Effects of Probiotic on Inflammation and Microbiota in Patients With NASH (NASHPro)

Evaluation of Alterations in Serum Inflammatory Markers and Fecal Microbiota Following Administration of the Probiotic Formulation VSL#3 in Patients With Nonalcoholic Fatty Liver Disease

Individuals with clinically identified non-alcoholic fatty liver disease will undergo baseline evaluation of IL-17 and other inflammatory markers as well as microbiome determination. The probiotic formulation VSL#3 450 Billion CFU twice daily will be administered for 8 weeks and the determination of Il-17 and microbiome will be repeated. Each subject will serve as his or her own control.

This study is designed as a prospective trial of the effects of probiotic on inflammatory and stool profiles in patients with NAFLD. These patients are actively followed by the Division of Hepatology. They will have confirmed normal liver function tests and absence of hepatitis C virus in order to be eligible for this study. Eligible subjects will be identified within the outpatient setting of the Division of Hepatology of the Northwell Health System. Division of Hepatology 400 Community Drive Manhasset, NY 11030 516-562-4281 Candidate subjects will be identified by investigators as a part of their typical work flow. Subjects will be evaluated according to inclusion and exclusion criteria presented. Eligible patients will be provided with a packet containing study information and informed consent documents. Should a patient remain interested in study participation, informed consent will be obtained. Financial compensation will not be provided to subjects. Forty patients with NAFLD will be enrolled. Following enrollment and informed consent, subjects will undergo the following assessments: Medical History Questionnaire Current Medication List Blood and stool samples will be obtained prior to study initiation and again after 8 weeks of exposure. Protocol for biological sample collection: Whole Blood Collection - Venipuncture will be performed under standard conditions. Three heparinized tubes will be obtained which each tube containing approximately 10 cc of whole blood Samples will be de-identified. Peripheral Blood Cells will be isolated from whole blood samples according to standard protocols. Serum cytokine levels, including IL-10 and IL-17, will be assessed. Stool Collection - Patients will be provided with stool collection kits. Samples will be de-identified. Stool samples will be preserved in a -20 degree freezer in the Division of Infectious Diseases.

Non-Alcoholic Fatty Liver Disease, Probiotics MeSH Descriptor Data 2018, Interleukin-17 MeSH Descriptor Data 2018

After baseline collection of serum and fecal microbiota, each subject will be administered the probiotic formulation VSL#3 450 Billion CFU Twice daily for 8 weeks. Serum and fecal microbiota will again be collected at the end of the intervention and compared with baseline with each subject serving as his or her own control.

Inclusion Criteria: 18 years of age or older Capable of giving informed consent Diagnosed with NAFLD as defined by the American Association for the Study of Liver Diseases (AASLD) who are treated or seen solely at the outpatient clinic at the Department of Hepatology at 400 Community Drive in Manhasset NY Exclusion Criteria: Cirrhosis Absence of secondary causes of hepatic fat accumulation including: Excessive alcohol consumption Hepatitis C Wilson's Disease Lipodystrophy Starvation Parenteral Nutrition Abetalipoproteinemia Specific Medications: Amiodarone, Methotrexate, Tamoxifen, Corticosteroids, Valproate, Anti-retroviral agents) Reye's Syndrome HELLP Syndrome Inborn errors of metabolism (LCAT deficiency, cholesterol ester storage disease, Wolman disease)

Li J, Sung CY, Lee N, Ni Y, Pihlajamaki J, Panagiotou G, El-Nezami H. Probiotics modulated gut microbiota suppresses hepatocellular carcinoma growth in mice. Proc Natl Acad Sci U S A. 2016 Mar 1;113(9):E1306-15. doi: 10.1073/pnas.1518189113. Epub 2016 Feb 16.