Role of Hyperinsulinemia in Non-Alcoholic Fatty Liver Disease (NAFLD) Pathogenesis: Pancreatic Clamp Pilot & Feasibility Study: DNA Viruses – Hepatitis B Virus
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Tracking Information
Trial Identifier | NCT05724134 |
First Submitted Date | |
First Posted Date | |
Results First Submitted Date | Not Provided |
Results First Posted Date | Not Provided |
Last Update Submitted Date | |
Last Update Posted Date | |
Primary Completion Date | |
Start Date | |
Current Primary Outcome Measures | •Plasma glucose (absolute values) (units: mg/dL) [ Time Frame: Up to 425 minutes from the start of the procedure. ] -- Goal is first to clamp insulin infusion rate to maintain mean basal fasting plasma glucose during the basal titration phase, and then during the intervention phase to observe the glucose levels that result from altering the basal IIR. |
•Plasma glucose (relative/change) (units: fold difference and/or ∆mg/dL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure. ] -- Goal is first to clamp insulin infusion rate to maintain mean basal fasting plasma glucose during the basal titration phase, and then during the intervention phase to observe the impact of altering the basal IIR on glycemia. | |
•Serum insulin (absolute values) (units: micro-international units per milliliter (IU/mL)) [ Time Frame: Up to 425 minutes from the start of the procedure. ] -- Investigators will assess the insulin levels attained at the basal IIR, and at each stepwise reduction in IIR during the intervention phase. | |
•Serum insulin (relative/change) (units: fold difference and/or ∆ IU/mL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure. ] -- Investigators will compare the baseline insulin level to that attained at the basal IIR, as well as comparing to the change in insulin level that occurs with alterations in the IIR during the intervention phase. | |
•Serum C-peptide (absolute values) (units: ng/mL) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Suppression of endogenous insulin by octreotide during pancreatic clamp is expected to result in a fall in C-peptide levels to near zero. | |
•Serum C-peptide (relative/change) (units: fold difference and/or ∆ IU/mL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Suppression of endogenous insulin by octreotide during pancreatic clamp is expected to result in a fall in C-peptide levels to near zero. | |
Current Secondary Outcome Measures | •Serum or plasma triglyceride (TG) (absolute values) (units: mg/dL) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- TG levels in serum reflect hepatic synthesis/storage and very low-density lipoprotein (VLDL) secretion. |
•Serum or plasma triglyceride (TG) (relative/change) (units: fold difference and/or ∆mg/dL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- TG levels in serum reflect hepatic synthesis/storage and VLDL secretion. | |
•Serum or plasma free fatty acid (FFA) (absolute values) (units: mg/dL) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- FFA levels reflect adipose tissue lipolysis and its response to insulin and counterregulatory hormones. | |
•Serum or plasma free fatty acid (FFA) (relative/change) (units: fold difference and/or ∆mg/dL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- FFA levels reflect adipose tissue lipolysis and its response to insulin and counterregulatory hormones. | |
•Serum or plasma apolipoprotein B (ApoB) (absolute values) (units: mg/dL) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- ApoB level is a surrogate for triglyceride-rich lipoproteins, especially hepatic VLDL. | |
•Serum or plasma apolipoprotein B (ApoB) (relative/change) (units: fold difference and/or ∆mg/dL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- ApoB level is a surrogate for triglyceride-rich lipoproteins, especially hepatic VLDL. | |
•Plasma glucose kinetics: rate of appearance (units: mg/kg/min) [ Time Frame: Measured every 5 min x 4 at the end of each steady-state IIR period, up to 425 minutes from the start of the procedure ] -- Calculated from D2G tracer enrichment by the Steele equations. | |
•Plasma glucose kinetics: rate of disappearance (units: mg/kg/min) [ Time Frame: Measured every 5 min x 4 at the end of each steady-state IIR period, up to 425 minutes from the start of the procedure ] -- Calculated from D2G tracer enrichment by the Steele equations | |
•Plasma glucose kinetics: endogenous glucose production (units: mg/kg/min) [ Time Frame: Measured every 5 min x 4 at the end of each steady-state IIR period, up to 425 minutes from the start of the procedure ] -- Calculated from D2G tracer enrichment by the Steele equations | |
Other Outcome Measures | •Widely Targeted Small Polar Metabolite (WTSM) (metabolomics panel) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Mass spectrometry of plasma using Sciex 6500+ quadropule ion trip (QTRAP) |
•Widely Targeted Lipidomic Profiling (WTLP) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Mass spectrometry of plasma using Sciex 6500+ QTRAP | |
•Serum/plasma glucagon (absolute values) (units: ng/L) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Assesses the adequacy of exogenous glucagon replacement. | |
•Serum or plasma glucagon (relative/change) (units: fold difference and/or ∆ng/L relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Assesses the adequacy of exogenous glucagon replacement. | |
•Serum or plasma growth hormone (absolute values) (units: ng/mL) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Assesses the adequacy of exogenous rhGH replacement. | |
•Serum or plasma growth hormone (relative/change) (units: fold difference and/or ∆ng/mL relative to previous time points) [ Time Frame: Up to 425 minutes from the start of the procedure ] -- Assesses the adequacy of exogenous rhGH replacement. | |
Change History | Complete list of historical revisions of study NCT05724134 |
Descriptive Information
Brief Title | Pancreatic Clamp in NAFLD |
Official Title | Role of Hyperinsulinemia in Non-Alcoholic Fatty Liver Disease (NAFLD) Pathogenesis: Pancreatic Clamp Pilot & Feasibility Study |
Brief Summary | This is a single-center, prospective, randomized, controlled (crossover) clinical study designed to investigate the specific dose-response impact of insulin infusion rate (IIR) on blood glucose levels during a pancreatic clamp study. The investigators will recruit participants with a history of overweight/obesity and prediabetic state (i.e., prediabetes or impaired fasting glucose, with fasting hyperinsulinemia), with evidence of, or clinically judged to be at high risk for, uncomplicated non-alcoholic fatty liver disease (NAFLD). Participants will undergo two pancreatic clamp procedures in which individualized basal IIR are identified, followed in one by maintenance of basal IIR (maintenance hyperinsulinemia, MH) and in the other by a stepped decline in IIR (reduction toward euinsulinemia, RE). In both clamps the investigators will closely monitor plasma glucose and various metabolic parameters. The primary outcome will be the absolute and relative changes in steady-state plasma glucose levels at each stepped decline in IIR. |
Detailed Description | Although high blood sugar and risk of heart disease are the most well-known health effects of type 2 diabetes (T2DM), nonalcoholic fatty liver disease (NAFLD), in which too much fat accumulates in the liver, has come to be recognized as another important complication. Unchecked, NAFLD can progress to severe liver inflammation, liver failure, and even liver cancer. The investigators suspect that high levels of the blood sugar-lowering hormone insulin leads to excessive fat production by the liver, and so lowering insulin levels might help to improve NAFLD. In order to answer this question, the investigators will recruit people at risk for T2DM and NAFLD to perform a “pancreatic clamp” - a procedure in which the body’s production of insulin is temporarily shut off and then replaced at the same or lower levels. Again, the investigators expect that lowering insulin levels will lower fat production. Because this is a new research approach, the investigators first need to understand how lowering insulin levels affects blood sugar. Research participants in this pilot study will therefore undergo two pancreatic clamps in random order: one roughly maintaining their own internal (“basal”) insulin level and one in which the investigators lower that basal insulin level by 10%, 25%, and 40%. In each case, the investigators will observe the absolute and relative changes in blood sugar and the levels of certain fats as the investigators change the insulin level. Once the investigators have found a lower insulin level that they can safely maintain, the investigators will go on to study its effect on fat production in a later study. |
Study Type | Interventional |
Study Phase | Phase 1 |
Study Design | Allocation: Randomized |
Intervention Model: Crossover Assignment | |
Primary Purpose: Basic Science | |
Masking: Single | |
Masking Description: Participant will be blinded to study group assignment. | |
Intervention Model Description: All participants will undergo (i.e., cross over between) both pancreatic clamp protocols ( |
|
Condition | Insulin Resistance |
Prediabetic State | |
Hyperinsulinemia | |
Non-Alcoholic Fatty Liver Disease | |
Obesity | |
Intervention | •Drug: Insulin human |
Insulin infusion rate (IIR) will be determined empirically first to maintain mean basal fasting plasma glucose, and then either maintained at the basal rate (MH protocol) or be reduced stepwise toward euinsulinemia (RE protocol). | |
•Drug: Octreotide Acetate | |
Octreotide will be infused at 30 ng/kg/min to suppress endogenous insulin, glucagon, and growth hormone secretion. Co-administered with glucagon and rhGH. | |
•Drug: Glucagon | |
Glucagon will be replaced at a constant rate of 0.65 ng/kg/min to maintain baseline counterregulatory response. Co-administered with octreotide and rhGH. | |
Other Names: | |
⚬GlucaGen | |
•Drug: Growth Hormone, Human | |
Recombinant human growth hormone (rhGH) will be replaced at a constant rate of 3 ng/kg/min to maintain baseline counterregulatory response. Co-administered with octreotide and glucagon. | |
Other Names: | |
⚬Humatrope | |
•Other: [6,6-2H2] D-glucose | |
Stable isotope tracer administered to calculate glucose kinetics during pancreatic clamp. | |
Other Names: | |
⚬D2-glucose, D2G | |
•Drug: 20% D-glucose (aq) | |
20% D-glucose (aq) (D20W) will be administered to counteract hypoglycemia or strongly downward blood glucose trends, as needed. | |
Other Names: | |
⚬D20W | |
•Dietary Supplement: BOOST Plus | |
Nutritional supplement will be administered to provide three standardized “mixed meals” on the day before the pancreatic clamp. | |
•Device: Harvard Apparatus PHD ULTRA CP syringe pump | |
Syringe pump used for highly precise administration of insulin, octreotide/glucagon/rhGH, and D20W (as needed) even at low infusion rates. | |
•Device: Yellow Springs Instruments (YSI) 2500 Biochemistry Glucose/Lactate Analyzer | |
Glucose oxidase analyzer used to detect plasma glucose levels at the point of care. YSI have been the gold standard in clamp studies for many years. Two machines will run in parallel to ensure accuracy of results. | |
Study Arms | •Active Comparator: Maintenance hyperinsulinemia (MH) protocol |
The basal insulin infusion rate (IIR) necessary to maintain participants’ mean basal fasting plasma glucose (mbFPG) will be determined during the basal titration period. Then, during the intervention period, the IIR will remain | |
Interventions: | |
⚬Drug: Insulin human | |
⚬Drug: Octreotide Acetate | |
⚬Drug: Glucagon | |
⚬Drug: Growth Hormone, Human | |
⚬Other: [6,6-2H2] D-glucose | |
⚬Drug: 20% D-glucose (aq) | |
⚬Dietary Supplement: BOOST Plus | |
⚬Device: Harvard Apparatus PHD ULTRA CP syringe pump | |
⚬Device: Yellow Springs Instruments (YSI) 2500 Biochemistry Glucose/Lactate Analyzer | |
•Experimental: Reduction toward euinsulinemia (RE) protocol | |
The basal insulin infusion rate (IIR) necessary to maintain participants’ mean basal fasting plasma glucose (mbFPG) will be determined during the basal titration period. Then, during the intervention period, the IIR will be redu | |
Interventions: | |
⚬Drug: Insulin human | |
⚬Drug: Octreotide Acetate | |
⚬Drug: Glucagon | |
⚬Drug: Growth Hormone, Human | |
⚬Other: [6,6-2H2] D-glucose | |
⚬Drug: 20% D-glucose (aq) | |
⚬Dietary Supplement: BOOST Plus | |
⚬Device: Harvard Apparatus PHD ULTRA CP syringe pump | |
⚬Device: Yellow Springs Instruments (YSI) 2500 Biochemistry Glucose/Lactate Analyzer |
Recruitment Information
Recruitment Status | Recruiting |
Estimated Enrollment | 20 |
Estimated Completion Date | |
Primary Completion Date | |
Eligibility | Inclusion Criteria: Any gender, aged 18-65 years Body mass index of 27.0-35.0 kg/m2 Able to understand written and spoken English and/or Spanish Meeting either of the American Diabetes Association’s (ADA) definitions for prediabetes or impaired fasting glucose (IFG) within the previous year* and on screening labs: i. Prediabetes: Hemoglobin A1c 5.7-6.4% ii. IFG: plasma glucose of 100-125 mg/dL after 8-h fast * Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) may be used to identify potential recruits, but recruits must meet at least one of the |
Sex/Gender | Sexes Eligible for Study: All |
Ages | 18 years to 65 years |
No | |
Contacts | Primary contact: Joshua R Cook, MD, PhD, 2123056289, [email protected] |
Listed Location Countries | |
Removed Location Countries |
Administrative Information
NCT Number | NCT05724134 |
Other Study ID Numbers | AAAU3014 |
Has Data Monitoring Committee | Not Provided |
Studies a |
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Studies a |
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Plan to Share Data | Yes |
Plan to Share Data (IPD) Description | Blood samples will be banked in our Insulin Resistance Biobank and will be made available to other researchers for legitimate research purposes upon request. Associated data will be shared along with specimens in the smallest possible quantity and on a need-to-know basis. No Protected Health Information (PHI) will ever be disclosed to other researchers. All requests will be reviewed by the PI for scientific merit and samples/data will be transferred only upon completion of an |
Collaborators | |
Investigators | Principal Investigator: |
Information Provided By | |
Verification Date |
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