Figure 3.

Dysregulation of metabolic pathways in NASH and HCC. There is an increase in the TCA cycle and lactate (HSCs) production in NASH, while β-oxidation, lipid esterification, and intrahepatic lipolysis are decreased, leading hepatic steatosis. The tumor cells express an increase of glycolysis with production of lactate (Warburg effect), elevated pentose phosphate pathway (nucleotide synthesis for multiplying tumor cells), FA synthesis and lipogenesis. The tumor cells also show reduced TCA cycle, β-oxidation and gluconeogenesis, indicating that metabolic reprograming plays a key role in hepatocarcinogenesis. Abbreviations: DNL, de novo lipogenesis; FA, fatty acid; HSCs, hepatic stellate cells; TCA, tricarboxylic acid.