LIPIDOMICS BASED DIAGNOSTICS FOR NONALCOHOLIC STEATOHEPATITIS

 描述（由申请方提供）：非酒精性脂肪性肝炎（NASH）是一种侵袭性形式的非酒精性脂肪性肝病（NAFLD），影响3-4%的成年人群，并在15-20%的受试者中进展为肝硬化。目前没有批准的NASH治疗方法，诊断这种疾病的唯一准确方法是肝活检，这是侵入性的，痛苦的，偶尔与死亡率相关。许多人认为，缺乏诊断NASH、评估疾病进展与消退以及对各种治疗剂的反应的“即时”诊断工具是大规模鉴定受影响个体和开发针对NASH的药物的最重要障碍。该提案代表了多PI努力开发基于脂质组学的生物标志物组，以填补这些知识空白。NIDDK NASH临床研究网络（CRN）的Sanyal博士（PI）将领导这项工作，之前领导NIGMS LIPID_MAPS联盟的Dennis博士（Co-PI）将领导脂质分析。NASH CRN数据协调中心（DCC）将继续担任本提案的DCC。这些研究将从NASH CRN生物储存库中抽取血浆，该生物储存库包含在肝活检时从2000多名高表型NAFLD受试者中抽取的血浆。三个具体目标将检验NAFLD中脂质代谢的变化允许鉴定诊断NASH、疾病进展和对特定疗法的反应的循环脂质特征的假设。目的1将定义和验证诊断基础NASH及其严重程度的循环脂质谱。将研究一个模型构建队列和两个验证队列。模型构建队列将包括患有和不患有NAFLD的受试者。验证队列将包括：（1）一组具有不同NAFLD表型的受试者和年龄、性别、种族和体重匹配的无NAFLD对照组，以及（2）一组在“真实世界”环境中的前瞻性受试者，他们将接受临床指示的疑似NASH肝活检。目的2将定义诊断NASH疾病进展的循环脂质变化。这将通过对基线肝活检时抽取的血浆进行脂质组学分析来实现，该基线肝活检是在具有不同NAFLD表型且已接受两次或更多次肝活检的受试者队列中进行的。目的3将定义与治疗诱导的NASH改善相关的循环脂质特征。这将利用NASH CRN在临床试验入组受试者的方案驱动活检期间获得的独特样本集。这些研究将通过应用LIPID_MAPS开发的最先进的分析平台来进一步创新，用于NASH的诊断开发。初步数据支持拟议研究和目标的可行性。这些研究将满足诊断准确性评估（QUADAS）的所有质量指标，并将通过开发允许NASH护理点评估的诊断平台对该领域产生强烈的积极影响。这将增加获得护理的机会，并最终改善人民的健康，从而与国家卫生研究院的使命保持一致。

 DESCRIPTION (provided by applicant): Nonalcoholic steatohepatitis (NASH) is an aggressive form of nonalcoholic fatty liver disease (NAFLD) that affects 3-4% of the adult population and progresses to cirrhosis in 15-20% of affected subjects. There is currently no approved therapy for NASH and the only accurate method to diagnose this condition is a liver biopsy which is invasive, painful and occasionally associated with mortality. The lack of a "point-of-care" diagnostic tool to diagnose NASH, to assess disease progression versus regression and response to various therapeutics is considered by many to be the most important barrier towards large scale identification of affected individuals and for drug-development against NASH. This proposal represents a multi-PI effort to develop a lipidomics-based biomarker panel to fill these gaps in knowledge. Dr. Sanyal (PI) from the NIDDK NASH Clinical Research Network (CRN) will lead this effort and Dr. Dennis (Co-PI) who previously led the NIGMS LIPID_MAPS consortium will lead the lipid analysis. The NASH CRN data coordinating center (DCC) will continue to serve as the DCC for this proposal. The studies will draw from the NASH CRN biorepository which contains plasma drawn at the time of a liver biopsy from over 2000 highly phenotyped subjects with NAFLD. Three specific aims will test the hypothesis that changes in lipid metabolism in NAFLD allow identification of a circulating lipid signature diagnostic of NASH, disease progression and response to specific therapies. Aim 1 will define and validate a circulating lipid profile diagnostic of underlying NASH and its severity. A model building cohort and two validation cohorts will be studied. The model building cohort will include subjects with and without NAFLD. The validation cohort will include: (1) a group of subjects with varying phenotypes of NAFLD and age, gender, race and weight-matched controls without NAFLD, and (2) a prospective group of subjects in a "real-world" setting who are going to receive a clinically-indicated liver biopsy for suspected NASH. Aim 2 will define changes in circulating lipids diagnostic of disease progression in NASH. This will be accomplished by performing lipidomic analyses on plasma drawn at the time of baseline liver biopsies in a cohort of subjects with varying phenotypes of NAFLD who have undergone two or more liver biopsies. Aim 3 will define the circulating lipid signature associated with treatment-induced improvement of NASH. This will utilize unique sample-sets obtained during protocol-driven biopsies from subjects enrolled in clinical trials by the NASH CRN. The studies will further innovate by applying the state-of-the-art analytic platforms developed by LIPID_MAPS for diagnostics development for NASH. Preliminary data support the feasibility of the proposed studies and aims. These studies will meet all of the quality metrics for accuracy assessment of diagnostics (QUADAS) and will have a strong positive impact on the field by allowing development of a diagnostic platform that will permit point of care evaluation of NASH. This will enhance access to care and eventually improve the health of the people thereby aligning with the mission of the NIH.