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Natriuretic Peptides and Metabolic Risk in Obesity

Primary Purpose

Obesity, Hyperinsulinemia

Status
Withdrawn
Phase
Early Phase 1
Locations
Study Type
Interventional
Intervention
Nesiritide
Insulin
Saline
Sponsored by
Vanderbilt University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Obesity focused on measuring natriuretic peptide, insulin, lipolysis, hormones, metabolism

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Men and women ages 18-50 years
  • BMI 18 to <25 kg/m2 (lean group, N=20) or BMI 30 to <40 kg/m2 (obese group, N=20)

Exclusion Criteria:

  • Current use of antihypertensive medications
  • Current use of glucocorticoids, metformin, or any antidiabetes medications
  • Prior or current cardiovascular disease, renal disease, or liver disease
  • Diabetes mellitus (taking insulin, other anti-diabetic agents, or diet-controlled)
  • Atrial fibrillation
  • Bleeding disorder or anemia
  • Elevated LFTs
  • estimuated GFR < 60 ml/min
  • Abnormal sodium or potassium level
  • Positive pregnancy test, women of child-bearing age not practicing birth control, women who are breastfeeding

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Placebo Comparator

    Experimental

    Experimental

    Arm Label

    Saline Infusion

    Insulin Clamp

    BNP Infusion (Nesiritide)

    Arm Description

    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).

    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).

    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).

    Outcomes

    Primary Outcome Measures

    Change in natriuretic peptide levels
    Change in glycerol levels
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion

    Secondary Outcome Measures

    Change in free fatty acid levels
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Change in triglyceride levels
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Change in energy expenditure assessed by indirect calorimetry
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion

    Full Information

    First Posted
    November 24, 2015
    Last Updated
    October 31, 2017
    Sponsor
    Vanderbilt University Medical Center
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02642523
    Brief Title
    Natriuretic Peptides and Metabolic Risk in Obesity
    Official Title
    Natriuretic Peptides and Metabolic Risk in Obesity
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2017
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Preliminary data run on rat samples showed that this study question and design would not produce conclusive results. The PI decided not to carry out the study.
    Study Start Date
    undefined (undefined)
    Primary Completion Date
    February 2017 (Actual)
    Study Completion Date
    February 2017 (Actual)

    3. Sponsor/Collaborators

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

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The investigators are examining: the relationships of insulin levels and natriuretic peptide hormone levels, and the effects of administering an infusion of natriuretic peptide hormone on the breakdown of fat in healthy lean and otherwise healthy obese individuals.
    Detailed Description
    The cardiac natriuretic peptide hormonal system may protect against the development of cardiometabolic risk. Epidemiologic studies have shown that in relatively healthy individuals without heart failure, low natriuretic peptide levels are associated with unfavorable cardiometabolic phenotypes, including higher blood pressure, obesity, higher insulin levels, and diabetes mellitus. Understanding the mechanisms behind the "natriuretic peptide deficiency" of obesity would illuminate an important way in which obesity interacts with the cardiovascular system. The investigators propose a prospective cross-over design in 40 healthy lean and otherwise healthy obese individuals. The investigators propose the following specific aims and hypotheses: Aim 1: To study the effect of hyperinsulinemia on the response of the natriuretic peptide system to salt loading. Hypothesis 1: Hyperinsulinemia will suppress natriuretic peptide levels in both obese and lean individuals. Aim 2: To examine the effect of an intravenous infusion of natriuretic peptide on acute markers of lipolysis. Hypothesis 2: An intravenous infusion of natriuretic peptide will raise acute markers of lipolysis in both obese and lean individuals.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Obesity, Hyperinsulinemia
    Keywords
    natriuretic peptide, insulin, lipolysis, hormones, metabolism

    7. Study Design

    Primary Purpose
    Other
    Study Phase
    Early Phase 1
    Interventional Study Model
    Crossover Assignment
    Masking
    None (Open Label)
    Allocation
    Non-Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Saline Infusion
    Arm Type
    Placebo Comparator
    Arm Description
    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).
    Arm Title
    Insulin Clamp
    Arm Type
    Experimental
    Arm Description
    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).
    Arm Title
    BNP Infusion (Nesiritide)
    Arm Type
    Experimental
    Arm Description
    All subjects will undergo 3 interventions, performed at 3 separate outpatient study visits. The order of the 3 interventions will be randomly assigned. The interventions are: Saline Infusion, Insulin Clamp, and BNP Infusion (Nesiritide).
    Intervention Type
    Drug
    Intervention Name(s)
    Nesiritide
    Other Intervention Name(s)
    Recombinant human BNP
    Intervention Description
    Subjects will receive an intravenous infusion of recombinant human b-type natriuretic peptide (BNP) (Nesiritide) over 2 hours at 2 doses: 0.003 ug/kg/min for 1 hour, followed by 0.01 ug/kg/min for 1 hour. Nesiritide (Johnson and Johnson) is FDA-approved for the treatment of heart failure. Study investigators received approval from the FDA for an IND exemption for nesiritide in this study. While receiving the BNP infusion, subjects will also receive an intravenous infusion of normal (0.9%) saline over 2 hours. Subjects will receive a standardized high-salt diet for at least 6 days prior to this study visit.
    Intervention Type
    Drug
    Intervention Name(s)
    Insulin
    Other Intervention Name(s)
    Human Insulin
    Intervention Description
    The hyperinsulinemic-euglycemic insulin clamp, which will last between 2-2.5 hours, involves continuous intravenous infusions of human regular insulin and of dextrose solution. Simultaneously, subjects receive an intravenous infusion of normal (0.9%) saline over 2 hours. Subjects will receive a standardized high-salt diet for at least 6 days prior to this study visit.
    Intervention Type
    Other
    Intervention Name(s)
    Saline
    Other Intervention Name(s)
    Normal Saline
    Intervention Description
    Subjects will receive an intravenous infusion of normal (0.9%) saline over 2 hours at a rate of 0.25 ml/kg/min. Subjects will receive a standardized high-salt diet for at least 6 days prior to this study visit.
    Primary Outcome Measure Information:
    Title
    Change in natriuretic peptide levels
    Time Frame
    4 hours (during 2-hour study infusions and for 2 hours after study infusions)
    Title
    Change in glycerol levels
    Description
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Time Frame
    1 hour
    Secondary Outcome Measure Information:
    Title
    Change in free fatty acid levels
    Description
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Time Frame
    1 hour
    Title
    Change in triglyceride levels
    Description
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Time Frame
    1 hour
    Title
    Change in energy expenditure assessed by indirect calorimetry
    Description
    Change during 1-hour of low-dose BNP infusion, 1-hour of high-dose BNP infusion, and 1-hour of normal saline infusion
    Time Frame
    1 hour
    Other Pre-specified Outcome Measures:
    Title
    Change in plasma renin activity
    Time Frame
    4 hours (during 2-hour study infusions and for 2 hours after study infusions)
    Title
    Change in aldosterone
    Time Frame
    4 hours (during 2-hour study infusions and for 2 hours after study infusions)

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    50 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Men and women ages 18-50 years BMI 18 to <25 kg/m2 (lean group, N=20) or BMI 30 to <40 kg/m2 (obese group, N=20) Exclusion Criteria: Current use of antihypertensive medications Current use of glucocorticoids, metformin, or any antidiabetes medications Prior or current cardiovascular disease, renal disease, or liver disease Diabetes mellitus (taking insulin, other anti-diabetic agents, or diet-controlled) Atrial fibrillation Bleeding disorder or anemia Elevated LFTs estimuated GFR < 60 ml/min Abnormal sodium or potassium level Positive pregnancy test, women of child-bearing age not practicing birth control, women who are breastfeeding
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Katherine N Bachmann, MD
    Organizational Affiliation
    Vanderbilt Diabetes/Endocrinology
    Official's Role
    Study Director
    First Name & Middle Initial & Last Name & Degree
    Thomas J Wang, MD
    Organizational Affiliation
    Vanderbilt Cardiovascular Medicine
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

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