Clinical Research Network in NASH

NASH 临床研究网络

• 批准号: 6946615
• 负责人: NATHAN M BASS
• 金额: $ 15.1万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-06-15 至 2009-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6946615
• 关键词: clinical research; cooperative study; epidemiology; fatty liver; genetic susceptibility; hepatitis; human subject; lipid metabolism; longitudinal human study; pathologic process; patient /disease registry; patient oriented research; peroxisome proliferator activated receptor; questionnaires; tissue resource /registry; transaminases

Non-alcoholic fatty liver disease (NAFLD) is a common cause of asymptomatic liver test abnormalities in the general population often associated with obesity and insulin resistance. The severe public health problem with a significant impact in terms of morbidity, mortality and health care cost outcomes. This proposal brings together a unique consortium of investigators and resources within the State of California with a plan for participating Clinical Center in the NASH Clinical Research Network. The proposed NASH patient informational database and tissue bank will comprise cross-sectional and prospective cohorts derived from four separate sources, each providing distinct epidemiological facets and research potential. These include tertiary care referral specialty clinics at two large university medical centers and an HMO patient population. We propose to identify patients with definite (biopsy-proven) NASH and probable (association-defined) NAFLD/NASH from these sources, and outline a plan for longitudinal follow-up of selected sub-populations for the purpose of studying the natural history of progression, identification of risk factors for progression and to enable the implementation of therapeutic trials in patients with NASH. Secondly, we describe two research protocols that would use the NASH Clinical Research Network database and tissue bank to test the hypothesis, supported by our preliminary data that familial/genetic factors underlie the development of NASH and its progression. These projects include: 1) Determining genetic factors predisposing to NASH by exploring a possible etiologic relationship between our newly discovered genomic variants and lipid metabolism in patients (and their kindreds) with NASH. These involve key regulatory components of cellular lipid metabolism (peroxisome proliferator- activated receptors and microsomal triglyceride transfer protein and would be prime candidate genes for exploration utilizing the Network resources; and 2) To design and validate a questionnaire to identify factors in the family history that are predictors of the presence of NASH in patients with unexplained chronically elevated aminotransferases and that are independent predictors of disease severity and progression. We plan to use this approach to identify kindreds to correlate familial factors with specific mutations in key regulatory genes of lipid metabolism in order to elucidate the genetic basis for NASH and the putative genetic association between NASH and cryptogenic cirrhosis.

非酒精性脂肪性肝病（NAFLD）是一般人群中无症状肝脏检查异常的常见原因，通常与肥胖和胰岛素抵抗有关。严重的公共卫生问题，在发病率、死亡率和卫生保健成本结果方面产生重大影响。本提案汇集了加州州内的研究者和资源的独特联盟，并计划参与NASH临床研究网络的临床中心。拟议的NASH患者信息数据库和组织库将包括来自四个不同来源的横断面和前瞻性队列，每个来源提供不同的流行病学方面和研究潜力。其中包括两个大型大学医疗中心的三级护理转诊专科诊所和HMO患者人群。我们建议从这些来源中确定明确（活检证实）NASH和可能（相关定义）NAFLD/NASH患者，并概述对选定亚群进行纵向随访的计划，以研究进展的自然史，确定进展的风险因素，并在NASH患者中实施治疗试验。其次，我们描述了两个研究方案，将使用NASH临床研究网络数据库和组织库来测试假设，我们的初步数据支持家族/遗传因素是NASH发展及其进展的基础。这些项目包括：1）通过探索我们新发现的基因组变异与NASH患者（及其运动学）的脂质代谢之间的可能病因学关系，确定诱发NASH的遗传因素。 这些涉及细胞脂质代谢的关键调节成分（过氧化物酶体增殖物激活受体和微粒体甘油三酯转移蛋白，将是利用网络资源进行探索的主要候选基因;和2）设计并验证一份调查问卷，以确定家族史中的因素，这些因素是不明原因的慢性转氨酶升高患者中NASH存在的预测因素，并且是独立的疾病严重程度和进展的预测因子。我们计划使用这种方法来确定与家族因素相关的激酶，这些家族因素与脂质代谢关键调控基因的特定突变相关，以阐明NASH的遗传基础以及NASH和隐源性肝硬化之间的假定遗传关联。