New Non-invasive Biomarkers of Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD)

NCT ID: NCT06647095

Last Updated: 2024-11-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

172 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-09-01

Study Completion Date

2024-09-01

Brief Summary

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The goal of this observational study is to learn if some components of blood or exhaled breath can diagnose people having more fat in their livers than is normal, because of their poorer metabolic health (for example, because of obesity and diabetes). The main questions it aims to answer are:

1. Can a method find participants with higher liver fat than healthy participants?
2. Can a method find participants in whom higher liver fat was a cause of liver inflammation or stiffness?

Participants will:

* fast overnight
* have a routine blood draw
* easily exhale a few times into a special device or a plastic bag and fill in a short dietary questionnaire (if participating in a breath test)
* optionally swallow capsules with an orange peel extract and fish oil before exhaling, which can help get better results from breath (capsules will be medically safe and approved)

Detailed Description

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Patients with MASLD and healthy volunteers will be offered an observational study evaluating the diagnostic role of new non-invasive experimental methods (serum bile acids, breath VOC, and plasmatic spectroscopic patterns) assessing the presence and severity of liver fibrosis and steatosis.

First, this study aims to differentiate patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) from healthy controls (or simple steatosis) using three experimental methods.

Second, the investigators aim to stratify patients with MASLD according to the presence/grade of steatosis and fibrosis (any, significant F2-3, advanced F3, cirrhosis F4) using the same methods.

Experimental methods tested in this study include:

1. analyzing the fasting spectrum of serum bile acids using liquid chromatography-mass spectrometry
2. analyzing the disease-specific spectroscopy patterns given by vibrational and chiroptical spectroscopy of blood plasma
3. analyzing trace concentrations of volatile organic compounds (VOC) in exhaled human breath using the Selected ion flow tube mass spectrometry. This contains the so-called stress test to monitor breath VOC (d-Limonene and triethylamine) after their regulated ingestion in the form of capsules

These parameters may eventually be combined with anthropometric and laboratory parameters (such as age or BMI).

Clinical examinations, blood sampling, ultrasound examinations of the liver, and liver elastography will be performed as part of routine care.

The results of the blood parameters can be retrospectively evaluated.

Approximately 60-80 participants in total were anticipated for each method. For patients who participate in breath tests, adequate insurance must be guaranteed.

Statistical processing: individual parameters will be evaluated in an exploratory and a validation group or by the PLS-DA algorithm with repeated cross-validation. A difference of p \<0.05 will be considered a statistically significant change.

Conditions

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Healthy Simple Steatosis (SS) Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) Metabolic Dysfunction-associated Steatohepatitis (MASH)

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Healthy controls

D-Limonene Gelcaps

Intervention Type DIETARY_SUPPLEMENT

Capsules containing d-Limonene will be optionally given during the breath test to all participants of all groups

Fish Oil Concentrate, 1000 Mg Oral Capsule

Intervention Type DIETARY_SUPPLEMENT

Capsules containing fish oil will be optionally given during the breath test to all participants of all groups

MASH

D-Limonene Gelcaps

Intervention Type DIETARY_SUPPLEMENT

Capsules containing d-Limonene will be optionally given during the breath test to all participants of all groups

Fish Oil Concentrate, 1000 Mg Oral Capsule

Intervention Type DIETARY_SUPPLEMENT

Capsules containing fish oil will be optionally given during the breath test to all participants of all groups

Steatosis

D-Limonene Gelcaps

Intervention Type DIETARY_SUPPLEMENT

Capsules containing d-Limonene will be optionally given during the breath test to all participants of all groups

Fish Oil Concentrate, 1000 Mg Oral Capsule

Intervention Type DIETARY_SUPPLEMENT

Capsules containing fish oil will be optionally given during the breath test to all participants of all groups

Interventions

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D-Limonene Gelcaps

Capsules containing d-Limonene will be optionally given during the breath test to all participants of all groups

Intervention Type DIETARY_SUPPLEMENT

Fish Oil Concentrate, 1000 Mg Oral Capsule

Capsules containing fish oil will be optionally given during the breath test to all participants of all groups

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* Presence of liver steatosis (detected either by hepatic ultrasonography/CAP/histologically) or MASH/simple steatosis confirmed by liver biopsy
* Absence of secondary causes of fat accumulation in the liver and other liver disease: ruled out other etiologies of liver disease, such as viral hepatitis, drug-induced liver disease, autoimmune liver disease, biliary tract disease, and hereditary metabolic diseases


* Absence of liver disease
* For breath analysis: absence of liver steatosis (normal liver ultrasound image and CAP less than 248 dB/m)
* For plasma spectroscopy and bile acid analysis: Body Mass Index ≤ 25 and waist-hip ratio ≤ 0.95 plus normal liver ultrasound
* Absence of diabetes mellitus and metabolic syndrome
* Normal liver function tests, lipid spectrum, fasting glycemia
* Alcohol intake less than 20 g/ day (women) or 30 g/ day (men)

Exclusion Criteria

* Non-compliance with the investigation program
* Failure to sign the informed consent form
* Liver biopsy/clinic discrepancy
* For LMN a TMA "stress test": fish, see fruit and citrus fruit allergy
* Pregnancy
* For bile acid analysis: Treatment with BA or BA sequestrants
* For bile acid analysis: Portal hypertension (does not apply for MASH patients)
* For bile acid analysis: Cirrhosis (does not apply for MASH patients)
* For plasma spectroscopy: Cirrhosis
* Anamnesis of alcohol abuse (based on GGT, carbohydrate-deficient transferrin, urinary ethyl-glucuronide, and patient's history)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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General University Hospital, Prague

OTHER

Sponsor Role lead

Responsible Party

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Barbora Nováková, MD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Barbora Nováková, MD

Role: PRINCIPAL_INVESTIGATOR

General University Hospital, Prague

Locations

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Regional Hospital Liberec

Liberec, Czech Republic, Czechia

Site Status

General University Hospital in Prague

Prague, Czech Republic, Czechia

Site Status

Countries

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Czechia

References

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Zizalova K, Novakova B, Vecka M, Petrtyl J, Lanska V, Pelinkova K, Smid V, Bruha R, Vitek L, Lenicek M. Serum concentration of taurochenodeoxycholic acid predicts clinically significant portal hypertension. Liver Int. 2023 Apr;43(4):888-895. doi: 10.1111/liv.15481. Epub 2022 Nov 25.

Reference Type BACKGROUND
PMID: 36433660 (View on PubMed)

WED-280 Spectroscopy of blood plasma has the potential to differentiate metabolic dysfunction-associated steatohepatitis from steatosis Nováková, Barbora et al. Journal of Hepatology, Volume 80, S539 - S540

Reference Type BACKGROUND

Puri P, Daita K, Joyce A, Mirshahi F, Santhekadur PK, Cazanave S, Luketic VA, Siddiqui MS, Boyett S, Min HK, Kumar DP, Kohli R, Zhou H, Hylemon PB, Contos MJ, Idowu M, Sanyal AJ. The presence and severity of nonalcoholic steatohepatitis is associated with specific changes in circulating bile acids. Hepatology. 2018 Feb;67(2):534-548. doi: 10.1002/hep.29359. Epub 2017 Dec 23.

Reference Type BACKGROUND
PMID: 28696585 (View on PubMed)

Spanel P, Smith D. Quantification of volatile metabolites in exhaled breath by selected ion flow tube mass spectrometry, SIFT-MS. Clin Mass Spectrom. 2020 Feb 13;16:18-24. doi: 10.1016/j.clinms.2020.02.001. eCollection 2020 Apr.

Reference Type BACKGROUND
PMID: 34820516 (View on PubMed)

Sinha R, Lockman KA, Homer NZM, Bower E, Brinkman P, Knobel HH, Fallowfield JA, Jaap AJ, Hayes PC, Plevris JN. Volatomic analysis identifies compounds that can stratify non-alcoholic fatty liver disease. JHEP Rep. 2020 Jun 15;2(5):100137. doi: 10.1016/j.jhepr.2020.100137. eCollection 2020 Oct.

Reference Type BACKGROUND
PMID: 32775974 (View on PubMed)

Ten-Doménech I, Rienda I, Pérez-Rojas J, et al. Progress and challenges of mid-infrared spectroscopy for liver characterization focusing on steatosis, fibrosis and cancer. Applied Spectroscopy Reviews. 2024;59(4):578-599

Reference Type BACKGROUND

Targher G, Byrne CD, Tilg H. MASLD: a systemic metabolic disorder with cardiovascular and malignant complications. Gut. 2024 Mar 7;73(4):691-702. doi: 10.1136/gutjnl-2023-330595.

Reference Type BACKGROUND
PMID: 38228377 (View on PubMed)

Other Identifiers

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GUHPrague83/21

Identifier Type: -

Identifier Source: org_study_id

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