Metabolic Associated Fatty Liver DiseaseNIMBLENCT07122700
Evaluation of Non-Invasive Tests for Metabolic Liver Disease
An observational study of Metabolic Associated Fatty Liver Disease and Metabolic Associated Steatotic Liver Disease, run by Foundation for the National Institutes of Health at 4 sites in United States.
Trial summary
The Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) study is a comprehensive, multi-year collaborative effort to standardize, validate and advance the regulatory qualification of blood- and imaging-based biomarkers to diagnose and stage Metabolic dysfunction-associated steatohepatitis (MASH), previously… Read more about this study
- Who is it for?
- Ages 18 to 75 years
- Conditions the study is for
- Metabolic Associated Fatty Liver Disease, Metabolic Associated Steatotic Liver Disease, Cirrhosis, Liver
- How many people
- 400 participants
- Where
- 4 sitesUnited States
- Study dates
- 13 May 2025to 31 Dec 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- All sexes
- Adult, Older adult
Study population: This study will enroll participants with suspected or confirmed diagnosis of MASLD. Sex: Male and female participants Age: ≥ 18 and < 75 years Population sample: Patients with a high probability of MASLD based on eligibility criteria (details under inclusion/exclusion criteria in Section 5.1) General health status: Patients with suspected or confirmed diagnosis of MASLD and no contraindications precluding participation in any study procedures. Geographic location: United States, multi-site
Who may be able to join
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the duration of the study
- Male or female, aged > 18 years and < 75 years
- Participants must exhibit some manifestations of metabolic dysregulation. Either:
- Physician-diagnosed T2DM for at least 90 days with HbA1c > 6.5 and antidiabetic therapy, if any, stable for at least 90 days prior to screening or B. At least any one of the following six metabolic syndrome criteria [6]
- 1. body mass index (BMI) of > 25 kg/m2 2. waist circumference: i. > 102 cm for men ii. > 88.9 cm for women 3. fasting triglyceride concentration > 150 mg/dL i. or ongoing treatment with triglyceride lowering medication 4. HDL-cholesterol concentration: i. < 40 mg/dL for men ii. < 50 mg/dL for women iii. or ongoing treatment with cholesterol lowering medication. 5. fasting glucose concentration > 100 mg/dL 6. either semi-recumbent or supine blood pressure systolic > 130 mmHg and/ or diastolic > 85 mmHg i. or ongoing treatment with antihypertensive medication. 5. FIB-4 > 1.3 (age < 65 years) and > 2.0 (age > 65 years) 6. Agreement to adhere to Lifestyle Considerations (see section 5.3) throughout study duration
Who cannot join
- Known history or evidence of other forms of chronic liver disease other than MASLD/MASH including but not limited to viral hepatitis B or C, autoimmune liver disease, primary biliary cholangitis, primary sclerosing cholangitis, Wilson disease, hemochromatosis, drug-induced liver disease, conditions involving bile duct obstructions, liver cancer, past history of HCC or HCC treatment, listed for or history of liver transplantation, prior resection of liver, etc.
- Current or past evidence of decompensated liver disease defined by overt ascites that is clinically obvious and requires diuretic therapy, overt encephalopathy requiring therapy or history of variceal hemorrhage
- Circulating Alanine aminotransferase (ALT)> 5xULN
- Ongoing or recent (within the last two years prior to screening) consumption of significantly greater than moderate amounts of alcohol.
- A standard alcoholic drink is any drink that contains about 14 g of pure alcohol, such as 12 fluid ounces of regular beer 8-10 fluid ounces of malt liquor or flavored malt beverages such as hard seltzer 5 fluid ounces of table wine 3-4 fluid ounces of fortified wine such as sherry or port 2-3 fluid ounces of cordial liqueur or aperitif 1.5 fluid ounces (a single jigger or shot) of brandy, cognac, or distilled spirits such as gin, rum, tequila, vodka, whiskey, etc.
- Significantly greater than moderate alcohol consumption is defined as on average over a 2-year period prior to screening:
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- Women
- >1 standard drink per day and/or
- >14 standard drinks per week Men
- >2 standard drinks per day and/or
- >21 standard drinks per week in men
- An Alcohol Use Disorders Identification Test (AUDIT) score of 7 or higher
- A PEth test score of ≥ 20ng/ml.
- In the opinion of the investigator, any contraindications to liver biopsy including but not limited to having significant uncorrected coagulopathy or thrombocytopenia, on chronic anticoagulation with Direct Oral Anticoagulants (DOACs), or on low dose heparin or Warfarin.
- Uncontrolled systolic blood pressure > 180 mmHg and diastolic blood pressure > 120 mmHg at screening. Blood pressure will be obtained after at least 10 minutes of resting in a semi-recumbent or supine position.
- Any systemic disease that in the opinion of the investigator precludes inclusion of the patient in the trial
- Unable or unwilling to provide informed consent
- Unwilling to undergo liver biopsy procedure
- Unable or unwilling to comply with requirements for study procedures (such as fasting)
- Unable to perform study procedures in the opinion of the investigator
- Participants who are unwilling or unable (e.g. due active implants such as pacemaker or having a waist diameter (calculated as: diameter = circumference / π) 70cm, unless a wide-bore MRI machine is available) to undergo MRI procedures.
- Pregnancy or planned pregnancy within 4 months of screening.
- Participation in another clinical trial within 30 days, or dosing with an investigational agent within 90 days prior to signing the ICF for this study.
Trial locations and contacts
4 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States4 sites, 4 recruiting
- Recruiting
First Surgical Hospital
Bellaire, Texas, 77401
Daveshvari Solanki, (210) 253-7778, RecruitmentHD@ergclinical.com
- Recruiting
Ohio Clinical Trials
Columbus, Ohio, 43212
Angela Eakin, (614) 754-7679, RecruitmentOCT@ergclinical.com
- Recruiting
Clinical Pharmacology of Miami
Miami, Florida, 33172
Alexander Prezioso, MD, (305) 320-1164, RecruitmentCPMI@ergclinical.com
- Recruiting
Endeavor Clinical Trials
San Antonio, Texas, 78240
Emanuel De Noia, MD, (210) 305-5771, RecruitmentECT@ergclinical.com
About this study
Official title: Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) Study 2.0 - An FNIH Biomarkers Consortium Study
The Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) study is a comprehensive, multi-year collaborative effort to standardize, validate and advance the regulatory qualification of blood- and imaging-based biomarkers to diagnose and stage Metabolic dysfunction-associated steatohepatitis (MASH), previously known as nonalcoholic steatohepatitis (NASH). MASH is characterized by liver inflammation accompanied by simultaneous fat accumulation in the liver.
Read the detailed description
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is a common liver problem which affects 30% of the United States population. Liver biopsy-based histopathology is accepted as the most accurate technique to detect patients at risk of developing serious liver conditions secondary to non-alcoholic steatohepatitis (MASH). However, the liver biopsy is an invasive test with risk for complications and even risk of mortality. Alternative non-invasive blood-based and imaging biomarkers are needed to replace liver biopsy for diagnosis and staging of MASH with fibrosis with the ultimate goal to guide timely decisions for clinical care including pharmacologic intervention for patients with MASH.
The Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) project was commissioned by the FNIH to qualify non-invasive tests (NITs) for MASLD. It represents a collaborative effort involving the FNIH, Food and Drug Administration (FDA), academics and multiple industry partners to qualify biomarkers for diagnosis and staging of MASH with fibrosis. The NIMBLE project plan was designed to occur across two stages (Stage 1 and Stage 2) and with the ultimate goal to generate data on blood-based, Vibration Controlled Transient Elastography- (VCTE) based and imaging-based biomarkers to support seeking regulatory approval of one or more biomarker(s) or biomarker panel(s) for diagnosis and staging of MASH.
Data generated within NIMBLE Stage 1 were able to successfully identify a set of candidate blood-based and imaging biomarkers that met prespecified criteria for further evaluation in Stage 2. The current study aims to deliver on that goal for NIMBLE Stage 2, namely, to confirm and extend the findings from NIMBLE Stage 1 in the setting of a prospective non-interventional trial in a population at risk for MASH with fibrosis. To that end, NIMBLE Study 2.0 is primarily designed to evaluate the performance characteristics of prespecified blood-based, VCTE-based and imaging-based biomarker(s) and biomarker panel(s) when calibrated against liver biopsy-based histology as well as currently available tools for diagnosis and staging of MASH in those at risk.
- Conditions
- Metabolic Associated Fatty Liver Disease, Metabolic Associated Steatotic Liver Disease, Cirrhosis, Liver, NASH, Liver Fibrosis, Liver Fat
- Medical subject headings
- Liver Cirrhosis, Fatty Liver, Hepatitis
What is being measured
The primary outcome is the main question the study is designed to answer.
Detection of At-Risk MASH
Evaluate the diagnostic performance of individual and combined biomarkers (e.g., NIS2+, ADAPT [PRO-C3-based score], MRI-AST (MAST) [MRE + PDFF + AST], FAST and Metabolomics-Advanced Steatohepatitis Fibrosis (MASEF) [included in the OWLiver Test]) for identifying at-risk MASH (MASH + MAS ≥4 + fibrosis stage ≥2).
Measured: within 120 days of study enrollment.
Fibrosis Staging
Assess blood-based, imaging, and composite biomarkers (e.g., Enhanced Liver Fibrosis (ELF) Test, Liver Stiffness Measure (LSM) by VCTE, MRE, Agile 3+, Agile 4) for detecting clinically significant fibrosis (≥2), advanced fibrosis (≥3), and fibrosis stage 4 (cirrhosis, histologically defined).
Measured: within 120 days of study enrollment.
Liver Fat Content Monitoring
Evaluate imaging-based biomarkers (e.g., MRI-PDFF, Hepatorenal Index, Controlled Attenuation Parameter (CAP)) for hepatic steatosis monitoring.
Measured: within 120 days of study enrollment.
Diagnostic Enrichment
Identify biomarkers that enhance participant selection for clinical trials, focusing on populations with at-risk MASH, specific fibrosis stages, or steatosis.
Measured: within 120 days of study enrollment.
Exploratory Biomarkers
Investigate exploratory biomarkers (e.g., AI-based histological scoring, sequential testing strategies) for novel diagnostic workflows.
Measured: within 120 days of study enrollment.
Secondary outcomes (4)
Comparison to Fibrosis (FIB)-4 or other fibrosis-related standards
To compare the performance characteristics of one or more 1) blood-based biomarkers, 2) imaging-based biomarkers, 3) VCTE-based biomarkers and 4) multiparametric biomarkers to to FIB-4 or other fibrosis-related standards specific to the context of use (COU) for fibrosis in a population at risk for MASH with fibrosis.
Measured: within 120 days of study enrollment.
Comparison to ALT or other activity-related standards.
To compare the performance characteristics of one or more 1) blood-based biomarkers, 2) imaging-based biomarkers, 3) VCTE-based biomarkers and 4) multiparametric biomarkers to ALT or other activity-related standards specific to the context of use (COU) of at-risk MASH in a population at risk for MASH with fibrosis.
Measured: within 120 days of study enrollment.
Comparison to Histology.
To compare the performance characteristics of one or more 1) blood-based biomarkers, 2) imaging-based biomarkers, 3) VCTE-based biomarkers and 4) multiparametric biomarkers to histology standards to the context of use (COU) for steatosis in a population at risk for MASH with fibrosis.
Measured: within 120 days of study enrollment.
AI-driven histology endpoints
- Correlation of AI-based digital pathology results with traditional histological scoring systems (MAFLD Activity Score (MAS), fibrosis stages).
Measured: within 120 days of study enrollment.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Aug 2025
- Study start13 May 2025
- Primary completion30 Jun 2027 (estimated)
- Study completion31 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Metabolic Associated Fatty Liver DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 400 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Foundation for the National Institutes of Health
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Arun Sanyal, Principal investigator, Virginia Commonwealth University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07122700
- Sponsor's protocol ID
- NIMBLE Study 2.0
- Acronym
- NIMBLE
- Status last verified
- Oct 2026
- First submitted
- 7 Aug 2025
- Last updated
- 26 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: NIMBLE has an ancillary studies protocol which governs all requests for use of data, beyond the primary publication by project team members who have contributed services to the project. For example, this request covers clinical data that are associated with the biospecimens each company obtained and analyzed, as well as biomarker values, imaging results, and biopsy results generated by project team members.
Study at a glance
From the registry record, last updated by the sponsor on 26 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) Study 2.0 - An FNIH Biomarkers Consortium Study
- ClinicalTrials.gov ID
- NCT07122700
- Acronym / sponsor ID
- NIMBLE / NIMBLE Study 2.0
- Conditions
- Metabolic Associated Fatty Liver Disease, Metabolic Associated Steatotic Liver Disease, Cirrhosis, Liver, NASH, Liver Fibrosis, Liver Fat
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 400 participants (estimated)
- Lead sponsor
- Foundation for the National Institutes of HealthUniversity, hospital or other
- Study start
- 13 May 2025 (actual)
- Primary completion
- 30 Jun 2027 (estimated)
- Study completion
- 31 Dec 2027 (estimated)
- First posted
- 14 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) study is a comprehensive, multi-year collaborative effort to standardize, validate and advance the regulatory qualification of blood- and imaging-based biomarkers to diagnose and stage Metabolic dysfunction-associated steatohepatitis (MASH), previously known as nonalcoholic steatohepatitis (NASH). MASH is characterized by liver inflammation accompanied by simultaneous fat accumulation in the liver.
Detailed description
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as nonalcoholic fatty liver disease (NAFLD), is a common liver problem which affects 30% of the United States population. Liver biopsy-based histopathology is accepted as the most accurate technique to detect patients at risk of developing serious liver conditions secondary to non-alcoholic steatohepatitis (MASH). However, the liver biopsy is an invasive test with risk for complications and even risk of mortality. Alternative non-invasive blood-based and imaging biomarkers are needed to replace liver biopsy for diagnosis and staging of MASH with fibrosis with the ultimate goal to guide timely decisions for clinical care including pharmacologic intervention for patients with MASH.
The Non-Invasive Biomarkers for Metabolic Liver Disease (NIMBLE) project was commissioned by the FNIH to qualify non-invasive tests (NITs) for MASLD. It represents a collaborative effort involving the FNIH, Food and Drug Administration (FDA), academics and multiple industry partners to qualify biomarkers for diagnosis and staging of MASH with fibrosis. The NIMBLE project plan was designed to occur across two stages (Stage 1 and Stage 2) and with the ultimate goal to generate data on blood-based, Vibration Controlled Transient Elastography- (VCTE) based and imaging-based biomarkers to support seeking regulatory approval of one or more biomarker(s) or biomarker panel(s) for diagnosis and staging of MASH.
Data generated within NIMBLE Stage 1 were able to successfully identify a set of candidate blood-based and imaging biomarkers that met prespecified criteria for further evaluation in Stage 2. The current study aims to deliver on that goal for NIMBLE Stage 2, namely, to confirm and extend the findings from NIMBLE Stage 1 in the setting of a prospective non-interventional trial in a population at risk for MASH with fibrosis. To that end, NIMBLE Study 2.0 is primarily designed to evaluate the performance characteristics of prespecified blood-based, VCTE-based and imaging-based biomarker(s) and biomarker panel(s) when calibrated against liver biopsy-based histology as well as currently available tools for diagnosis and staging of MASH in those at risk.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 18 to 75 years
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- This study will enroll participants with suspected or confirmed diagnosis of MASLD. Sex: Male and female participants Age: ≥ 18 and < 75 years Population sample: Patients with a high probability of MASLD based on eligibility criteria (details under inclusion/exclusion criteria in Section 5.1) General health status: Patients with suspected or confirmed diagnosis of MASLD and no contraindications precluding participation in any study procedures. Geographic location: United States, multi-site
Key inclusion criteria (6 listed)
- Provision of signed and dated informed consent form
- Stated willingness to comply with all study procedures and availability for the duration of the study
- Male or female, aged > 18 years and < 75 years
- Participants must exhibit some manifestations of metabolic dysregulation. Either:
- Physician-diagnosed T2DM for at least 90 days with HbA1c > 6.5 and antidiabetic therapy, if any, stable for at least 90 days prior to screening or B. At least any one of the following six metabolic syndrome criteria [6]
Key exclusion criteria (23 listed)
- Known history or evidence of other forms of chronic liver disease other than MASLD/MASH including but not limited to viral hepatitis B or C, autoimmune liver disease, primary biliary cholangitis, primary sclerosing cholangitis, Wilson disease, hemochromatosis, drug-induced liver disease, conditions involving bile duct obstructions, liver cancer, past history of HCC or HCC treatment, listed for or history of liver transplantation, prior resection of liver, etc.
- Current or past evidence of decompensated liver disease defined by overt ascites that is clinically obvious and requires diuretic therapy, overt encephalopathy requiring therapy or history of variceal hemorrhage
- Circulating Alanine aminotransferase (ALT)> 5xULN
- Ongoing or recent (within the last two years prior to screening) consumption of significantly greater than moderate amounts of alcohol.
- Women
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Detection of At-Risk MASH
Time frame: within 120 days of study enrollment.
Evaluate the diagnostic performance of individual and combined biomarkers (e.g., NIS2+, ADAPT [PRO-C3-based score], MRI-AST (MAST) [MRE + PDFF + AST], FAST and Metabolomics-Advanced Steatohepatitis Fibrosis (MASEF) [included in the OWLiver Test]) for identifying at-risk MASH (MASH + MAS ≥4 + fibrosis stage ≥2).
Fibrosis Staging
Time frame: within 120 days of study enrollment.
Assess blood-based, imaging, and composite biomarkers (e.g., Enhanced Liver Fibrosis (ELF) Test, Liver Stiffness Measure (LSM) by VCTE, MRE, Agile 3+, Agile 4) for detecting clinically significant fibrosis (≥2), advanced fibrosis (≥3), and fibrosis stage 4 (cirrhosis, histologically defined).
Liver Fat Content Monitoring
Time frame: within 120 days of study enrollment.
Evaluate imaging-based biomarkers (e.g., MRI-PDFF, Hepatorenal Index, Controlled Attenuation Parameter (CAP)) for hepatic steatosis monitoring.
Diagnostic Enrichment
Time frame: within 120 days of study enrollment.
Identify biomarkers that enhance participant selection for clinical trials, focusing on populations with at-risk MASH, specific fibrosis stages, or steatosis.
Exploratory Biomarkers
Time frame: within 120 days of study enrollment.
Investigate exploratory biomarkers (e.g., AI-based histological scoring, sequential testing strategies) for novel diagnostic workflows.
4 secondary outcomes
Comparison to Fibrosis (FIB)-4 or other fibrosis-related standards
Time frame: within 120 days of study enrollment.
Comparison to ALT or other activity-related standards.
Time frame: within 120 days of study enrollment.
Comparison to Histology.
Time frame: within 120 days of study enrollment.
AI-driven histology endpoints
Time frame: within 120 days of study enrollment.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 26 Oct 2026.
- Individual participant dataSharing planned: Yes. NIMBLE has an ancillary studies protocol which governs all requests for use of data, beyond the primary publication by project team members who have contributed services to the project. For example, this request covers clinical data that are associated with the biospecimens each company obtained and analyzed, as well as biomarker values, imaging results, and biopsy results generated by project team members.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Arun Sanyal principal investigator
Virginia Commonwealth University
4 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Metabolic Associated Fatty Liver Disease and Metabolic Associated Steatotic Liver Disease, run by Foundation for the National Institutes of Health at 4 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 26 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 4 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Geraldine Dacpano (908-650-1353, gdacpano@ergclinical.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Detection of At-Risk MASH (time frame: within 120 days of study enrollment.). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Oct 2026.