Sulfation of Bile Acids as a Biomarker for Hepatobiliary Diseases

Study Overview
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Brief Summary
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The investigators hypothesize that the extent of sulfation of toxic BAs and their urinary elimination can be used as a biomarker to predict the severity and prognosis of hepatobiliary diseases. The investigators rationale in this project is that the discovery of biomarkers specific to liver injury would provide the foundation for a specific and non-invasive tool to evaluate disease prognosis, determine patients with higher risk of developing end-stage liver diseases, and determine patients with higher risk of recurrence of hepatobiliary complications after liver transplant. Patients on the liver transplant list are continuously monitored during their hospitalization and are scheduled for follow-up visits for 12 months after their release post-surgery. Disease progression will be evaluated by monitoring MELD scores, survival, incidence of liver transplant, and incidence of complications related to hepatobiliary conditions such as fluid retention, GI bleeding, encephalopathy, and biliary stricture complications.

Detailed Description
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The investigators propose the following specific aims to test the investigators hypothesis: Specific Aim #1: Establish a baseline of individual and total urinary BAs and BA-sulfates in healthy controls and patients with hepatobiliary diseases. A baseline reference of the average and distribution of the percentage of urinary BA-sulfates will be determined in healthy subjects and in patients with hepatobiliary diseases including chronic hepatitis C/B, alcoholic liver disease, hereditary, drug-induced, and autoimmune hepatobiliary diseases. The investigators working hypothesis is that patients' capability to sulfate total or specific BAs, as determined by the percentage of total or specific BAs excreted in the sulfate form, can predict the severity of hepatobiliary diseases, as determined by mayo model for end-stage liver disease (MELD) score and compensation status(compensated and decompensated). Patients with higher MELD score are considered to be at higher risk of developing severe hepatobiliary complications. Specific Aim #2: Determine the relationship between BA sulfation and the progression of hepatobiliary diseases. This is an exploratory aim to collect preliminary data on the relationship between urinary BAs and the progression of hepatobiliary diseases in liver-transplant and non-liver-transplant patients, as monitored over a1-year period. The investigators working hypothesis is that patients' capabilities of sulfating BAs determine the progression of the disease.

Official Title
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Sulfation of Bile Acids as a Biomarker for Hepatobiliary Diseases

Conditions
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Hepatobiliary Diseases

Participation Criteria
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Eligibility Criteria
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Healthy Controls Inclusion Criteria: Male or female, age 19-65, no apparent signs of hepatobiliary diseases Exclusion Criteria: Levels higher than 50, 56, 78 U/L for ALT, AST, and GGT, respectively. Patient Population Inclusion Criteria: Male or female, age 19-65, visiting the UNMC hepatology clinic for treatment from hepatobiliary diseases Exclusion Criteria: MELD score less than 6

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy Controls<br>Male or female, age 19-65, no apparent signs of hepatobiliary diseases | |
| Patients with hepatobiliary diseases<br>Male or female, age 19-65, visiting the UNMC hepatology clinic for treatment from hepatobiliary diseases | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Urinary bile acid indexes | Bile acids (BAs), the end products of cholesterol metabolism, are synthesized in liver and excreted into bile, which flows to the small intestine via the bile duct. Most of the BAs are reabsorbed from the intestine into the portal circulation and undergo enterohepatic recirculation with minimal levels detected in urine and blood under normal conditions. | Healthy controls: 4 visits over 28 days. Patients: urine collction at every visit as decided in their course of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mayo model for end-stage liver disease score (MELD) | MELD score= 3.8*loge (bilirubin [mg/dL]) + 11.2*loge (INR) + 9.6*loge (creatinine [mg/dL]). | Healthy controls: 1st visit only (1 week). Patients: every time a MELD score is required by hepatologists as partrt of their regular course of treatment (1 year) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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chronic hepatitis C/B, alcoholic liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, progressive familial intrahepatic cholestasis