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Exendin(9-39)Amide as a Glucagon-like Peptide-1 (GLP-1) Receptor Antagonist in Humans

Primary Purpose

Hyperglycemia

Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
GLP-1 control
GLP-1 and Exendin(9-39) 300
saline control
GLP-1 and Exendin(9-39) 600
GLP-1 and Exendin(9-39) 900
GLP-1 and Exendin(9-39) 1200
Sponsored by
Ludwig-Maximilians - University of Munich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Hyperglycemia focused on measuring GLP-1, Exendin(9-39), Insulin, Glucagon, Human physiology

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Male or female (postmenopausal, surgically sterile or using double-barrier method of contraception) healthy volunteers
  • Age 18-65 years
  • Hemoglobin A1c (HbA1c) < 6%
  • Body mass index (BMI) < 30 kg/m2
  • Must have a fasting blood glucose below 100 mg/dl at screening and on all study days
  • Able to provide written informed consent prior to study participation
  • Able to communicate well with the investigator and comply with the requirements of the study

Exclusion Criteria:

  • Diabetes mellitus
  • Fasting triglycerides > 5.1 mmol/L (> 450 mg/dL) within the past 4 weeks.
  • Treatment with systemic steroids and thyroid hormone
  • Patients with any history of gastrointestinal surgery, e.g. partial bowel resections, partial gastric resections, etc.
  • Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation.
  • Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing.
  • Significant illness within the two weeks prior to dosing.
  • Past medical history of clinically significant electrocardiogram (ECG) abnormalities or a family history of a prolonged QT-interval syndrome.
  • History of clinically significant drug allergy; history of atopic allergy (asthma, urticaria, eczematous dermatitis). A known hypersensitivity to the study drug or drugs similar to the study drug.
  • Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of drugs or which may jeopardize the subject in case of participation in the study. The investigator should be guided by evidence of any of the following:

    • history of inflammatory bowel syndrome, gastritis, ulcers, gastrointestinal or rectal bleeding
    • history of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection
    • history or clinical evidence of pancreatic injury or pancreatitis
    • history or presence of impaired renal function as indicated by abnormal creatinine or urea values or abnormal urinary constituents (e.g., albuminuria)
    • evidence of urinary obstruction or difficulty in voiding at screening
  • Polymorphonuclears < 1500/µL at inclusion or platelet count < 100,000/μL at screening and baseline.
  • Evidence of liver disease as indicated by abnormal liver function tests such as SGOT, SGPT, GGT, alkaline phosphatase, or serum bilirubin.
  • History of drug or alcohol abuse within the 12 months prior to dosing or evidence of such abuse as indicated by the laboratory assays conducted during the screening or baseline evaluations.

Sites / Locations

  • Ludwig Maximilians University, Clinical Research Unit

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Intravenous infusion

Arm Description

intravenous infusion of test substances

Outcomes

Primary Outcome Measures

To assess the effect of increasing doses of exendin(9-39) on first and second phase insulin secretion stimulated by intravenous GLP-1 during hyperglycemia

Secondary Outcome Measures

To assess the effect of increasing doses of exendin(9-39) on plasma glucagon levels decreased by intravenous GLP-1 during hyperglycemia

Full Information

First Posted
October 26, 2006
Last Updated
October 2, 2011
Sponsor
Ludwig-Maximilians - University of Munich
Collaborators
German Research Foundation, Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00393445
Brief Title
Exendin(9-39)Amide as a Glucagon-like Peptide-1 (GLP-1) Receptor Antagonist in Humans
Official Title
Effect of GLP-1 on Glucose Metabolism in Healthy Subjects and Patients With T2DM. Part 1: A Pilot Study to Assess the Efficacy of Exendin(9-39)Amide as a GLP-1 Receptor Antagonist in Healthy Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
October 2011
Overall Recruitment Status
Completed
Study Start Date
November 2006 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
May 2007 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ludwig-Maximilians - University of Munich
Collaborators
German Research Foundation, Merck Sharp & Dohme LLC

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine the dose of the GLP-1 receptor antagonist exendin(9-39) which blocks the insulinotropic action of synthetic GLP-1 by at least 95%.
Detailed Description
Following a meal, gut-produced incretin hormones such as glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are released into the circulation. GLP-1 and GIP, the two dominant incretin hormones, are part of a natural endogenous system involved in maintaining glucose homeostasis. In the presence of normal or elevated, but not low, glucose concentration, both GLP-1 and GIP increase insulin secretion from pancreatic islet beta-cells (β-cells). GLP-1 also lowers glucagon secretion from pancreatic alpha-cells and delays nutrient delivery from the stomach by inhibiting gastric emptying. This rise in insulin concentration enhances glucose clearance in peripheral tissues such as muscle, and the lower glucagon concentration combined with the rise in insulin reduces hepatic glucose production. By enhancing glucose clearance and lowering hepatic glucose production, the post-meal glucose excursion is reduced. However, the role that each incretin has in glucoregulation is not fully understood. Use of a GLP-1 antagonist, exendin (9-39)NH2, will allow for the assessment of non-GLP-1 incretin's role in glucoregulation. Therefore, it is of great interest to examine the role that specific incretins have in glucoregulation in patients with T2DM. Exendin(9-39) has been shown a specific and reversible antagonist at the human GLP-1 receptor in vivo. In initial validation studies intravenous exendin(9-39) dose-dependently reduced the insulinotropic action of intravenous GLP-1. The maximal dose of 300 pmol/kg/min used in these studies was sufficient to reduce GLP-1 stimulated insulin plasma levels by about 83%. However, to quantify the contribution of incretin hormones to the incretin effect as stated above a nearly complete inhibition of the GLP-1 action is necessary. Therefore the purpose of this pilot study is to characterize the dose-response characteristics of exendin(9-39) more completely and to find a dosage which inhibits the insulinotropic action of GLP-1 by at least 95%.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hyperglycemia
Keywords
GLP-1, Exendin(9-39), Insulin, Glucagon, Human physiology

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intravenous infusion
Arm Type
Experimental
Arm Description
intravenous infusion of test substances
Intervention Type
Drug
Intervention Name(s)
GLP-1 control
Other Intervention Name(s)
GLP-1(7-36)amide
Intervention Description
intravenous infusion of GLP-1
Intervention Type
Drug
Intervention Name(s)
GLP-1 and Exendin(9-39) 300
Intervention Description
intravenous infusion of exendin(9-39) at 300 pmol/kg/min during GLP-1 at 0.3 and 0.9 pmol/kg/min
Intervention Type
Drug
Intervention Name(s)
saline control
Intervention Description
intravenous infusion of saline
Intervention Type
Drug
Intervention Name(s)
GLP-1 and Exendin(9-39) 600
Intervention Description
intravenous infusion of exendin(9-39) at 600 pmol/kg/min during GLP-1 at 0.3 and 0.9 pmol/kg/min
Intervention Type
Drug
Intervention Name(s)
GLP-1 and Exendin(9-39) 900
Intervention Description
intravenous infusion of exendin(9-39) at 900 pmol/kg/min during GLP-1 at 0.3 and 0.9 pmol/kg/min
Intervention Type
Drug
Intervention Name(s)
GLP-1 and Exendin(9-39) 1200
Intervention Description
intravenous infusion of exendin(9-39) at 1200 pmol/kg/min during GLP-1 at 0.3 and 0.9 pmol/kg/min
Primary Outcome Measure Information:
Title
To assess the effect of increasing doses of exendin(9-39) on first and second phase insulin secretion stimulated by intravenous GLP-1 during hyperglycemia
Time Frame
within the actual study period
Secondary Outcome Measure Information:
Title
To assess the effect of increasing doses of exendin(9-39) on plasma glucagon levels decreased by intravenous GLP-1 during hyperglycemia
Time Frame
within the actual study period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Male or female (postmenopausal, surgically sterile or using double-barrier method of contraception) healthy volunteers Age 18-65 years Hemoglobin A1c (HbA1c) < 6% Body mass index (BMI) < 30 kg/m2 Must have a fasting blood glucose below 100 mg/dl at screening and on all study days Able to provide written informed consent prior to study participation Able to communicate well with the investigator and comply with the requirements of the study Exclusion Criteria: Diabetes mellitus Fasting triglycerides > 5.1 mmol/L (> 450 mg/dL) within the past 4 weeks. Treatment with systemic steroids and thyroid hormone Patients with any history of gastrointestinal surgery, e.g. partial bowel resections, partial gastric resections, etc. Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation. Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing. Significant illness within the two weeks prior to dosing. Past medical history of clinically significant electrocardiogram (ECG) abnormalities or a family history of a prolonged QT-interval syndrome. History of clinically significant drug allergy; history of atopic allergy (asthma, urticaria, eczematous dermatitis). A known hypersensitivity to the study drug or drugs similar to the study drug. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of drugs or which may jeopardize the subject in case of participation in the study. The investigator should be guided by evidence of any of the following: history of inflammatory bowel syndrome, gastritis, ulcers, gastrointestinal or rectal bleeding history of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection history or clinical evidence of pancreatic injury or pancreatitis history or presence of impaired renal function as indicated by abnormal creatinine or urea values or abnormal urinary constituents (e.g., albuminuria) evidence of urinary obstruction or difficulty in voiding at screening Polymorphonuclears < 1500/µL at inclusion or platelet count < 100,000/μL at screening and baseline. Evidence of liver disease as indicated by abnormal liver function tests such as SGOT, SGPT, GGT, alkaline phosphatase, or serum bilirubin. History of drug or alcohol abuse within the 12 months prior to dosing or evidence of such abuse as indicated by the laboratory assays conducted during the screening or baseline evaluations.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joerg Schirra, MD
Organizational Affiliation
Clinical Research Unit (CRU), Department of Internal Medicine II-Grosshadern, Ludwig-Maximilans-University of Munich
Official's Role
Study Chair
Facility Information:
Facility Name
Ludwig Maximilians University, Clinical Research Unit
City
Munich
ZIP/Postal Code
D-81377
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
9525985
Citation
Schirra J, Sturm K, Leicht P, Arnold R, Goke B, Katschinski M. Exendin(9-39)amide is an antagonist of glucagon-like peptide-1(7-36)amide in humans. J Clin Invest. 1998 Apr 1;101(7):1421-30. doi: 10.1172/JCI1349.
Results Reference
result
PubMed Identifier
8550855
Citation
Schirra J, Katschinski M, Weidmann C, Schafer T, Wank U, Arnold R, Goke B. Gastric emptying and release of incretin hormones after glucose ingestion in humans. J Clin Invest. 1996 Jan 1;97(1):92-103. doi: 10.1172/JCI118411.
Results Reference
result

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Exendin(9-39)Amide as a Glucagon-like Peptide-1 (GLP-1) Receptor Antagonist in Humans

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