Sulfation of Bile Acids as a Biomarker for Hepatobiliary Diseases
Sulfation of Bile Acids as a Biomarker for Hepatobiliary Diseases
The investigators hypothesize that the extent of sulfation of toxic BAs and their urinary
 elimination can be used as a biomarker to predict the severity and prognosis of hepatobiliary
 diseases. The investigators rationale in this project is that the discovery of biomarkers
 specific to liver injury would provide the foundation for a specific and non-invasive tool to
 evaluate disease prognosis, determine patients with higher risk of developing end-stage liver
 diseases, and determine patients with higher risk of recurrence of hepatobiliary
 complications after liver transplant.

 Patients on the liver transplant list are continuously monitored during their hospitalization
 and are scheduled for follow-up visits for 12 months after their release post-surgery.
 Disease progression will be evaluated by monitoring MELD scores, survival, incidence of liver
 transplant, and incidence of complications related to hepatobiliary conditions such as fluid
 retention, GI bleeding, encephalopathy, and biliary stricture complications.
The investigators propose the following specific aims to test the investigators hypothesis:

 Specific Aim #1: Establish a baseline of individual and total urinary BAs and BA-sulfates in
 healthy controls and patients with hepatobiliary diseases. A baseline reference of the
 average and distribution of the percentage of urinary BA-sulfates will be determined in
 healthy subjects and in patients with hepatobiliary diseases including chronic hepatitis C/B,
 alcoholic liver disease, hereditary, drug-induced, and autoimmune hepatobiliary diseases. The
 investigators working hypothesis is that patients' capability to sulfate total or specific
 BAs, as determined by the percentage of total or specific BAs excreted in the sulfate form,
 can predict the severity of hepatobiliary diseases, as determined by mayo model for end-stage
 liver disease (MELD) score and compensation status(compensated and decompensated). Patients
 with higher MELD score are considered to be at higher risk of developing severe hepatobiliary
 complications.

 Specific Aim #2: Determine the relationship between BA sulfation and the progression of
 hepatobiliary diseases. This is an exploratory aim to collect preliminary data on the
 relationship between urinary BAs and the progression of hepatobiliary diseases in
 liver-transplant and non-liver-transplant patients, as monitored over a1-year period. The
 investigators working hypothesis is that patients' capabilities of sulfating BAs determine
 the progression of the disease.
Healthy Controls

 Inclusion Criteria:

 -  Male or female, age 19-65, no apparent signs of hepatobiliary diseases

 Exclusion Criteria:

 -  Levels higher than 50, 56, 78 U/L for ALT, AST, and GGT, respectively.

 Patient Population

 Inclusion Criteria:

 -  Male or female, age 19-65, visiting the UNMC hepatology clinic for treatment from
 hepatobiliary diseases

 Exclusion Criteria:

 -  MELD score less than 6