Amino Acids and Pediatric Hepatic Steatosis

7.项目摘要/摘要 非酒精性脂肪性肝病(NAFLD)是北美最常见的肝病。肝脏 脂肪变性(HS)是NAFLD的标志(2)。NAFLD可能在亚组中转变为慢性炎症(非 酒精性脂肪性肝炎(NASH)，最终发展为肝硬变。HS在NAFLD的各个阶段中普遍存在。3%-10% 美国所有儿童和40%-70%的肥胖儿童都患有HS(3)。大约有1500万的肥胖者 美国的儿童(4)，这意味着多达1000万年轻人拥有HS。儿科HS与 2型糖尿病(T2D)、心血管疾病(CVD)和进行性肝病导致的过早死亡 成年早期(5，6岁)。因此，儿童HS的成功治疗对长期代谢和 心血管健康。推荐的选项很大程度上仅限于行为改变(即减肥 和运动)和维生素E营养补充剂(3，5-7)。目前还没有FDA批准的治疗这种疾病的药物 治疗任何年龄段的非酒精性脂肪肝。 我们建议对患有HS的年轻人进行随机临床试验(RCT)。我们将扩大我们以前的 在研究中，我们基于必需氨基酸(EAA)的成分AMS2392治疗降低了肝脏 多囊卵巢综合征(PCOS)青春期女性的脂肪。 具体目标1.我们将调查AMS2392治疗8周将降低肝脏脂肪的假设 在患有HS的年轻人中。我们将对48名13至18岁的男性和女性进行随机双盲随机对照试验 (Tanner分期4或5)有活检记录的HS。肝脏脂肪含量将通过磁共振进行测量 在开始和八周干预后进行磁共振成像(MRI)。 具体目标2。我们提出肝脏硬度、身体成分、胰岛素敏感性、 血浆极低密度甘油三酯(VLDL-TG)、丙氨酸转氨酶(ALT)、载脂蛋白B100、 与安慰剂相比，服用AMS2392的患者的肌酐和胰岛素敏感性将得到改善。 具体目标3.遵守方案的比例将超过90%，并且不会出现不良事件 服用AMS2392，包括血浆谷胱甘肽浓度无变化。 完成这项随机对照试验将提供有关疗效、效果大小、安全性和耐受性的信息 这将使我们能够成功地将AMS2392作为一种医用营养产品进行营销。

7. Project Summary/Abstract Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in North America (1). Hepatic steatosis (HS) is the hallmark of NAFLD (2). NAFLD may transition in sub-groups to chronic inflammation (non- alcoholic steatohepatitis, NASH), and ultimately to cirrhosis. HS is prevalent in all stages of NAFLD. 3-10% of all children in the US and 40-70% of obese children have HS (3). There are approximately 15 million obese children in the US (4), meaning that as many as 10 million youths have HS. Pediatric HS is associated with premature mortality due to type 2 diabetes (T2D), cardiovascular disease (CVD) and progressive liver disease in early adulthood (5,6). Successful treatment of pediatric HS is therefore central to long-term metabolic and cardiovascular health. Recommended options are largely limited to behavioral modifications (i.e., weight loss and exercise) and nutritional supplement with Vitamin E (3,5-7). There is no FDA-approved drug for the treatment of NAFLD in individuals of any age. We propose to perform a randomized clinical trial (RCT) in youths with HS. We will expand our previous study in which treatment with our essential amino acid (EAA)-based composition called AMS2392 reduced liver fat in adolescent females with polycystic ovary syndrome (PCOS). Specific Aim 1. We will investigate the hypothesis that 8 weeks of treatment with AMS2392 will reduce liver fat in youths with HS. We will perform a double-blind RCT in 48 male and female youths 13 to 18 years of age (Tanner stage 4 or 5) with biopsy-documented HS. Liver fat content will be measured by magnetic resonance imaging (MRI) at the outset and after the eight-week intervention. Specific Aim 2. We propose that secondary end points of liver stiffness, body composition, insulin sensitivity, and plasma concentrations of very-low density triglycerides (VLDL-TG), alanine transaminase (ALT), ApoB100, creatinine and insulin sensitivity will be improved in the group receiving AMS2392 as compared to placebo. Specific Aim 3. Adherence to protocol will be greater than 90% and there will be no adverse events in those consuming AMS2392, including no change in plasma glutathione concentration. Completion of this RCT will provide information regarding efficacy, effect size, safety and tolerance that will position us to successfully market AMS2392 as a medical nutrition product.