Mitochondria matter: Systemic aspects of nonalcoholic fatty liver disease (nafld) and diagnostic assessment of liver function by stable isotope dynamic breath tests

Agostino Di Ciaula, Giuseppe Calamita, Harshitha Shanmugam, Mohamad Khalil, Leonilde Bonfrate, David Q.H. Wang, Gyorgy Baffy, Piero Portincasa

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


The liver plays a key role in systemic metabolic processes, which include detoxification, synthesis, storage, and export of carbohydrates, lipids, and proteins. The raising trends of obesity and metabolic disorders worldwide is often associated with the nonalcoholic fatty liver disease (NAFLD), which has become the most frequent type of chronic liver disorder with risk of progression to cirrhosis and hepatocellular carcinoma. Liver mitochondria play a key role in degrading the pathways of carbohydrates, proteins, lipids, and xenobiotics, and to provide energy for the body cells. The morphological and functional integrity of mitochondria guarantee the proper functioning of β‐oxidation of free fatty acids and of the tricarboxylic acid cycle. Evaluation of the liver in clinical medicine needs to be accurate in NAFLD patients and includes history, physical exam, imaging, and laboratory assays. Evaluation of mitochondrial function in chronic liver disease and NAFLD is now possible by novel diagnostic tools. “Dynamic” liver function tests include the breath test (BT) based on the use of substrates marked with the non‐radioactive, naturally occurring stable isotope13C. Hepatocellular metabolization of the substrate will generate13CO2, which is excreted in breath and measured by mass spectrometry or infrared spectroscopy. Breath levels of 13 CO2 are biomarkers of specific metabolic processes occurring in the hepatocyte cytosol, microsomes, and mitochondria.13 C‐BTs explore distinct chronic liver diseases including simple liver steatosis, non‐alcoholic steatohepatitis, liver fibrosis, cirrhosis, hepatocellular carcinoma, drug, and alcohol effects. In NAFLD,13C‐BT use substrates such as α‐ketoisocaproic acid, methionine, and octanoic acid to assess mitochondrial oxidation capacity which can be impaired at an early stage of disease.13C‐BTs represent an indirect, cost‐effective, and easy method to evaluate dynamic liver function. Further applications are expected in clinical medicine. In this review, we discuss the involvement of liver mitochondria in the progression of NAFLD, together with the role of13C‐BT in assessing mitochondrial function and its potential use in the prevention and management of NAFLD.

Original languageEnglish (US)
Article number7702
JournalInternational Journal of Molecular Sciences
Issue number14
StatePublished - Jul 2 2021


  • Breath test
  • Hepatic mitochondrial function
  • Hepatocellular carcinoma
  • Ketoisocaproic acid
  • Liver diseases
  • Liver steatosis
  • Methacetin
  • Methionine
  • Octanoic acid
  • β‐oxidation

ASJC Scopus subject areas

  • Catalysis
  • Molecular Biology
  • Spectroscopy
  • Computer Science Applications
  • Physical and Theoretical Chemistry
  • Organic Chemistry
  • Inorganic Chemistry


Dive into the research topics of 'Mitochondria matter: Systemic aspects of nonalcoholic fatty liver disease (nafld) and diagnostic assessment of liver function by stable isotope dynamic breath tests'. Together they form a unique fingerprint.

Cite this