Measuring serum thrombospondin-2 (TSP2) levels in obese individuals can identify patients at risk of metabolic-associated fatty liver disease (MAFLD) and also its severity, according to a study published in The Journal of Clinical Endocrinology and Metabolism.¹

A research team from Hong Kong, China, Australia and Canada set out to examine a correlation between serum thrombospondin-2 (TSP2) and severity of metabolic syndrome and metabolic associated fatty liver disease (MAFLD). They also investigated the diagnostic proficiency of serum TSP2 in identifying at-risk patients with metabolic-associated steatohepatitis (MASH). A total of 252 patients who underwent bariatric surgery for morbid obesity were enrolled for the study. Serum TSP2 was measured by ELISA. Liver biopsies along with blood samples were obtained from the participants.

Levels of serum TSP2 were significantly raised among patients with metabolic syndrome compared with those who did not have metabolic syndrome; 1.58 vs 1.28, respectively. After adjusting for confounders, patients with high TSP2 levels were positively associated with increasing number of components of metabolic syndrome, fasting glucose, fasting insulin, glycosylated hemoglobin, C-peptide, and homeostatic model assessment (HOMA)of insulin resistance. “Serum TSP2 levels differentiated MASH (1.74 ng/mL) from the other non-MASH less severe groups: normal liver (1.41 ng/mL), simple steatosis (1.45 ng/mL) and borderline MASH (1.30 ng/mL)”. Results also observed a positive association between higher serum TSP2 values and severity of hepatic steatosis, inflammation, fibrosis and hepatic dysfunction. This correlation was independent of sex, age and obesity.

TSP2 is part of a group of secretory glycoproteins, called thrombospondins. TSP2 has been reported to have a role in formation of collagen or fibrin and TSP2 levels have been linked to fibrosis in patients with type 2 diabetes and NAFLD.^2,3 Based on these findings, the authors suggest that serum TSP2 may reveal at-risk patients with MASH among the obese persons. Therefore, it may have potential clinical application as a non-invasive biomarker to distinguish between MASH and benign steatosis as well as to monitor the progression of metabolic associated fatty liver disease (MAFLD), earlier known as nonalcoholic fatty liver disease (NAFLD).

References

1. Xuerui Wu, et al. Serum thrombospondin-2 levels are closely associated with the severity of metabolic syndrome and metabolic associated fatty liver disease. J Clin Endocrinol Metab. 2022 Jul 14;107(8):e3230-e3240. doi: 10.1210/clinem/dgac292.
2. Takefumi Kimura, et al. Serum thrombospondin 2 is a novel predictor for the severity in the patients with NAFLD. Liver Int. 2021 Mar;41(3):505-514. doi: 10.1111/liv.14776.
3. Chi-Ho Lee, et al. Circulating thrombospondin-2 as a novel fibrosis biomarker of nonalcoholic fatty liver disease in type 2 diabetes. Diabetes Care. 2021 Sep;44(9):2089-2097. doi: 10.2337/dc21-0131.