Trial to Examine the Effect of Two Doses of GRI-0621 in Patients With Chronic Liver Disease (GRI-201)

Inclusion Criteria:

A participant will be eligible for participation in the trial if all of the following inclusion criteria are met:

1. Completion of the written informed consent process for trial participation prior to all trial-related procedures, including HIV testing.
2. Male or female participants aged 18 to 65 years.
3. Female participants of child-bearing potential must practice an effective method of birth control from four weeks prior to randomization and agree to continue this until 6 months after the completion of the end-of-trial follow-up visit. Effective birth control must include two methods, one of which must be a barrier method. Female participants are considered not to be of child-bearing potential if they are post-menopausal (12 months of spontaneous amenorrhoea with an appropriate clinical profile, or 6 months of spontaneous amenorrhoea with local laboratory serum follicle-stimulating hormone [FSH] levels in keeping with post-menopause) or surgically sterile (after bilateral oophorectomy, hysterectomy or salpingectomy). For the purpose of this trial any participant who has had a tubal ligation will not be considered surgically sterile due to the teratogenic nature of this class of chemical entities.
4. Female participants of child-bearing potential must have negative serum and urine pregnancy tests at screening and randomization respectively.
5. History of chronic liver disease [CLD] as a result of viral hepatitis, alcoholic steatohepatitis [ASH] or non-alcoholic steatohepatitis [NASH].

6. Evidence of viral hepatitis, ASH or NASH as described beneath:

   • Viral Hepatitis:

     • Hepatitis C virus [HCV] infection as confirmed by the presence of HCV RNA (determined by PCR) and no other cause of liver disease or
     • Hepatitis B virus [HBV] infection as confirmed by the presence of HBV DNA > 104 copies/ml (determined by the Roche COBA TaqMan HBV DNA assay) and no other cause for liver disease or
     • Hepatitis C and B co-infection (as defined above) OR

   • ASH:

     • Findings and history consistent with the diagnosis of ASH in the opinion of the investigator OR

   • NASH:

     • Absence of viral hepatitis and
     • A history of no or minimal alcohol use and
     • Findings and history consistent with the diagnosis of NASH in the opinion of the investigator
7. Body Mass Index (BMI) of 18 to 39kg/m2.
8. Weight ≥ 45kg
9. ALT > 1.5 x ULN but less than 10 x ULN on two occasions during the screening period (Day -28 to Day -1). The second occasion must be between Day -7 and Day -1.
10. An ability to communicate well with the investigator and to understand and comply with the requirements of the trial.
11. Agree to stay in contact with the trial site for the duration of the trial, provide updated contact information as necessary.

Exclusion Criteria:

A participant will not be eligible for trial participation if any of the following exclusion criteria are met:

1. Use of any other investigational drug within 30 days or five half-lives (whichever is longer) of the first dose of GRI-0621.
2. Current pregnancy or lactation.
3. A history of anaphylaxis or severe hypersensitivity to any drugs.
4. A known hypersensitivity to any component of the investigational product or to any other retinoids.
5. ALT or AST > 10 x ULN on any occasion during the screening period (Day -28 to Day -1)
6. ALT or AST known to have been > 10 X ULN on any occasion during the 2 months prior to screening.

7. Any of the following laboratory abnormalities at screening:

   • Serum creatinine > 1.5 x ULN
   • Hemoglobin < 10.0 g/L
   • Platelets < 75 x 109/L
   • White cell count < 3.0 x 109/L.
8. Known hypothyroidism requiring treatment or laboratory results suggestive of hypothyroidism at screening (thyroxine [T4] < LLN and thyroid-stimulating hormone [TSH] > ULN).
9. Any clinically significant ECG abnormalities.
10. Current or recent (during the 3 months prior to screening) or required treatment for tuberculosis infection.
11. A history of any malignancy (other than treated localized basal cell carcinoma of the skin) in the last 5 years.
12. A history or known presence of osteoporosis.
13. A history of arthritic conditions requiring treatment with symptom- or disease-modifying drugs for > 4 weeks.
14. A history of atopic dermatitis.
15. History or presence of decompensated liver disease
16. Previous histological evidence of hepatic fibrosis stage > 3.
17. The presence of any acute disorder that could further compromise the hepato-biliary system including but not limited to acute infectious or alcoholic hepatitis, acute pancreatitis, biliary obstruction and cholecystitis.
18. History or presence of hepatocellular carcinoma, hepatic abscess, biliary obstruction or portal vein thrombosis as confirmed by ultrasound, CT or MRI scans.
19. A history of severe gastro-intestinal bleeding requiring blood transfusion therapy (packed cells or whole blood).
20. Any surgical or medical condition other than CLD which might significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the safety of the participant or the objectives of the trial including but not limited to inflammatory bowel disease, major gastro-intestinal surgery (e.g. gastrectomy, gastroenterostomy or bowel resection) or pancreatic injury.
21. A history of hemachromatosis, Wilson's disease, alpha-1-antitrypsin deficiency or celiac disease.
22. Previous organ or hematopoietic transplantation.
23. HIV infection confirmed by a positive HIV test result.
24. Any other medical condition which, in the opinion of the investigator, could affect the participant's health during trial participation or could compromise his/her ability to participate in the trial. This includes but is not limited to significant cardiovascular, respiratory, renal, neurological, hematological, immunological, endocrinological or metabolic disorders.
25. Any psychiatric or mental disorder which could limit the validity of the informed consent or the participant's ability to comply with the protocol requirements.
26. A history of drug abuse during the 12 months prior to screening, or evidence of such abuse as indicated by urine testing for drugs of abuse at screening that, in the opinion of the investigator, may be indicative of potential participant adherence issues during the course of the trial.
27. In the opinion of the investigator, the participant is not reliable to participate in the trial.