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Alloveda Liver Update: Alanine Aminotransferase, Gamma Glutamyl Transpeptidase Predict Histologic Improvement in Pediatric NASH |
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Alloveda Liver Update: Alanine Aminotransferase, Gamma Glutamyl Transpeptidase Predict Histologic Improvement in Pediatric NASH

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There is a need for predictive, non-invasive tools that can help monitor key features of nonalcoholic fatty liver disease (NAFLD) in children that point to improvement in liver histology.

A study was therefore designed to determine the relationship between liver chemistries and liver histology using data from the CyNCh clinical trial. A total of 146 children were included in this study.

Improvement in liver histology, defined as a decline in NAFLD Activity Score of ≥2 points without worsening of fibrosis, was noted in 43 participants (30%). Forty six participants had borderline zone 1 nonalcoholic steatohepatitis (NASH) at baseline. Twelve of these, i.e., 28%, demonstrated resolution.

Investigators developed multivariate models using baseline and change in ALT, AST, and GGT at 52 weeks, for improvement in liver histology, borderline zone 1 NASH, and fibrosis. For improvement in histology, the model retained baseline and change in GGT (AUROC 0.79; 95% CI 0.71 - 0.87). For borderline zone 1 NASH, the model retained baseline and change in ALT (AUROC 0.80; 95% CI 0.67 - 0.93), and for fibrosis, the model was found to retain baseline and change in ALT (AUROC 0.80, 95% CI 0.67-0.93). Further introduction of additional clinical parameters to the models using Akaikes Information Criteria selection significantly boosted performance: improvement in histology with AUROC of 0.89 (95% CI 0.82 - 0.95), borderline zone 1 NASH with AUROC of 0.91 (95% CI 0.83 - 0.99) and fibrosis with AUROC of 0.89 (95% CI 0.82-0.94).

In children with NAFLD, dynamic changes in serum ALT and GGT seem to be linked with change in liver histology and could be robust indicators of histologic response.

Source: Newton KP, Lavine JE, Wilson L, et al; Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Alanine Aminotransferase and Gamma Glutamyl Transpeptidase Predict Histologic Improvement in Pediatric Nonalcoholic Steatohepatitis. Hepatology. 2020 May 16. doi: 10.1002/hep.31317.

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