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The Autonomic Nervous System and Obesity

Primary Purpose

OBESITY, HYPERTENSION, PURE AUTONOMIC FAILURE

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Trimethaphan
Trimethaphan
Pseudoephedrine
Sponsored by
Vanderbilt University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for OBESITY focused on measuring OBESITY, RESTING ENERGY EXPENDITURE, SYMPATHETIC NERVOUS SYSTEM, HYPERTENSION, AUTONOMIC FAILURE

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Healthy normal (BMI <= 25 Kg/m2), obese (BMI between 30 and 40)volunteers, lean hypertensive (BMI 20-28 Kg/m2), and obese hypertensive (BMI between 30 and 40) Ages 18-60 Patients with pure autonomic failure and multiple system atrophy ages 18-80, referred to our service for the diagnosis and treatment of their condition, and their age sex-matched sedentary, healthy controls ages 18-80 Exclusion criteria: All medical students Pregnant women Heart failure, symptomatic coronary artery disease, liver impairment, history of stroke or myocardial infarction, glaucoma History of serious allergies or asthma Subjects using beta-blockers

Sites / Locations

  • Vanderbilt University

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Other

Other

Other

Other

Other

Arm Label

Part 1

Part 2 (closed)

Part 3

Part 4a (closed)

Part 4b (closed)

Arm Description

Estimation of resting energy expenditure and effect of autonomic blockade with trimethaphan infusion.

Estimation of autonomic function and effect of autonomic blockade with trimethaphan infusion.

Estimation of energy metabolism and effect of sympathetic stimulation with pseudoephedrine.

Isoproterenol sensitivity in adipose and muscle tissue with and without systemic autonomic blockade with trimethaphan infusion.

Metabolic and hemodynamic response to submaximal exercise in adipose and muscle tissue with and without systemic autonomic blockade with trimethaphan infusion.

Outcomes

Primary Outcome Measures

Change in supine systolic blood pressure after achieving complete ganglionic blockade.

Secondary Outcome Measures

Change in resting energy expenditure after achieving complete autonomic blockade.

Full Information

First Posted
September 13, 2005
Last Updated
February 27, 2018
Sponsor
Vanderbilt University
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1. Study Identification

Unique Protocol Identification Number
NCT00179023
Brief Title
The Autonomic Nervous System and Obesity
Official Title
The Autonomic Nervous System and Obesity
Study Type
Interventional

2. Study Status

Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
April 2003 (undefined)
Primary Completion Date
January 2017 (Actual)
Study Completion Date
January 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Vanderbilt University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
In its simplest terms, obesity is the results of a positive balance between food intake and energy expenditure (EE). I.e., we take in more energy, in the form of food, than we expend, e.g., by exercise. In our sedentary society, resting EE accounts for most of total energy expenditure. The sympathetic nervous system (SNS, the one that produces adrenaline) is thought to contribute to resting EE. This conclusion is based on experiments where resting EE is decreased by beta-blockers, high blood pressure medicines that block only one aspect of the sympathetic nervous system. The investigators propose to use a different approach, by using a medication called trimethaphan that produces transient withdrawal of the autonomic nervous system. The investigators will then compare the measured resting EE before and after SNS withdraw and quantify the degree of contribution to the resting EE by the SNS and delineate differences between healthy normal, healthy obese, and patients with autonomic dysfunctions.
Detailed Description
The rationale for this study is that even small alterations to energy metabolism can significantly change energy balance and body weight in the long term. We will test the hypothesis that the sympathetic nervous system (SNS) activity contributes to resting and thermogenic components of energy expenditure (EE). This study is divided in four different parts: (1), (2), (3), (4). Part (1): we will gauge the contribution of the sympathetic nervous system to resting energy expenditure, blood pressure, and determine differences between lean, obese, and patients with primary autonomic failure . Part (2): we will determine the degree of sympathetic blockade by a gradual infusion of the ganglionic blocker trimethaphan.[Part 2 has been closed] Part (3): we will determine the energy balance in patients with primary autonomic failure. Part (4): we will determine the contribution of the sympathetic nervous system to lipolysis.[Part 4 has been closed] Subjects selections*: For part (1) and (2) we will study six groups of subjects (n = 40 for each group): patients with pure autonomic failure, patients with multiple system atrophy, healthy normal controls (BMI <= 25), obese controls (BMI 30-40) and obese hypertensive (BMI 30-40) and lean hypertensive (BMI 20-28). A time interval of at least 1 week is required for those subjects who wish to participate in part (1) and part (2). For part (3) we will study two groups of subjects (n=12 for each group): patients with autonomic failure, and their age sex-matched sedentary, healthy controls. For part (4) we will study two groups of subjects (n=12 for each group): healthy normal controls (BMI 20-25), obese controls (BMI 30-40). *Part 2 and 4 have been closed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
OBESITY, HYPERTENSION, PURE AUTONOMIC FAILURE, SHY-DRAGER SYNDROME
Keywords
OBESITY, RESTING ENERGY EXPENDITURE, SYMPATHETIC NERVOUS SYSTEM, HYPERTENSION, AUTONOMIC FAILURE

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
128 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Part 1
Arm Type
Other
Arm Description
Estimation of resting energy expenditure and effect of autonomic blockade with trimethaphan infusion.
Arm Title
Part 2 (closed)
Arm Type
Other
Arm Description
Estimation of autonomic function and effect of autonomic blockade with trimethaphan infusion.
Arm Title
Part 3
Arm Type
Other
Arm Description
Estimation of energy metabolism and effect of sympathetic stimulation with pseudoephedrine.
Arm Title
Part 4a (closed)
Arm Type
Other
Arm Description
Isoproterenol sensitivity in adipose and muscle tissue with and without systemic autonomic blockade with trimethaphan infusion.
Arm Title
Part 4b (closed)
Arm Type
Other
Arm Description
Metabolic and hemodynamic response to submaximal exercise in adipose and muscle tissue with and without systemic autonomic blockade with trimethaphan infusion.
Intervention Type
Drug
Intervention Name(s)
Trimethaphan
Intervention Description
Start dose: 0.05 ml/min (0.5 mg/min), IV infusion. The dose will be increased every 2-4 minutes to 1, 2, 4, and 5 mg/min. Total duration: 1 hour
Intervention Type
Drug
Intervention Name(s)
Trimethaphan
Intervention Description
Start dose: 0.05 ml/min (0.5 mg/min), IV infusion. The dose will be increased every 30 minutes to 1, 2, 4, and 5 mg/min. Total duration: 1-2 hours
Intervention Type
Drug
Intervention Name(s)
Pseudoephedrine
Other Intervention Name(s)
Sudafed
Intervention Description
30mg tablet,VO. Single dose.
Primary Outcome Measure Information:
Title
Change in supine systolic blood pressure after achieving complete ganglionic blockade.
Time Frame
1-2 hour
Secondary Outcome Measure Information:
Title
Change in resting energy expenditure after achieving complete autonomic blockade.
Time Frame
1-2 hour

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Healthy normal (BMI <= 25 Kg/m2), obese (BMI between 30 and 40)volunteers, lean hypertensive (BMI 20-28 Kg/m2), and obese hypertensive (BMI between 30 and 40) Ages 18-60 Patients with pure autonomic failure and multiple system atrophy ages 18-80, referred to our service for the diagnosis and treatment of their condition, and their age sex-matched sedentary, healthy controls ages 18-80 Exclusion criteria: All medical students Pregnant women Heart failure, symptomatic coronary artery disease, liver impairment, history of stroke or myocardial infarction, glaucoma History of serious allergies or asthma Subjects using beta-blockers
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Italo Biaggioni, MD
Organizational Affiliation
Vanderbilt University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Vanderbilt University
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
17116758
Citation
Shibao C, Gamboa A, Diedrich A, Ertl AC, Chen KY, Byrne DW, Farley G, Paranjape SY, Davis SN, Biaggioni I. Autonomic contribution to blood pressure and metabolism in obesity. Hypertension. 2007 Jan;49(1):27-33. doi: 10.1161/01.HYP.0000251679.87348.05. Epub 2006 Nov 20.
Results Reference
result
PubMed Identifier
22469621
Citation
Shibao C, Buchowski MS, Chen KY, Yu C, Biaggioni I. Chronic sympathetic attenuation and energy metabolism in autonomic failure. Hypertension. 2012 May;59(5):985-90. doi: 10.1161/HYPERTENSIONAHA.111.190157. Epub 2012 Apr 2.
Results Reference
result

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The Autonomic Nervous System and Obesity

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