Bay Biosciences provides high-quality, liver biopsy tissue samples. FFPE tissue blocks with matching fresh, frozen sera (serum), plasma, peripheral blood mononuclear cells (PBMC) Bio-fluids from patients diagnosed with non-alcoholic steatohepatitis (NASH).
The sera (serum), plasma and PBMC biofluid specimens are processed from non-alcoholic steatohepatitis (NASH) patient’s peripheral whole-blood using customized collection and processing protocols.
The biopsy tissue and matched biofluid samples are collected from unique patients diagnosed with non-alcoholic steatohepatitis (NASH) and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Non-alcoholic steatohepatitis (NASH), sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluids are processed from patients peripheral whole-blood using customized collection and processing protocols.
Non-Alcoholic Steatohepatitis (NASH) Overview
Non-alcoholic steatohepatitis (NASH) is an advanced form of non-alcoholic fatty liver disease (NAFLD). NAFLD is caused by buildup of fat in the liver. When this buildup causes inflammation and damage the liver, it is known as NASH, which can lead to scarring of the liver. Scarring of the liver is a potentially life-threatening condition called cirrhosis of the liver.
NAFLD is a general term for a range of conditions characterized by extra fat in liver cells that is not caused by alcohol. It’s normal for the liver to contain some fat. However, if more than 5 percent of the liver’s weight is fat, it’s considered a fatty liver (steatosis).
According to the NIDDK NAFLD is one of the most common causes of liver disease in the United States. The majority of people with NAFLD have NAFL. Only a small number of people with NAFLD have NASH. Experts estimate about 24% of U.S. adults have NAFLD and about 1.5% to 6.5% of U.S. adults have NASH.
NAFLD is more common in people who have certain diseases such as obesity and conditions that may be related to obesity, such as type 2 diabetes. Some studies suggest that one-third to two-thirds of people with type 2 diabetes have NAFLD. Research also suggests that NAFLD is present in up to 75% of patients who are overweight and in more than 90% of patients who have severe obesity, also called extreme obesity.
NAFLD can affect people of any age, including kids. Research suggests that close to 10% of U.S. children ages 2 to 19 have NAFLD. However, people are more likely to develop NAFLD as they get older.
While NAFLD develop in patients people of all races and ethnicities, it is most common among Hispanic individuals, followed by non-Hispanic whites and Asian Americans, including those of East Asian and South Asian descent. NAFLD is less common among non-Hispanic Blacks. On average, Asian Americans with NAFLD have a lower BMI than non-Hispanic whites with NAFLD. Experts think that genes may help explain some of the racial and ethnic differences in NAFLD.
Types of NAFLD
Simple Fatty Liver
- In this form of NAFLD you have fat in your liver, but little or no inflammation of the liver or damage to liver cells. Doctors may refer to this as nonalcoholic fatty liver (NAFL). Typically, this form does not progress to cause liver damage.
Nonalcoholic Steatohepatitis (NASH)
- NASH is the more severe form of NAFLD in which you have hepatitis, which means swelling or inflammation of the liver, and liver cell damage, in addition to fat in the liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver.
Fibrosis of the Liver
- Fibrosis of the liver can progress to cirrhosis, where hard scar tissue replaces an increasingly larger amount of soft healthy liver tissue. Cirrhosis from NASH typically takes years of damage to develop.
Signs & Symptoms of Non-Alcoholic Steatohepatitis (NASH)
Usually there are no visible outward signs or symptoms associated with NASH. The most common symptoms are:
NASH may lead to cirrhosis of the liver, causing some of the following signs and symptoms as the disease progresses:
- Bruising easily
- Bleeding easily
- Confusion
- Drowsiness
- Fluid accumulation in your abdomen
- Itchy skin
- Jaundice
- Loss of appetite
- Nausea
- Slurred speech
- Spider-like blood vessels on the skin
- Swelling in the legs
Causes of Nonalcoholic Steatohepatitis (NASH)
Exact causes of why some people with a buildup of fat in the liver get nonalcoholic steatohepatitis (NASH) and some don’t are unknown. It could be that something in the environment triggers the inflammation in these patients. It could also be a inherited disorder which runs in their families.
Things that put people at risk for nonalcoholic steatohepatitis (NASH) and for liver damage include:
- Obesity
- Insulin resistance and type 2 diabetes
- High cholesterol and high triglycerides
- Metabolic syndrome
Most patients who have nonalcoholic steatohepatitis (NASH) are 40 to 50 years old and have one or more of the problems listed above. But NASH disease can develop in patients who have none of these risk factors.
Diagnosis of Nonalcoholic Steatohepatitis (NASH)
There is no single test that can diagnose nonalcoholic steatohepatitis (NASH). Doctors use patients medical history, a physical exam, and tests to diagnose nonalcoholic fatty liver disease NAFLD, including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH).
Following are some of the diagnostics tests used to see if fat is building up in the liver and to rule out other diseases:
- Blood tests (CBC)
- Abdominal ultrasound
- CT scan
- MRI scan
In addition to the above tests, a a liver biopsy may also be performed to be sure that you have NASH. In a liver biopsy, your doctor takes a sample of tissue from your liver and checks it for signs of NASH. NASH is diagnosed by the histological examination of a liver biopsy showing steatosis with concomitant inflammation and hepatocyte injury (hepatocyte ballooning).
Medical History
Routinely doctors will ask patients if they have a history of health conditions that make you more likely to develop NAFLD, such as:
- Being overweight or having obesity
- Insulin resistance or type 2 diabetes
- Having high levels of triglycerides or having abnormal levels of cholesterol in the blood
- Metabolic syndrome metabolic syndrome
Your doctor will ask about diet and lifestyle factors that may make you more likely to develop NAFLD, such as a lack of physical activity, eating a diet high in sugar, or drinking sugary beverages.
Your doctor will also ask about other causes of liver disease or fat in the liver. Your doctor will ask about your alcohol intake to find out whether fat in your liver is a sign of alcohol-associated liver disease or NAFLD.
Physical Exam
During a physical exam, a doctor usually examines your body and checks your weight and height to calculate your body mass index (BMI). Your doctor will look for signs of NAFL or NASH, such as:
- An enlarged liver
- Signs of insulin resistance, such as darkened skin patches over your knuckles, elbows, and knees
- Signs of cirrhosis, such as an enlarged spleen, ascites, and muscle loss
Diagnostic Tests
Doctors use blood tests, imaging tests, and sometimes liver biopsy to diagnose NAFLD and to differentiate between NAFL and NASH.
Blood Tests
A health care professional may take a blood sample from you and send the sample to a lab. Your doctor may suspect you have NAFLD if your blood test shows increased levels of the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST).
Your doctor may use the results of routine blood tests to calculate special scores, such as the FIB-4 or APRI. These scores can help doctors identify or rule out advanced liver fibrosis, or scarring.
Your doctor may perform additional blood tests to find out if you have other health conditions that may increase your liver enzyme levels.
Imaging Tests
Routine imaging tests can show fat in your liver. These tests can’t show inflammation or fibrosis, so your doctor can’t use these tests to find out whether you have NAFL or NASH. If you have cirrhosis, routine imaging tests may show nodules, or lumps, in the liver.
Following imaging tests may be performed to help diagnose NAFLD:
- Computed Tomography (CT) scan: which uses a combination of x-rays and computer technology to create images of your liver.
- Magnetic Resonance Imaging (MRI): which uses radio waves and magnets to produce detailed images of organs and soft tissues without using x-rays.
- Ultrasound: which uses a device called a transducer that bounces safe, painless sound waves off your organs to create an image of their structure.
Elastography is a newer type of imaging test that can help determine if you have advanced liver fibrosis. In some cases, doctors may order elastography tests to measure the stiffness of your liver. Increased liver stiffness may be a sign of fibrosis. Commonly used types of elastography are
- vibration-controlled transient elastography, a special type of ultrasound
- sheer wave elastography, another type of ultrasound to detect increased liver stiffness
- magnetic resonance elastography, a special type of MRI to measure liver stiffness
Liver Biopsy
Liver biopsy is the only test that can prove a diagnosis of NASH and show clearly how severe the disease is. Liver biopsy can show fibrosis at earlier stages than elastography can. However, doctors don’t recommend liver biopsy for everyone with suspected NAFLD. Your doctor may recommend a liver biopsy if you are more likely to have NASH with advanced fibrosis or if your other tests show signs of advanced liver disease or cirrhosis. In some cases, doctors may recommend a liver cirrhosis to rule out other liver diseases.
During a liver cirrhosis, a doctor will take small pieces of tissue from your liver. A pathologist will examine the tissue under a microscope to look for signs of damage or disease.
Treatment of Nonalcoholic Steatohepatitis (NASH)
Treatment for nonalcoholic steatohepatitis (NASH) includes managing conditions that increase your risk for NASH or make it worse. You can:
- Reduce your total cholesterol level
- Reach a healthy weight. Losing 3% to 10% of your total body weight can make a difference
- Control diabetes
- Quit Smoking
- Stop or cut back on drinking alcohol
- Exercise regularly
Also, consult with your doctor or pharmacist about all the medicines you are taking. Some medications may harm your liver. In some cases, your doctor may suggest medicine to control or reverse liver damage caused by nonalcoholic steatohepatitis (NASH).
Prevention of Nonalcoholic Steatohepatitis (NASH)
Doctors recommend NAFLD patients to gradually loose weight if they are over weight or have obesity. In addition to maintaining healthy weight the doctor may also suggest to make the following changes in the diet:
- Avoiding and limiting the intake of rich and fatty foods, which are high in calories and increase the chances of developing obesity.
- Substituting saturated fats and trans fats in the diet with unsaturated fats, especially omega-3 fatty acids, which may reduce the chance of heart disease for patients who have NAFLD.
- Eating more low-glycemic index foods, such as most fruits, vegetables, and whole grains. These foods affect the blood glucose less than high-glycemic index foods, such as white bread, white rice, and potatoes.
- Avoiding foods and drinks that contain large amounts of simple sugars, especially fructose. Fructose is found in sweetened soft drinks, sports drinks, sweetened tea, and juices. Table sugar, called sucrose, is rapidly changed to glucose and fructose during digestion and is therefore a major source of fructose.
- Minimizing or avoiding alcohol use, which can further damage the liver.
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Samples available are cancer (tumor) tissue, cancer serum, cancer plasma cancer PBMC and human tissue samples from most other therapeutic areas and diseases.
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Patient’s data is extremely valuable for researchers and is used to help identify new effective treatments (drug discovery & development) in oncology, other therapeutic areas and diseases.
Bay Biosciences banks wide variety of human tissue samples and biological samples including cryogenically preserved at – 80°C.
Including fresh frozen tissue samples, tumor tissue samples, FFPE’s, tissue slides, with matching human bio-fluids, whole blood and blood derived products such as serum, plasma and PBMC’s.
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Please contact us anytime to discuss your special research projects and customized human tissue sample requirements.
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