Immunomediated Non-alcoholic SteaTohepatitis; Prevalence and Characterization. INSTInCT Study

Instituto de Investigación Marqués de Valdecilla

Status: Unknown

Conditions: Main Hypothesis is That in the NASH Associated to IMIDs, to Different Phenotypes co Exist

Study type: Observational

Funder types: Other

Identifiers

NCT03760172

PI18/01304

Details and patient eligibility

About

NAFLD is a common comordidity in patients with IMID, including inflammatory bowel disease and psoriasis.

Nevertheless, the prevalence of NAFLD and NASH in the IMID population is not clear, and the risk factors are not completely understood. Interestingly, NASH and most of IMIDs share main molecular and immunological mechanisms of disease, as the inflammatory pathways depending on TNFa or imbalance in T cell subtypes like Th17/Treg. This common pathogenesis may explain, at least in a subset of patients, the development of NASH in the absence of classic metabolic risk factor.

Thus, our main hypothesis is that in the NASH assciated to IMIDs two different phenotypes co-exist.

First, a predominantly inflammatory phenotype, and not associated to the metabolic syndrome ande second, a predominantly metabolic phenptype, strongly associated to he metabolic syndrome.

In this way, we believe that in a particular subset of NAFLD patients, NASH could be considered as an IMID, as most of the definiting features of IMIDs are present. To demonstrate our hypothesis, we consider a two-stage study. First, we will determine the NAFLD and NASH prevalence in a cohort of well-characterized IMID patients and controls. Second, we will adress the molecular and immunophenotype characterization in liver biopsies of NASH patients with and without the co-existence of IMIDs.

Enrollment: 7,300 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• NAFLD with biopsy proven disease above 18 years
• IMID patients above 18 years
• All participants must give informed written consent

Exclusion criteria

• Patients who had any clinical evidence of malignancy
• Other secondary cause of chronic liver disease. Alternative causes of liver disease included excessive alcohol intake (higher than 20 g/day in women and 30 g/day in men), viral hepatitis, chronic alcohol consumption, autoimmune hepatitis, Wilson´s disease, alpha-1-antitripsine deficiency, inborn errors of metabolism or drug induced liver injury

Trial design

7,300 participants in 4 patient groups

Prevalence of NAFLD in patients with IMID

Description:

To analyze the global prevalence of NAFLD in patients with an immune-mediated inflammatory disease IMID

Prevalence of High-risk NASH in patients with IMID

Description:

To evaluate the prevalence of high-risk NASH (NASH with advanced fibrosis) in patients with IMID through clinical, radiological and histological evaluation

Immunophenptypic characterization

Description:

To investigate the existence of common and differential immunophenotypes between the subjects with NASH with and without IMID, and patients with IMID without liver involment

Genetic and Molecular characterization

Description:

Liver molecular characterization of NASH associated to IMID