Abstract
BackgroundNonalcoholic fatty liver disease (NAFLD) is the most common liver disease in children, and currently, there are no FDA-approved therapies. Plasminogen activator inhibitor-1 (PAI-1) is elevated in children with NAFLD and associated with increased disease severity. Losartan potassium (losartan) is an angiotensin II receptor blocker (ARB) that reduces PAI-1 production and improves insulin sensitivity that has been proposed as a treatment for pediatric NAFLD but has not previously been tested.MethodsThis was an 8-week randomized, double-blind, placebo-controlled, phase 2a, crossover study (with a 6-week washout between conditions) for safety and preliminary efficacy of losartan 50 mg a day taken orally in 12 normotensive children with biopsy proven nonalcoholic steatohepatitis (NASH).ResultsTwelve children enrolled in the study, and nine completed all visits. No changes in blood pressure or serious adverse events occurred during the study. Trends in improvement in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and homeostatic model assessment insulin resistance (HOMA-IR) were seen with losartan treatment compared to the placebo time-period. More participants decreased ALT on losartan as compared to placebo (89% [8 out 9] vs. 56% [5 out of 9], respectively).ConclusionsThis data provides preliminary evidence that losartan treatment is safe over 8 weeks in children with NAFLD and supports consideration of larger studies to test its efficacy.Trial registrationURL and trial identification number: https://clinicaltrials.gov/show/NCT01913470, NCT01913470.Date registered: August 1, 2013.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in children, and currently, there are no FDA-approved therapies
Plasminogen activator inhibitor-1 (PAI-1) is an acute-phase protein which increases in states of insulin resistance, inflammation, and injury [8] and is elevated in both adults and children with hepatic steatosis [9,10,11]
Twelve children were enrolled in the study; data from ten participants was available for the analysis
Summary
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in children, and currently, there are no FDA-approved therapies. Plasminogen activator inhibitor-1 (PAI-1) is elevated in children with NAFLD and associated with increased disease severity. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in children [1]. The clinical importance of NAFLD extends beyond liver injury to include increased cardiovascular disease [2], type 2 diabetes [3], and increased overall mortality [4]. Plasminogen activator inhibitor-1 (PAI-1) is an acute-phase protein which increases in states of insulin resistance, inflammation, and injury [8] and is elevated in both adults and children with hepatic steatosis [9,10,11].
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