A Study Of Ursolic Acid For Primary Sclerosing Cholangitis

In the first phase of this trial, 6 healthy subjects and 2 PSC subjects will assigned to
ursolic acid taken orally as a single dose of 40 mg, 80 mg, and 120 mg to determine the
optimal dose in humans.

The second phase of this trial will involve 20 PSC subjects assigned to treatment with daily
oral ursolic acid at the dose determined to be optimal in the first phase of the study. The
treatment will last for 24 weeks with an off-treatment follow up of 28 weeks.

Inclusion Criteria:

- Male or female age 18 - 70 years of age

- PSC documented by typically cholangiogram findings of strictures and dilations with no
evidence of a secondary cause of sclerosing cholangitis

- Serum alkaline phosphatase greater than 1.5 times the upper limit of the normal
reference range at the UC Davis Health Systems Clinical Laboratory

- AST and ALT ≤ 10 x ULN

- Serum creatinine < 2.0 mg/dL

- Mayo Activity Index of < 2 (in those with ulcerative colitis or Crohn's colitis)

- Negative serum pregnancy test for female subjects of childbearing potential, agreement
to use a highly effective method of contraception during heterosexual intercourse
(females of childbearing potential), lactating females must agree to discontinue
nursing before starting study treatment, and barrier contraception during heterosexual
intercourse (males not vasectomized).

Exclusion Criteria:

- Pregnancy

- Hepatic decompensation defined as ascites (or use of diuretics), episodes of hepatic
encephalopathy, variceal bleeding or an INR > 1.2

- Positive HCV RNA or HBsAg, positive anti-mitochondrial antibody, alcohol consumption
greater than 21oz/week for males or 14oz/week for females

- Clinically significant cardiac disease, history of cholangiocarcinoma, history of
liver transplantation, history of cancers, other than non-melanomatous skin cancer,
within 5 years prior to screening

- Ascending cholangitis within 60 days of screening

- Use of immunosuppressants including 6-mercaptopurine, azathioprine, methotrexate,
mycophenolate mofetil, tacrolimus, cyclosporine, and anti-TNF or other biologics
within 6 months of enrollment

- Use of antibiotics including vancomycin, metronidazole, or rifaximin within 60 days of
enrollment