Using Nuclear Magnetic Resonance (NMR) Spectroscopy to understand hepatic lipid metabolism in paediatric NAFLD

Dr Emer Fitzpatrick of King’s College Hospital discusses her research and what it means for the future of treating childhood liver disease.

What is this study looking at?

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in children and young people (CYP). NAFLD is an overweight/obesity-related condition, but a high body mass index is only one of the factors that determine disease. Certain people are more susceptible to the condition.

This is partially determined by genetics, but other influences are likely to also be important. Studying liver tissue (biopsy) is one such way to examine the processes involved in development of disease. However, it is unpleasant and invasive. Given the risks, inconvenience and limitations of studying liver tissue itself, modern imaging techniques can be utilised to look at processes going on in the cells. Once these processes are understood treatments can be targeted to modify them.This project will look at tiny frozen sections of liver to further evaluate and develop imaging protocols using a technique called nuclear magnetic resonance (NMR) spectroscopy. The study will look specifically at the pattern and the ‘metabolism’ (i.e. uptake, processing and release) of lipids (fats) within the liver cells of a CYP with NAFLD, comparing this with the pattern in their blood and also with liver cells from CYP without NAFLD.

Why is this research important?

NAFLD is estimated to occur in up to 10% of CYP with 3% having evidence of progressive disease. Separating out those who will develop significant liver injury (progressive fibrosis) from those who will not, is not currently possible.This study will be of value for phenotyping (observing biochemical characteristics) of CYP with NAFLD to decide which groups of patients are most suitable for therapeutic intervention. The data will assist the development of biopsy-free evaluation of liver disease and used to inform studies of novel therapies for NAFLD in CYP.

What about the future?

The hope is that this study will lead to the ability to use NMR to evaluate the patterns of lipids in liver cells of patients with NAFLD in a non-invasive and safe way. This project may also yield results which can be used to develop a planned trial of novel treatment in children and young people with NAFLD. This treatment will be aimed at changing the lipid profile and metabolism of the liver to reduce progression of NAFLD.

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