Athens, Athens, Greece; 11 Blood Transfusion Service Eastern Switzerland, Swiss Red Cross, St. Gallen, Switzerland; 12 Department of Internal Medicine, General Hospital Aghios Pavlos of Thessaloniki, Thessaloniki, Greece; 13 Second Neonatal Department and NICU, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 14 Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Thessaloniki, Greece


Nonalcoholic fatty liver disease (NAFLD) was recently renamed to metabolic (dysfunction)-associated fatty liver disease (MAFLD) to better characterize its pathogenic origin. NAFLD represents, at least in western societies, a potential epidemic with raising prevalence. Its multifactorial pathogenesis is partially unraveled and till now there is no approved pharmacotherapy for NAFLD. A plethora of various choices are investigated in clinical trials, targeting an arsenal of different pathways and molecules. Since the mineralocorticoid receptor (MR) and renin-angiotensin-aldosterone system (RAAS) appear to be implicated in NAFLD, within this concise review, we focus on a rather classical and inexpensive pharmacological agent, spironolactone. We present the current lines of evidence of MR and RAAS-related preclinical models and human trials reporting an association with NAFLD. In conclusion, evidence about spironolactone of RAAS is commented, as potential future pharmacological management of NAFLD.

KEY WORDS: NASH; NAFLD; MAFLD; MASH; Spironolactone; Pharmacotherapy; Liver fibrosis; MR; Mineralocorticoid receptor; RAAS; Aldosterone

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