Tinjauan Terpadu terhadap Terapi Presisi dan Standardized Herbal Drug untuk Non-Alcoholic Fatty Liver Disease (NAFLD): Kemajuan Molekuler, BuktiKlinis, serta Implikasi Integratif

Raymond R. Tjandrawinata

doi:10.56951/mh4ry926

Tinjauan Terpadu terhadap Terapi Presisi dan Standardized Herbal Drug untuk Non-Alcoholic Fatty Liver Disease (NAFLD): Kemajuan Molekuler, BuktiKlinis, serta Implikasi Integratif

Penulis

Raymond R. Tjandrawinata Farmakolog Molekular, Center for Pharmaceutical and Nutraceutical Research and Policy, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia

DOI:

https://doi.org/10.56951/mh4ry926

Editorial

Non-alcoholic fatty liver disease (NAFLD) merupakan gangguan hepatik progresif yang kini menjadi bagian sentral dalam spektrum sindrom metabolik global. Perkembangannya yang kompleks melibatkan resistansi insulin, inflamasi kronis, stres oksidatif, serta aktivasi jalur fibrogenik. Seiring dengan pemahaman molekuler yang semakin mendalam, terapi presisi berbasis agonis farnesoid X receptor (FXR), peroxisome proliferator-activated receptor (PPAR), incretin mimetics, dan teknologi RNA mulai dikembangkan, meski masih menghadapi tantangan dari sisi efek samping dan keterjangkauan. Dalam konteks ini, Veprolin mengandung Proliverenol, fraksi bioaktif dari Phaleria macrocarpa, menawarkan potensi
sebagai standardized herbal drug ajuvan dengan efek antiinflamasi, antifibrotik, dan reparatif yang telah dibuktikan secara preklinik. Kajian ini menyoroti pentingnya strategi terapeutik multimodal yang integratif, berorientasi presisi, dan berkelanjutan.

Unduhan

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Referensi

1. Armstrong MJ, Gaunt P, Aithal GP, Barton D, Hull D, Parker R, et al. Liraglutide safety and efficacy in patients with nonalcoholic steatohepatitis (LEAN): a multicentre, double blind, randomised, placebo controlled phase 2 study. Lancet. 2016;387(10019):679–90.

2. Berlian G, Tandrasasmita OM, Tjandrawinata RR. Standardized bioactive fraction of Phaleria macrocarpa (Proliverenol) prevents ethanol‑induced hepatotoxicity via down‑regulation of NF-κB, TNF‑α and caspase‑8 pathway. Asian Pac J Trop Biomed. 2016;6(8):686–91.

3. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2018;67(1):328–57.

4. Doulberis M, Kotronis G, Gialamprinou D, Kountouras J, Katsinelos P. Non-alcoholic fatty liver disease: an update with special focus on the role of gut microbiota. Metabolism 2017;71:182-97.

5. Francque SM, Bedossa P, Ratziu V, Anstee QM, Bugianesi E, Sanyal AJ, et al. A randomized, controlled trial of the pan-PPAR agonist lanifibranor in NASH. N Engl J Med. 2021;385(17):1547–58.

6. Friedman SL, Ratziu V, Harrison SA, Abdelmalek MF, Aithal GP, Caballeria J, et al. A randomized, placebocontrolled trial of cenicriviroc for treatment of nonalcoholic steatohepatitis with liver fibrosis. Hepatology 2018;67(5):1754–67.

7. Jiang X, et al. RNA based precision therapies targeting PNPLA3 and miR 122 in NAFLD: preclinical advances. J Clin Invest. 2023;Advance online publication.

8. Nailufar F, Kristiana H, Tjandrawinata RR. Hepatoprotective activity evaluation of DLBS1433 bioactive fraction from Phaleria macrocarpa. International Journal of Pharma and Bio Sciences 2017; 8(2):313-9. https://doi.org/10.22376/ijpbs.2017.8.2.p313-9. Newsome PN, Buchholtz K, Cusi K, Linder M, Okanoue T, Ratziu V, et al. A placebo-controlled trial of subcutaneous semaglutide in nonalcoholic steatohepatitis. N Engl J Med. 2021;384(12):1113–24.

10. Polyzos SA, et al. Oxidative stress in nonalcoholic fatty liver disease: mechanisms and therapeutic strategies. J Clin Endocrinol Metab. 2016;101(4):1355–68.

11. Ratziu V, Harrison SA, Francque S, Bedossa P, Lehert P, Serfaty L, et al. Elafibranor, an agonist of the peroxisome proliferator–activated receptor-α and -δ, induces resolution of nonalcoholic steatohepatitis without fibrosis worsening. Gastroenterology. 2016;150(5):1147–59.e5.

12. Sanyal AJ, et al. Targeting TNF-α, IL-1β, and TGF-β in NASH: early-phase biologic therapy studies. Hepatology 2015;62(2):808–19.

13. Sundari N, Soetikno V, Louisa M, Wardhani BW, Tjandrawinata RR. Protective effect of Phaleria macrocarpa water extract (Proliverenol) against carbon tetrachloride induced liver fibrosis in rats: role of TNF α and TGF-β1. J Toxicol. 2018;2018:2642714. https://doi.org/10.1155/2018/2642714.

14. Tilg H, Moschen AR. Evolution of inflammation in nonalcoholic fatty liver disease: The multiple parallel hits hypothesis. Hepatology 2010;52(5):1836–46.

15. Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology 2023;77(4):1335–47.