1. IL‐31 levels correlate with pruritus in patients with cholestatic and metabolic liver diseases and is farnesoid X receptor responsive in NASH
- Author
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Xu, Jun, Wang, Ya, Khoshdeli, Mina, Peach, Matt, Chuang, Jen‐Chieh, Lin, Julie, Tsai, Wen‐Wei, Mahadevan, Sangeetha, Minto, Wesley, Diehl, Lauri, Gupta, Ruchi, Trauner, Michael, Patel, Keyur, Noureddin, Mazen, Kowdley, Kris V, Gulamhusein, Aliya, Bowlus, Christopher L, Huss, Ryan S, Myers, Robert P, Chung, Chuhan, and Billin, Andrew N
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Digestive Diseases ,Digestive Diseases - (Gallbladder) ,Liver Disease ,Chronic Liver Disease and Cirrhosis ,Clinical Research ,Rare Diseases ,Oral and gastrointestinal ,Humans ,Animals ,Mice ,Non-alcoholic Fatty Liver Disease ,Cholestasis ,Biomarkers ,Metabolic Diseases ,Pruritus ,Liver Cirrhosis ,Biliary ,Medical Biochemistry and Metabolomics ,Immunology ,Gastroenterology & Hepatology ,Clinical sciences - Abstract
Background and aimsPruritus is associated with multiple liver diseases, particularly those with cholestasis, but the mechanism remains incompletely understood. Our aim was to evaluate serum IL-31 as a putative biomarker of pruritus in clinical trials of an farnesoid X receptor (FXR) agonist, cilofexor, in patients with NASH, primary sclerosing cholangitis (PSC), and primary biliary cholangitis (PBC).Approach and resultsSerum IL-31 was measured in clinical studies of cilofexor in NASH, PSC, and PBC. In patients with PSC or PBC, baseline IL-31 was elevated compared to patients with NASH and healthy volunteers (HVs). IL-31 correlated with serum bile acids among patients with NASH, PBC, and PSC. Baseline IL-31 levels in PSC and PBC were positively correlated with Visual Analog Scale for pruritus and 5-D itch scores. In patients with NASH, cilofexor dose-dependently increased IL-31 from Week (W)1 to W24. In patients with NASH receiving cilofexor 100 mg, IL-31 was higher in those with Grade 2-3 pruritus adverse events (AEs) than those with Grade 0-1 pruritus AEs. IL-31 weakly correlated with C4 at baseline in patients with NASH, and among those receiving cilofexor 100 mg, changes in IL-31 and C4 from baseline to W24 were negatively correlated. IL-31 messenger RNA (mRNA) was elevated in hepatocytes from patients with PSC and NASH compared to HVs. In a humanized liver murine model, obeticholic acid increased IL-31 mRNA expression in human hepatocytes and serum levels of human IL-31.ConclusionsIL-31 levels correlate with pruritus in patients with cholestatic disease and NASH, with FXR agonist therapy resulting in higher serum levels in the latter group. IL-31 appears to derive in part from increased hepatocyte expression. These findings have therapeutic implications for patients with liver disease and pruritus.
- Published
- 2023