Analysis of PNPLA3, TM6SF2 and GCKR gene polymorphisms in patients with metabolic dysfunction-associated steatohepatitis treated with probiotics ‒ An exploratory study.

Background and aim: genetics significantly influences the development and progression of metabolic dysfunction-associated steatohepatitis (MASH). This study aimed to evaluate key single-nucleotide polymorphisms (SNPs) in PNPLA3 (Patatin-like phospholipase domainecontaining 3), TM6SF2 (transmembrane 6 superfamilymember 2), and GCKR (glucokinase regulatory protein) genes in patients with MASH who were treated with probiotics, focusing on their relationship with changes in anthropometric, biochemical and hepatic inflammatory markers. Methods: yhis cross-sectional study included participants from PROBILIVER Randomized Clinical Trial (ClinicalTrials.gov ID: NCT0346782), whose intervention consisted of 24 weeks of supplementation with probiotic mix Lactobacillus acidophilus (1 x 109 CFU) + Lactobacillus rhamnosus (1 x 109 CFU) + Lactobacillus paracasei (1 x 109 CFU) + Bifidobacterium lactis (1 x 109 CFU) or placebo, twice a day. Patients provided additional blood samples for DNA extraction, and genotyping of the PNPLA3 rs738409 (C/G), TM6SF2 rs58542926 (C/T) and GCKR rs780094 (C/T) SNPs were performed by real-time PCR using TaqMan probes. Results: 41 patients (mean age 50.5 years old; 53.7 % female; 63.4 % with grade 1 liver fibrosis) were analyzed. Among them, 75.61 % carried the G risk allele of PNPLA3 rs738409 SNP, 14.63 % carried the T allele of TM6SF2 rs58542926 SNP and 70.73 % had the T allele of GCKR rs780094 SNP. Participants with the PNPLA3 C/C genotype showed lower glucose levels (-10.38 mg/dL), while those with TM6SF2 C/T+T/T genotype had lower LDL-c (-13.05 mg/dL) and toll-like receptor 4 (TLR4) levels (-7.08 ng/dL). Carriers of the GCKR C/T+T/T genotype exhibited an increase in phase angle (BIA) (+0.69) and a reduction in serum glucose levels (-7.20 mg/dL), while C/C carriers showed a reduction in waist circumference (-2.98 cm) and TLR4 levels (-5.68 ng/dL) but an increase in glucose levels (+34.40 mg/dL), (p < 0.05 for all). Conclusion: genetic profile influenced response of MASH patients to probiotics. These findings could aid in the development of personalized therapeutic strategies for MASH in the future.