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Metabolic Pathology of Pediatric NAFLD

Primary Purpose

Nonalcoholic Fatty Liver, Nonalcoholic Steatohepatitis, Obesity

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Oral sugar tolerance test
De novo lipogenesis test
Gluconeogenesis test
Sponsored by
University of Oklahoma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Nonalcoholic Fatty Liver

Eligibility Criteria

10 Years - 20 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Age: All participants must be 10.0 to 20.9 years old at the time of enrollment.
  • Sex: Male and Female participants are eligible.
  • Race/Ethnicity: Participants of all racial/ethnic identities will be recruited.
  • Body mass index (BMI): Participants must be either in the normal weight (NW control group) or obese [Ob control, nonalcoholic fatty liver disease (NALFD) groups] range for BMI percentile. BMI percentile will be calculated from age- and sex-specific growth charts for children.
  • NAFLD status: The NAFLD group participants will be eligible if they are scheduled for liver biopsy for clinical reasons and their histopathology report confirms a diagnosis of NAFLD. NW control, and Ob control, and Liver control participants must not have diagnosed NAFLD.

Exclusion Criteria:

  • Chronic illness: Participants will not be able to participate if they have conditions that are likely to affect metabolic variables (either directly or due to required medications) or result in them being unable to complete the required tests. Such conditions could include, but are not limited to, untreated hypothyroidism or other endocrine disorders, rheumatoid arthritis requiring steroids or limiting mobility, cardiovascular disease, stroke, or cardiac failure, neurological disorders such as multiple sclerosis, cancer, liver diseases other than NAFLD (e.g., Wilson's disease), other organ disorders, or orthopedic conditions that limit physical activity.
  • Acute illness: Participants will not be able to participate if they develop acute conditions that are likely to affect metabolic outcomes (either directly or due to required medications) or result in them being unable to participate; e.g., respiratory illness, infectious disease, fever, accident resulting in bone fractures, myocardial infarction, major depression. If such conditions resolve and there are no longer risks or likelihood of adverse effect on the study outcomes, participants may be rescheduled for testing.
  • Medications and nutritional supplements: Medications, vitamins, or supplements that have known effects on the primary outcomes will be cause for exclusion. Examples include weight loss medications, glucocorticoids, or experimental medications used to correct a metabolic or hepatic condition. Medications used to control asthma, allergies, anxiety, depression, attention deficit disorder, menstrual cycle, hypothyroidism, gastric reflux, hypertension, and sleep will be allowed. Participants who are taking medications for treatment of acute illness or conditions such as cold, flu, injury, or infection will be rescheduled after they complete their treatment course.
  • Pregnancy: Evidence of pregnancy or intent to become pregnant during the study is cause for exclusion.
  • Smoking, alcohol abuse, or illicit drug abuse: Participants who smoke or have signs or symptoms of alcohol or substance abuse will be excluded.

Sites / Locations

  • University of Oklahoma Health Sciences CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

NAFLD

Ob control

NW control

Liver control

Arm Description

Participants in the pediatric NAFLD clinic

Participants with obesity, without NAFLD

Participants in the normal range for body weight, without NAFLD

Participants undergoing liver biopsy or liver surgery, without NAFLD

Outcomes

Primary Outcome Measures

De novo lipogenesis
Measurement of the rate of newly synthesized triglycerides in plasma using deuterated water
Gluconeogenesis
Measurement of the rate newly synthesized glucose in circulation using labeled glycerol and deuterated water
Serum microRNA
Abundance of microRNAs in serum using a broad profiling platform and real-time quantitative polymerase chain reaction tests for confirming individual miRNAs
Abundance of liver collagen
Abundance of collagen in liver biopsy sections, using Second Harmonic Generation microscopy
Liver mitochondrial flux
Reported as the fluorescent lifetime redox ratio (FLIRR), which is calculated from measurements of free and bound NADH and FAD in liver biopsy sections, using fluorescence lifetime imaging microscopy
Insulin sensitivity
Calculated value of insulin sensitivity, using the oral minimal model and serial concentrations of glucose and insulin during an oral sugar tolerance test

Secondary Outcome Measures

Targets of microRNA-122
Transcripts bound to microRNA-122, measured using high-throughput sequencing of cross- linked immunoprecipitates (HITS-CLIP)
Liver transcriptomics
Spatial distribution of messenger RNAs in liver biopsies

Full Information

First Posted
June 1, 2022
Last Updated
February 8, 2023
Sponsor
University of Oklahoma
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT05430178
Brief Title
Metabolic Pathology of Pediatric NAFLD
Official Title
Understanding the Metabolic Pathology of Pediatric Obesity and NAFLD
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 25, 2022 (Actual)
Primary Completion Date
February 2026 (Anticipated)
Study Completion Date
June 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Oklahoma
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Nonalcoholic fatty liver disease (NAFLD) is now the most common liver disease worldwide and affects nearly 40% of obese youth and up to 10% of the general pediatric population. Some features of NAFLD are similar in children and adults, yet fibrosis and inflammation are more common in the portal zone and occur earlier in pediatric NAFLD patients than adults. This portends a rapid progression to end-stage liver disease in early adulthood. For the majority of children with NAFLD, mechanisms driving the origin and rapid progression of disease remain unknown. Thus, there is a critical, unmet need to study the specific underlying patterns of metabolic and molecular changes in the liver underlying the development and progression unique to children with NAFLD. This proposal will test the hypotheses that children with NAFLD have excess glucose and lipid produced by the liver, that those events are regulated by specific variations in the amount and location of RNAs and proteins in liver, and that the concentration of specific micro-RNAs in the blood can be used as a biomarker for NAFLD in pediatric patients.
Detailed Description
This project uses a cross-sectional design with a single testing period without a formal intervention (e.g., diet, drug, exercise) or natural follow-up period. Participants with nonalcoholic fatty liver disease (NAFLD), and age-matched control groups classified as either obese (Ob control) or normal weight (NW control) will complete all metabolic and descriptive tests, including blood analyses. The NAFLD group will also have a liver biopsy as part of their standard clinical care; a portion of the biopsy will be used for the research testing. The Ob and NW control groups will not undergo liver biopsy. To provide a set of reference liver samples to compare with the NAFLD group, we will enroll a "liver control" group, consisting of age-matched patients who are scheduled to have a cholecystectomy with liver biopsy or are undergoing liver resection for tumor removal.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nonalcoholic Fatty Liver, Nonalcoholic Steatohepatitis, Obesity

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Cross-sectional design in which all participants receive all interventions in the form of short-term observations following oral consumption of test materials.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
NAFLD
Arm Type
Experimental
Arm Description
Participants in the pediatric NAFLD clinic
Arm Title
Ob control
Arm Type
Experimental
Arm Description
Participants with obesity, without NAFLD
Arm Title
NW control
Arm Type
Experimental
Arm Description
Participants in the normal range for body weight, without NAFLD
Arm Title
Liver control
Arm Type
Experimental
Arm Description
Participants undergoing liver biopsy or liver surgery, without NAFLD
Intervention Type
Other
Intervention Name(s)
Oral sugar tolerance test
Intervention Description
Measurement of glucose and insulin for calculation of insulin sensitivity
Intervention Type
Other
Intervention Name(s)
De novo lipogenesis test
Intervention Description
Oral consumption of deuterated water to measure incorporation of label into lipids
Intervention Type
Other
Intervention Name(s)
Gluconeogenesis test
Intervention Description
Oral consumption of 13C-labeled glycerol to measure incorporation into glucose
Primary Outcome Measure Information:
Title
De novo lipogenesis
Description
Measurement of the rate of newly synthesized triglycerides in plasma using deuterated water
Time Frame
Day 1
Title
Gluconeogenesis
Description
Measurement of the rate newly synthesized glucose in circulation using labeled glycerol and deuterated water
Time Frame
Day 1
Title
Serum microRNA
Description
Abundance of microRNAs in serum using a broad profiling platform and real-time quantitative polymerase chain reaction tests for confirming individual miRNAs
Time Frame
Day 1
Title
Abundance of liver collagen
Description
Abundance of collagen in liver biopsy sections, using Second Harmonic Generation microscopy
Time Frame
Day 1
Title
Liver mitochondrial flux
Description
Reported as the fluorescent lifetime redox ratio (FLIRR), which is calculated from measurements of free and bound NADH and FAD in liver biopsy sections, using fluorescence lifetime imaging microscopy
Time Frame
Day 1
Title
Insulin sensitivity
Description
Calculated value of insulin sensitivity, using the oral minimal model and serial concentrations of glucose and insulin during an oral sugar tolerance test
Time Frame
Day 1
Secondary Outcome Measure Information:
Title
Targets of microRNA-122
Description
Transcripts bound to microRNA-122, measured using high-throughput sequencing of cross- linked immunoprecipitates (HITS-CLIP)
Time Frame
Day 1
Title
Liver transcriptomics
Description
Spatial distribution of messenger RNAs in liver biopsies
Time Frame
Day 1
Other Pre-specified Outcome Measures:
Title
Blood pressure
Description
Brachial and central blood pressures
Time Frame
Day 1
Title
Arterial stiffness
Description
Measured as carotid-femoral pulse wave velocity
Time Frame
Day 1
Title
Body composition
Description
Whole body and regional lean and fat mass, measure with dual energy X-ray absorptiometry
Time Frame
Day 1
Title
Cardiorespiratory fitness
Description
Peak oxygen consumption during bicycle ergometry test to volitional fatigue
Time Frame
Day 1
Title
Blood DNA analysis
Description
Measurement of single-nucleotide polymorphisms associated with NAFLD risk
Time Frame
Day 1
Title
Liver steatosis
Description
Use of Fibroscan to measure controlled attenuation parameter (measure of steatosis)
Time Frame
Day 1
Title
Liver fibrosis
Description
Use of Fibroscan to measure elastic modulus (surrogate measure of fibrosis)
Time Frame
Day 1

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age: All participants must be 10.0 to 20.9 years old at the time of enrollment. Sex: Male and Female participants are eligible. Race/Ethnicity: Participants of all racial/ethnic identities will be recruited. Body mass index (BMI): Participants must be either in the normal weight (NW control group) or obese [Ob control, nonalcoholic fatty liver disease (NALFD) groups] range for BMI percentile. BMI percentile will be calculated from age- and sex-specific growth charts for children. NAFLD status: The NAFLD group participants will be eligible if they are scheduled for liver biopsy for clinical reasons and their histopathology report confirms a diagnosis of NAFLD. NW control, and Ob control, and Liver control participants must not have diagnosed NAFLD. Exclusion Criteria: Chronic illness: Participants will not be able to participate if they have conditions that are likely to affect metabolic variables (either directly or due to required medications) or result in them being unable to complete the required tests. Such conditions could include, but are not limited to, untreated hypothyroidism or other endocrine disorders, rheumatoid arthritis requiring steroids or limiting mobility, cardiovascular disease, stroke, or cardiac failure, neurological disorders such as multiple sclerosis, cancer, liver diseases other than NAFLD (e.g., Wilson's disease), other organ disorders, or orthopedic conditions that limit physical activity. Acute illness: Participants will not be able to participate if they develop acute conditions that are likely to affect metabolic outcomes (either directly or due to required medications) or result in them being unable to participate; e.g., respiratory illness, infectious disease, fever, accident resulting in bone fractures, myocardial infarction, major depression. If such conditions resolve and there are no longer risks or likelihood of adverse effect on the study outcomes, participants may be rescheduled for testing. Medications and nutritional supplements: Medications, vitamins, or supplements that have known effects on the primary outcomes will be cause for exclusion. Examples include weight loss medications, glucocorticoids, or experimental medications used to correct a metabolic or hepatic condition. Medications used to control asthma, allergies, anxiety, depression, attention deficit disorder, menstrual cycle, hypothyroidism, gastric reflux, hypertension, and sleep will be allowed. Participants who are taking medications for treatment of acute illness or conditions such as cold, flu, injury, or infection will be rescheduled after they complete their treatment course. Pregnancy: Evidence of pregnancy or intent to become pregnant during the study is cause for exclusion. Smoking, alcohol abuse, or illicit drug abuse: Participants who smoke or have signs or symptoms of alcohol or substance abuse will be excluded.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kevin Short, PhD
Phone
405-271-8001
Ext
43094
Email
kevin-short@ouhsc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kevin Short, PhD
Organizational Affiliation
University of Oklahoma
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Oklahoma Health Sciences Center
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kevin Short, PhD
Phone
405-271-8001
Ext
43094
Email
kevin-short@ouhsc.edu

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Metabolic Pathology of Pediatric NAFLD

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