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Development of Kinetic Biomarkers of Liver Fibrosis Measuring NAFLD

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02124577
Recruitment Status : Unknown
Verified April 2014 by Rohit Loomba, University of California, San Diego.
Recruitment status was:  Not yet recruiting
First Posted : April 28, 2014
Last Update Posted : December 19, 2014
Information provided by (Responsible Party):
Rohit Loomba, University of California, San Diego

Brief Summary:
This is a small preliminary study conducted to explore new methods for the potential of aiding in diagnosis of liver fibrotic disease as well as predicting disease progression. There will be a total of 4 visits spread out over approximately 8 weeks. You will be asked to drink "heavy water" during most of that time. "Heavy Water" also known as deuterated water, is physically and chemically very similar to ordinary drinking water. It tastes and feels exactly like regular water. It is odorless and has no known harmful effects at the doses given here. Heavy water occurs naturally, and is a minor component of the water we all ingest daily.

Condition or disease
Non-alcoholic Fatty Liver Disease

Detailed Description:

Management of NASH and NAFLD remain a significant unmet medical challenge that is growing in importance as part of the obesity epidemic. Minimally invasive tools for monitoring disease progression and evaluating therapeutic interventions in NASH would be extremely valuable. Utilizing in vivo heavy water labeling, multiple pathways related to protein metabolism (fibrogenesis) and lipid metabolism can be quantified in human subjects. We have recently discovered that plasma lumicam synthesis represents a non-invasive kinetic biomarker of tissue fibrogenesis in patients with viral hepatitis. In addition, synthesis of fatty acids in plasma VLDL-triglycerides provide a window into hepatic lipid metabolism.

Stable isotopes have a long history as a safe, effective tracer for measuring synthesis of molecules in humans (1). Recently, new developments in stable isotope labeling techniques and advances in mass spectrometry have made in vivo kinetic measurement of slow metabolic processes possible. Through the use of 2H2O as the source of labeling, we and others have measured T-cell proliferation (2), mammary epithelial cell proliferation (3), prostate epithelial cell proliferation (4), triglyceride synthesis (5) and protein synthesis (6) in humans. We have recently evaluated this approach for the measurement of fibrogenesis patients with fibrotic liver disease.

Excess accumulation of collagen in the liver is termed fibrosis. Fibrosis is a common pathological feature of several chronic liver diseases (e.g. Hepatitis C, alcoholic liver disease, primary biliary sclerosis, drug/toxin induced liver disease, etc.). Currently, the standard method for detection of fibrosis is liver biopsy and histochemical analyses of tissue collagen content (8, 9). Although effective in diagnosing existing, advanced fibrosis, a single biopsy cannot measure current disease activity or predict rate of progression. To determine whether disease is progressing using current methods, a second biopsy is required. If significant additional collagen has accumulated since the first biopsy, this suggests that the disease is progressing. However, this measurement represents the history of the disease, not the current disease activity at the time of the second biopsy. There are also significant limitations in current methods, since changes in collagen pool size measurable by histochemistry cannot measure small changes in collagen content and intra-laboratory variability inherent in histochemical assays reduce their sensitivity (10, 11).

This stable isotope / mass spectrometry based method will be applied here for the quantification of fibrogenesis in vivo (from a bone marrow biopsy) and the identification of novel biomarkers of fibrogenesis in plasma in patients receiving investigational therapies.

If successful, this research will identify plasma proteins which can be easily measured by tandem mass spectrometry (LC/MS/MS) methods and whose synthesis rate reflects disease activity in the heart. Ideally, a set of markers related to NASH/ NAFLD will be developed that can detect and differentiate among multiple disease phenotypes, based on the kinetic signature measured in a single blood draw from a patient labeled with deuterated water.

The role of de novo lipogenesis (DNL) has been suggested by several clinical studies (Donnelly JCI 2005, Puri Hepatology 2009). DNL contributes significantly to the accumulation of lipid in NASH (Donnelly JCI 2005). Moreover DNL is elevated in many other inflammatory states and may be a useful marker of hepatic inflammation. DNL as well as hepatic TG assembly and cholesterogenesis are easily measured in plasma or dried blood spot samples from patients consuming 2H2O, after several days of labeling the plasma DNL reaches a steady state and reflects hepatic DNL rates.

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Study Type : Observational [Patient Registry]
Estimated Enrollment : 50 participants
Observational Model: Case Control
Time Perspective: Prospective
Target Follow-Up Duration: 8 Weeks
Official Title: Development of Kinetic Biomarkers of Liver Fibrosis Based on Stable Isotope Mass Spectrometry Techniques for Measuring Nonalcoholic Fatty Liver Disease NAFLD)
Study Start Date : May 2014
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : May 2019

Primary Outcome Measures :
  1. evaluate stable isotope/mass spectrometric methods [ Time Frame: Basline ]
    Our primary aim is to evaluate stable isotope/mass spectrometric methods for measuring in vivo liver collagen synthesis (fibrogenesis) and liver lipogenesis rates using liver biopsy specimens from patients with Non-Alcoholic Steatohepatitis (NASH)/ Nonalcoholic fatty liver disease (NAFLD).

Secondary Outcome Measures :
  1. serum or urine markers of liver fibrogenesis that can be measured by the same stable isotope/mass spectrometric approach [ Time Frame: Basline ]
    Our secondary aim is to look for new serum or urine markers of liver fibrogenesis that can be measured by the same stable isotope/mass spectrometric approach in the same subjects. Subjects will drink the safe, non-toxic stable isotope heavy water (2H2O, deuterated water) prior to having a liver biopsy and providing urine and blood samples.

Biospecimen Retention:   Samples With DNA

Stored specimen The specimens (serum, plasma, urine, stool, saliva, liver tissue, and DNA) collected as part of this study will be kept in Dr. Loomba' s locked research freezer at the Clinical Teaching Facility (CTF-building A).All collected data and patient charts will be maintained at the CTF building in a locked computer file with access available to the principal and study investigators only.

All samples and data will be labeled with a code number. The name, address, social security number, date of birth and other personal identifiers will not be available on the sample, and we will not give out any information that identifies the patient to the researchers who use these samples and data.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Adults, age 18 or above, may have NAFLD or NASH-related cirrhosis or may serve as a control participant without this condition.

Inclusion Criteria:

  1. Adults (≥ 18 years of age)
  2. Adult male and female subjects, all races, ethnic groups, social and economic backgrounds and health status who are scheduled to undergo a liver biopsy as part of routine medical care will be included in the research.
  3. Willingness to follow-up for 8 weeks
  4. Written inform consent.

Exclusion Criteria:

  1. Children younger than 18 will be excluded, since growth of liver tissue may confound measurements of collagen synthesis and cell proliferation due to normal turnover or disease.
  2. The eligibility of patients will be determined by Dr. Rohit Loomba, MD or a referring physician at the time the potential subject is recommended to undergo a liver biopsy procedure as part of their medical treatment.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02124577

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Contact: Leander A Lazaro 619-471-3915
Contact: Phirum Nguyen 619-471-0774

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United States, California
University of California, San Diego
San Diego, California, United States, 92103
Contact: Leander A Lazaro    619-471-3915      
Contact: Phirum S. Nguyen    619-471-0774   
Principal Investigator: Rohit Loomba, MD         
Sponsors and Collaborators
University of California, San Diego
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Principal Investigator: Rohit Loomba, MD University of California, San Diego

Additional Information:

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Responsible Party: Rohit Loomba, Assistant Professor of Clinical Medicine, Division of Gastroenterology, Department of Medicine and, University of California, San Diego Identifier: NCT02124577    
Other Study ID Numbers: 140338
First Posted: April 28, 2014    Key Record Dates
Last Update Posted: December 19, 2014
Last Verified: April 2014
Additional relevant MeSH terms:
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Liver Diseases
Fatty Liver
Non-alcoholic Fatty Liver Disease
Liver Cirrhosis
Digestive System Diseases