Effects of Alanine in Patients With Nonalcoholic Steatohepatitis

A Pilot Study: Therapeutic Effect of L-Alanine in Patients With Nonalcoholic Steatohepatitis

Purpose of this study is to assess the therapeutic efficacy of L-alanine in improving biological and histological findings by administrating 6-18g/day L-alanine for one year. We will also assess the safety and toxicity profile of long-term administration of L-alanine.

Study Overview

• Status: Completed
• Conditions: Nonalcoholic Steatohepatitis
• Intervention / Treatment: Drug: L-alanine

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Males and females, age between 18 and 75
• Histological diagnosis of steatohepatitis with or without fibrosis made within one year of entry
• Transaminase levels (ALT or AST) more than 1.5 times the upper normal limit on at least two occasions with one assessment in three months or more prior to treatment of this study
• Previous and current alcohol consumption less than 20g per day by patient-provided information.
• Written informed consent specific for this protocol available prior to entry.
• Patients with diabetes and on stable medical management for six months prior to entry and an anticipated stable program throughout the study will be eligible. Medications that may be used include insulin, biguanides and sulfonylureas.
• Patients with congestive heart failure, hypertension and arrhythmia controlled by medications and without cardiac episodes during the past 6 months will be eligible.

Exclusion Criteria:

• Any causes for liver disease other than nonalcoholic steatohepatitis that are confirmed by patient history, laboratory data, or histological data

• Decompensated liver disease based on laboratory data, or clinical manifestations

  1. Hemoglobin <11.0g/dl for male, <10.0 g/dl for female
  2. White blood cells <2000 /mm3
  3. Platelet count <50,000/mm3
  4. Prothrombin time >INR 1.5
  5. Total Bilirubin >2.0 g/dl
  6. Albumin <3.0/dl
  7. The presence of ascites
  8. The presence of bleeding varices
  9. The presence of spontaneous encephalopathy
• Any previous experimental treatment of NASH within the past 3 months such as betaine, thiazolidinediones, α-tocopherol, or UDCA
• Pre-existing diseases/situations that could interfere with the results or the completion of this trial.

• Uncontrolled diabetes mellitus meeting following criteria in previous 3 months

  1. Fasting blood sugar >200 mg/dl
  2. Hemoglobin A1c >12%
• Renal or liver transplant patients

• Renal dysfunction in previous 3 months

  a) CCr <50ml/min

• Severe cardiovascular dysfunction in previous 6 months
• Congestive heart failure
• Uncontrolled hypertension
• Uncontrolled arrhythmia
• Patients with hyperlipidemia on a medical program for control of lipids which has had a change in drug treatment in the proceeding six months or with anticipated changes in the year of the study.
• Chronic pulmonary disease such as COPD requiring corticosteroid therapy in previous 3 months
• Active autoimmune or immunologically mediated diseases including systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel diseases in previous 12 months
• Previous (in three years) or present malignant disease except for non-melanoma skin cancer
• Untreated hyperthyroidism and hypothyroidism
• Substance abuse of oral, I.V., or inhaled drugs.
• If patients with history of substance abuse are considered as participants in this trial, patients must have abstained from using the abused substance for at least one year.
• Patients receiving methadone within the past 6 months are also excluded.
• Any other conditions that would make the patients unsuitable for enrollment in the opinion of the investigator in terms of interference in completing the trial and/or results of trial.
• Pregnant women
• Unwillingness of patients and /or partner to use contraceptive during treatment and for 3 months after discontinuation of treatment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 1; Single arm, active treatment	Drug: L-alanine; 6g of L-alanine (powder)once per day for the first month, twice per day for the second month, then three times per day from the third month for 10 months.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To assess the safety and tolerability of long-term L-alanine supplementation and the therapeutic efficacy of long-term L-alanine supplementation by evaluating liver biochemistry and histological findings.	1 year

Secondary Outcome Measures

Outcome Measure	Time Frame
Determine the effect of L-alanine on gene profiles, anti-oxidant response and inflammatory response in hepatocytes. Evaluate possible correlation between therapeutic efficacy and gene profiles altered by L-alanine supplementation	1 year

Collaborators and Investigators

• Sponsor: Keith D Lindor, M.D.
• Collaborators: Ajinomoto USA, INC.

Publications and helpful links

General Publications

• Suzuki A, Charlton MR, Lymp JF, et al. A pilot study: No therapeutic effect of L-alanine in patients with nonalcoholic steatohepatitis. Food and Nutrition Sciences 2: 67-73, 2010.

Study record dates

Study Major Dates

• Study Start: February 1, 2004
• Primary Completion (Actual): June 1, 2006
• Study Completion (Actual): June 1, 2006

Study Registration Dates

• First Submitted: December 21, 2007
• First Submitted That Met QC Criteria: December 21, 2007
• First Posted (Estimate): January 7, 2008

Study Record Updates

• Last Update Posted (Estimate): October 11, 2012
• Last Update Submitted That Met QC Criteria: October 9, 2012
• Last Verified: October 1, 2012

More Information

Terms related to this study

• Keywords: Nonalcoholic Steatohepatitis; NASH; L-Alanine
• Additional Relevant MeSH Terms: Digestive System Diseases; Liver Diseases; Fatty Liver; Non-alcoholic Fatty Liver Disease
• Other Study ID Numbers: 1753-03