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Evaluation of 18F-FP-DTBZ Pancreatic PET Scanning as a Tool to Measure Beta Cell Mass

Primary Purpose

Healthy Volunteers, Diabetes Mellitus, Type 1

Status
Withdrawn
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
18F-FP-DTBZ
PET Scanning
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Healthy Volunteers focused on measuring dihydrotetrabenazine, beta cell mass, diabetes mellitus

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Patients with type 1 diabetes may be enrolled if they meet all of the following criteria:

    1. Are males or females between 18 and 70 years of age, inclusive
    2. Have a diagnosis of type 1 diabetes mellitus as defined by the American Diabetes Association (ADA) criteria or by diagnosed as per their endocrinologist; duration >5 years; Insulin dose requirements <0.8 units/kg/day
    3. HbA1c level between 5% and 8.5%
    4. Have fasting C-Peptide < 0.1 ng/ml
    5. Have a body mass index (BMI) between 18 and 32 kg/m2
    6. Able to tolerate PET imaging
    7. In the judgment of the physician, are capable of fasting 4 to 6 hours prior to screening and Day 1 imaging procedures
    8. Give informed consent

Healthy volunteers may be enrolled if they meeting all of the following criteria:

  1. Are males or females between 18 and 70 years of age, inclusive
  2. Have no history of type 1 or type 2 diabetes in a first degree relative
  3. Fasting blood glucose less than 100 mg/dL
  4. HbA1c level less than 6%
  5. Normal Mixed Meal Tolerance test at screening visit
  6. BMI between 18 and 32 kg/m2
  7. Able to tolerate PET imaging
  8. In the judgment of the physician, are capable of fasting 4 to 6 hours prior to screening and Day 1 imaging procedures, and
  9. Give informed consent

Exclusion Criteria:

  • Potential participants must not have any of the following exclusion criteria:

    1. Clinically significant renal dysfunction
    2. Clinically significant liver dysfunction as determined by history, physical examination, and standard liver function testing at screening (aspartate aminotransferase (AST), alanine aminotransferase (ALT), Total/Direct Bilirubin, Alkaline Phosphatase)
    3. Coagulopathy
    4. Use medications known to affect dopaminergic function, including monoamine oxidase (MAO) inhibitors, tetrabenazine, or levodopa
    5. Recent (within 3 months) or current treatment with drugs influencing beta cell function or insulin sensitivity (e.g. glucocorticoids, reserpine) medications known to affect dopaminergic function, including MAO inhibitors, tetrabenazine, or levodopa
    6. Have polycystic ovarian syndrome
    7. History of movement disorder such as Parkinson's Disease, Huntington's Disease
    8. Clinically significant psychiatric disease or history of psychiatric illness such as depression, bipolar disease, anxiety or schizophrenia
    9. Current use (within past year) of cocaine, methamphetamine, and/or ecstasy (3,4methylenedioxymethamphetamine (MDMA))
    10. Have a recent history of alcohol or substance abuse or dependence
    11. Clinically significant cardiovascular disease or clinically significant abnormalities on screening electrocardiogram (ECG) (including but not limited to QTc > 450 msec)
    12. Clinically significant pulmonary, renal or hepatic impairment, or cancer
    13. Have clinically significant infectious disease, including acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection or previous positive test for hepatitis B, hepatitis C, HIV1, or HIV2
    14. Are women of childbearing potential not refraining from sexual activity or not using adequate contraception.

      Women must not be pregnant (negative serum human chorionic gonadotropin (hCG) at the time of screen) or breastfeeding at screening, and must agree to take appropriate steps not to become pregnant during for 30 days following the clinical trial

    15. Require medications with a narrow therapeutic window (e.g., warfarin), are receiving any investigational medications, or have participated in a trial with investigational medications within the last 30 days
    16. Weigh more than the manufacturer recommended limit for the PET/computed tomography (CT) camera being used
    17. Any prior participation in other research protocols within the past month that involved radiation, with the exception of plain radiography studies (i.e., chest x-rays); And
    18. Have received a diagnostic or therapeutic radiopharmaceutical within the past week

Sites / Locations

  • Naomi Berrie Diabetes Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Healthy Controls

Patients with T1D

Arm Description

Pancreatic 18F-FP-DTBZ uptake will be measured with PET scanning in healthy controls: subjects with predicted normal BCM (healthy, normal weight, non-diabetic individuals who have stimulated insulin and c-peptide levels within the normal range).

Pancreatic 18F-FP-DTBZ uptake will be measured with PET scanning in patients with longstanding T1D: subjects with predicted reduced beta cell mass (subjects with established T1DM who have low or no measurable stimulated insulin and c-peptide levels).

Outcomes

Primary Outcome Measures

Mean BPND (non-displaceable binding potential)
We will be evaluating pancreatic uptake of the radiotracer 18F-FP-DTBZ in subjects with and without long-standing type 1 diabetes mellitus.

Secondary Outcome Measures

Full Information

First Posted
January 28, 2014
Last Updated
January 30, 2017
Sponsor
Columbia University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT02236754
Brief Title
Evaluation of 18F-FP-DTBZ Pancreatic PET Scanning as a Tool to Measure Beta Cell Mass
Official Title
Scan Re-Scan Pancreatic Beta Cell Imaging Using PET Imaging and 18F-FP-DTBZ
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Withdrawn
Why Stopped
Could not recruit participants
Study Start Date
July 2013 (Actual)
Primary Completion Date
January 30, 2017 (Actual)
Study Completion Date
March 1, 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Columbia University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Type 1 diabetes mellitus (T1DM) develops when there is impaired insulin production due to loss of insulin producing cells (beta cells). The amount of insulin that can be produced is imperfectly correlated with beta cell mass (BCM). The development of a reliable method to noninvasively quantify the total amount of insulin producing beta cells would be of great benefit by providing an important endpoint for the development of new treatments of diabetes. The investigators have previously identified a specific marker on islet cells called vesicular monoamine transporter 2 (VMAT2) that the investigators now propose to use in positron emission tomography (PET) scanning to determine islet beta cell mass. The PET radiopharmaceutical 18F-fluoropropyl(FP)-dihydrotetrabenazine(DTBZ) has been used previously in human subjects without adverse effects. It has shown promise in differentiating type 1 diabetes and non-diabetes. The investigators now hypothesize that repeat PET scans will be reproducible in the same subject. Subjects with normal BCM will be recruited from among normal weight non-diabetic people with plasma insulin levels within the normal range. Subjects with predicted reduced BCM will be recruited from among patients with T1DM who have low or non-measurable insulin levels. Two PET scan measurements will be taken in each subject and the amount of VMAT2 in the pancreas will be and compared for reproducible findings. Biochemical testing will also be performed and compared to PET scans as a potential indirect marker of beta cell mass.
Detailed Description
Diabetes results when the insulin secretory capacity of the beta cell population is lost or severely compromised.Plasma insulin levels have been used as a surrogate marker of beta cell mass (BCM) but insulin levels often do not correlate well. A "gold standard of measurement" to obtain BCM would be of great value. The aim of the proposed study is to evaluate an islet imaging technique using PET scanning to directly measure BCM and thus provide valuable information for monitoring disease progress and response to therapy in people with diabetes and in people at high risk for diabetes. Type 1 diabetes (T1DM) occurs when the beta cells are selectively destroyed by a T cell mediated autoimmune process. People at high risk for developing T1DM, such as first degree relatives of patients with T1DM, can sometimes be identified before the disease develops by measuring autoantibodies to beta cells, however this test is neither sensitive nor specific. Little is known about the natural history of BCM, turnover and cell lifetime, or the course of inflammation in diabetes. This is principally because the pancreas is a highly heterogeneous organ that is difficult to biopsy without significant complications, and BCM only comprises 1 to 2% of the total volume. Accurate assessment of BCM in human diabetes is limited to autopsy studies, which usually suffer from inadequate clinical information; thus, the development of non-invasive means of BCM measurement could be important for interventional therapies of T1DM, islet regeneration/stem cell therapy and islet transplantation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Healthy Volunteers, Diabetes Mellitus, Type 1
Keywords
dihydrotetrabenazine, beta cell mass, diabetes mellitus

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Healthy Controls
Arm Type
Other
Arm Description
Pancreatic 18F-FP-DTBZ uptake will be measured with PET scanning in healthy controls: subjects with predicted normal BCM (healthy, normal weight, non-diabetic individuals who have stimulated insulin and c-peptide levels within the normal range).
Arm Title
Patients with T1D
Arm Type
Other
Arm Description
Pancreatic 18F-FP-DTBZ uptake will be measured with PET scanning in patients with longstanding T1D: subjects with predicted reduced beta cell mass (subjects with established T1DM who have low or no measurable stimulated insulin and c-peptide levels).
Intervention Type
Drug
Intervention Name(s)
18F-FP-DTBZ
Intervention Description
The drug, no carrier added [18F]-FP-DTBZ, is formulated in 5% (v/v) ethanol in 0.9% sterile saline solution to produce [18F]-FP-DTBZ for injection. Subjects will receive a single i.v. administration of no more than 7.6 mCi of [18F]-FP-DTBZ for injection immediately prior to imaging. The specific activity at time of injection will less than 1.0 mCi/microgram and thus for a 7.6 mCi dose the maximal mass dose will be less than 10 microgram.
Intervention Type
Radiation
Intervention Name(s)
PET Scanning
Other Intervention Name(s)
Positron Emission Tomography
Intervention Description
Individuals will be imaged continuously (i.e. dynamically) for 2 hours.
Primary Outcome Measure Information:
Title
Mean BPND (non-displaceable binding potential)
Description
We will be evaluating pancreatic uptake of the radiotracer 18F-FP-DTBZ in subjects with and without long-standing type 1 diabetes mellitus.
Time Frame
Up to 2 months from enrollment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Patients with type 1 diabetes may be enrolled if they meet all of the following criteria: Are males or females between 18 and 70 years of age, inclusive Have a diagnosis of type 1 diabetes mellitus as defined by the American Diabetes Association (ADA) criteria or by diagnosed as per their endocrinologist; duration >5 years; Insulin dose requirements <0.8 units/kg/day HbA1c level between 5% and 8.5% Have fasting C-Peptide < 0.1 ng/ml Have a body mass index (BMI) between 18 and 32 kg/m2 Able to tolerate PET imaging In the judgment of the physician, are capable of fasting 4 to 6 hours prior to screening and Day 1 imaging procedures Give informed consent Healthy volunteers may be enrolled if they meeting all of the following criteria: Are males or females between 18 and 70 years of age, inclusive Have no history of type 1 or type 2 diabetes in a first degree relative Fasting blood glucose less than 100 mg/dL HbA1c level less than 6% Normal Mixed Meal Tolerance test at screening visit BMI between 18 and 32 kg/m2 Able to tolerate PET imaging In the judgment of the physician, are capable of fasting 4 to 6 hours prior to screening and Day 1 imaging procedures, and Give informed consent Exclusion Criteria: Potential participants must not have any of the following exclusion criteria: Clinically significant renal dysfunction Clinically significant liver dysfunction as determined by history, physical examination, and standard liver function testing at screening (aspartate aminotransferase (AST), alanine aminotransferase (ALT), Total/Direct Bilirubin, Alkaline Phosphatase) Coagulopathy Use medications known to affect dopaminergic function, including monoamine oxidase (MAO) inhibitors, tetrabenazine, or levodopa Recent (within 3 months) or current treatment with drugs influencing beta cell function or insulin sensitivity (e.g. glucocorticoids, reserpine) medications known to affect dopaminergic function, including MAO inhibitors, tetrabenazine, or levodopa Have polycystic ovarian syndrome History of movement disorder such as Parkinson's Disease, Huntington's Disease Clinically significant psychiatric disease or history of psychiatric illness such as depression, bipolar disease, anxiety or schizophrenia Current use (within past year) of cocaine, methamphetamine, and/or ecstasy (3,4methylenedioxymethamphetamine (MDMA)) Have a recent history of alcohol or substance abuse or dependence Clinically significant cardiovascular disease or clinically significant abnormalities on screening electrocardiogram (ECG) (including but not limited to QTc > 450 msec) Clinically significant pulmonary, renal or hepatic impairment, or cancer Have clinically significant infectious disease, including acquired immune deficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection or previous positive test for hepatitis B, hepatitis C, HIV1, or HIV2 Are women of childbearing potential not refraining from sexual activity or not using adequate contraception. Women must not be pregnant (negative serum human chorionic gonadotropin (hCG) at the time of screen) or breastfeeding at screening, and must agree to take appropriate steps not to become pregnant during for 30 days following the clinical trial Require medications with a narrow therapeutic window (e.g., warfarin), are receiving any investigational medications, or have participated in a trial with investigational medications within the last 30 days Weigh more than the manufacturer recommended limit for the PET/computed tomography (CT) camera being used Any prior participation in other research protocols within the past month that involved radiation, with the exception of plain radiography studies (i.e., chest x-rays); And Have received a diagnostic or therapeutic radiopharmaceutical within the past week
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chaitanya Divgi, MD
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Naomi Berrie Diabetes Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19223416
Citation
Goland R, Freeby M, Parsey R, Saisho Y, Kumar D, Simpson N, Hirsch J, Prince M, Maffei A, Mann JJ, Butler PC, Van Heertum R, Leibel RL, Ichise M, Harris PE. 11C-dihydrotetrabenazine PET of the pancreas in subjects with long-standing type 1 diabetes and in healthy controls. J Nucl Med. 2009 Mar;50(3):382-9. doi: 10.2967/jnumed.108.054866. Epub 2009 Feb 17. Erratum In: J Nucl Med. 2009 Oct;50(10):1578.
Results Reference
background
PubMed Identifier
26370678
Citation
Freeby MJ, Kringas P, Goland RS, Leibel RL, Maffei A, Divgi C, Ichise M, Harris PE. Cross-sectional and Test-Retest Characterization of PET with [(18)F]FP-(+)-DTBZ for beta Cell Mass Estimates in Diabetes. Mol Imaging Biol. 2016 Apr;18(2):292-301. doi: 10.1007/s11307-015-0888-7. Epub 2015 Sep 14.
Results Reference
result
Links:
URL
http://www.nbdiabetes.org/news/using-nuclear-imaging-measure-beta-cell-mass-and-function
Description
Investigator web site

Learn more about this trial

Evaluation of 18F-FP-DTBZ Pancreatic PET Scanning as a Tool to Measure Beta Cell Mass

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