The main objective of this pilot study is to evaluate whether 12 weeks of IMM-124E in children with nonalcoholic fatty liver disease (NAFLD) in combination with standard of care treatment will decrease inflammation in the liver as measured by alanine transaminase (ALT). Specifically, investigators will measure percent change in ALT from Week 0 to Week 12 in treatment compared to placebo.
This is a randomized, double blind, placebo controlled, three month treatment trial of children aged 6-19 years. Participants will be recruited from the Children's Healthcare of Atlanta pediatric liver clinical practice.The purpose of this study is to evaluate if a three month treatment with IMM-124E (a bovine colostrum enriched with anti-LPS antibodies) in combination with standard of care lifestyle advice is safe and leads to greater improvement in hepatic inflammation, insulin sensitivity, and blood lipids in children with nonalcoholic fatty liver disease (NAFLD) compared to placebo with standard of care treatment. Investigators also seek to define the mechanism of action in response to three months of treatment with IMM-124E.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
40
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
Percent Change in Alanine Aminotransferase (ALT) Level
Percent change in ALT level from baseline to end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Fasting Glucose Level
Fasting glucose level will be collected via blood draw. Percent Change in glucose levels between baseline and end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Change in Fasting Insulin Level
Fasting insulin level will be collected via blood draw. Change is the difference in insulin level from baseline to end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Change in Hemoglobin A1C Level
Hemoglobin A1C Level will be collected via blood draw. Change is the difference in hemoglobin AIC level from baseline to end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Change in Adipose Tissue Insulin Resistance (Adipo-IR)
Adipo-IR will be collected via blood draw. It is calculated as fasting non-esterified fatty acids x fasting insulin.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Change in Triglyceride/HDL (TG/HDL) Ratio
The TG/HDL ratio is the proportion of triglyceride levels in relation to HDL (good cholesterol). Change is defined as the difference in the TG/HDL ratio from baseline to the end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Blood Glucose Level
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The blood glucose level will be monitored via an oral glucose tolerance test (OGTT) at baseline and at the end of treatment. During the OGTT, the glucose level will be tested by a blood draw every thirty minutes for two hours. Percentage change between glucose measurements taken at baseline and at the end of treatment is reported.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Change in Insulin Levels
The insulin level will be monitored via an oral glucose tolerance test (OGTT) at baseline and at the end of treatment. During the OGTT, the insulin level will be tested by a blood draw every thirty minutes for two hours. Change is described as the difference between insulin measurements taken at baseline and at the end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Body Mass Index (BMI) Z-Score
BMI will be calculated from height and weight and converted into a z-score. Body mass index z-scores are measures of relative weight adjusted for age and sex.Change is the difference in BMI z-scores from base line to end of treatment.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Visceral Adiposity
Visceral adiposity will be measured with a magnetic resonance imaging (MRI) scan. Visceral adipose tissue is a hormonally active component of total body fat.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Hepatic Fat Percent
Hepatic fat percent will be measured with a magnetic resonance imaging (MRI) scan. Hepatic fat percent is the percentage of fat within the liver.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in Waist Circumference
Waist circumference will be measured in centimeters using measuring tape.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in PROMIS Fatigue Questionnaire Score
The PROMIS Fatigue questionnaire evaluates a range of self-reported symptoms, from mild subjective feelings of tiredness to an overwhelming, debilitating, and sustained sense of exhaustion that likely decreases one's ability to execute daily activities and function normally in family or social roles. Fatigue is divided into the experience of fatigue (frequency, duration, and intensity) and the impact of fatigue on physical, mental, and social activities. It assesses fatigue over the past seven days. A higher score represents more symptoms of fatigue.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in PROMIS Depression Questionnaire Score
The PROMIS Depression instruments assess self-reported negative mood (sadness, guilt), views of self (selfcriticism, worthlessness), and social cognition (loneliness, interpersonal alienation), as well as decreased positive affect and engagement (loss of interest, meaning, and purpose). It assesses depression over the past seven days. A higher score represents more symptoms of depression.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Percent Change in PROMIS Anxiety Questionnaire Score
The PROMIS Anxiety instruments measure self-reported fear (fearfulness, panic), anxious misery (worry, dread), hyperarousal (tension, nervousness, restlessness), and somatic symptoms related to arousal (racing heart, dizziness). Anxiety is best differentiated by symptoms that reflect autonomic arousal and experience of threat. Each assesses anxiety over the past seven days. A higher score represents more symptoms of anxiety.
Time frame: Baseline (Week 0), End of Treatment (Week 12)
Composite Metabolic Improvement
Composite metabolic improvement is defined as greater than 10% improvement in TG/HDL ratio, improvement in insulin resistance, and greater than 10% improvement in ALT.
Time frame: End of Treatment (Week 12)