A Pilot, Dose Escalating Study on VLX103 in Moderate Alcoholic Steatohepatitis

Eligible subjects must meet all of the following inclusion criteria:

1. Male and non pregnant female subjects; female subjects must use 2 reliable methods of contraception
2. 18-70 years
3. BMI less than 30 mg/kg2
4. Established diagnosis of Alcoholic Steatohepatitis (ASH), based on at least 2 of the following signs and symptoms should be present: nausea, jaundice, anorexia, right upper quadrant abdominal pain, leukocytosis or hepatomegaly AND
5. Elevation of total bilirubin > 3 mg/dL AND
6. Liver biopsy showing ASH OR ultrasound of liver showing increased echogenicity OR CT scan showing decreased attenuation of liver compared to spleen OR MRI showing fatty liver (decreased signaling intensity on T1 weighted images) History of chronic alcohol consumption, i.e. more than 50 g/day for a minimum of 6 months and at least 2 months before enrolment
7. AST/ALT ratio greater than 1.5
8. MELD score between 12 and 19
9. Signature of a dated Informed Consent Form (ICF) indicating that the subject has been informed of all the relevant aspects of the trial prior to enrolment Willingness and ability to comply with scheduled visits and trial procedures

Exclusion Criteria:

Eligible subjects must not meet any of the following exclusion criteria:

1. Liver disease caused by other etiologies than alcohol (except Hepatitis C and hemochromatosis)
2. Baseline ALT ≥ 200 IU/L
3. Baseline AST ≥ 500 IU/L
4. Signs of systemic infection: fever > 38°C and positive blood or ascites cultures on appropriate antibiotic therapy for ≥ 3 days within 3 days of inclusion
5. Presence of portosystemic encephalopathy at enrolment
6. Presence of cancer at enrolment
7. Presence of uncontrolled diabetes, defined as Hb1Ac ≥ 8.5
8. History of clinically significant hypoglycaemia, with fasting blood glucose \< 3 mmol/L within 3 months prior to enrolment
9. Presence of clinically significant renal impairment, defined as serum creatinine ≥ 2.0 x ULN
10. Hypotension with BP \< 80/50 mm Hg after volume repletion
11. Current or recent (2 years) history or presence of pancreatitis
12. History of Long QT Syndrome or any significant risk factor for clinically meaningful QT prolongation and Torsades de Pointe.
13. History of significant gastrointestinal surgery that may interfere with the absorption of VLX103
14. Previous treatment with corticosteroids or other immunosuppressive drugs including specific anti-TNF alpha therapy and calcineurin inhibitors within the previous 3 months. Inhaled steroids for asthma are acceptable as long as their use has not been initiated less than 10 days prior to enrolment and their dosing regimen remain stable during the study
15. Concomitant therapy with probiotics, oral neomycin or polymyxin B, rifaximin or other investigational agents or participation in another clinical trial within 3 months of signature of ICF
16. Previous use of pentamidine with treatment discontinuation of less than 12 months prior to study enrolment
17. History of allergy or hypersensitivity to pentamidine
18. Pregnancy or breastfeeding. All female subjects of childbearing potential must have a negative urine pregnancy test prior to first dose of study medication. Breastfeeding is prohibited during the study.
19. Severe acute or chronic medical or psychiatric condition, or laboratory abnormality that would impart, in the judgement of the investigator, excess risk associated with trial participation of study drug administration, or which in the judgement of the investigator, would make the subject inappropriate for entry into this trial.