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Lipolytic Effects of GH in Hypopituitary Patients in Vivo

Primary Purpose

Hypopituitarism, Insulin Resistance, Endocrine System Diseases

Status
Completed
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
Acipimox
Placebo
GH substitution
GH pause
Sponsored by
University of Aarhus
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Hypopituitarism

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • hypopituitary patients with documented GH-deficiency

Exclusion Criteria:

  • other significant disease

Sites / Locations

  • University Hospital of Aarhus

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Placebo Comparator

Placebo Comparator

Arm Label

Acipimox/GH substitution

Acipimox/GH pause

Placebo/GH substitution

Placebo/GH pause

Arm Description

Drug: Acipimox Tablet Acipimox 250 mg administered 4 times previous to and during the investigation day Other Name: Tablet Olbetam 250 mg Continue GH substitution as usually.

Drug: Acipimox Tablet Acipimox 250 mg administered 4 times previous to and during the investigation day Other Name: Tablet Olbetam 250 mg Pause GH substitution to days prior to the study day.

Drug: Placebo tablets Continue GH substitution as usually.

Drug: Placebo tablets Pause GH substitution to days prior to the study day.

Outcomes

Primary Outcome Measures

Lipolytic activity measured as area under the curve (AUC) for FFA (free fatty acid) before and during clamp-conditions.

Secondary Outcome Measures

GH signaling proteins and gene targets in adipose and skeletal muscle tissues measured by western blotting and qPCR
Insulin sensitivity as measured by M value and GIR (glucose infusion rate)
Substrate metabolism as measured by indirect calorimetry, tritiated glucose and circulating hormones and metabolites
PDH (pyruvate dehydrogenase) activity in skeletal muscle measured by an PDH activity assay

Full Information

First Posted
May 18, 2016
Last Updated
March 25, 2020
Sponsor
University of Aarhus
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1. Study Identification

Unique Protocol Identification Number
NCT02782208
Brief Title
Lipolytic Effects of GH in Hypopituitary Patients in Vivo
Official Title
Lipolytic Effects of GH in Hypopituitary Patients in Vivo: Molecular Mechanisms and Temporal Patterns.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Completed
Study Start Date
February 10, 2016 (Actual)
Primary Completion Date
December 22, 2016 (Actual)
Study Completion Date
December 22, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Aarhus

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Growth hormone (GH) is essential for longitudinal bone growth and somatic development. These protein anabolic effects require sufficient nutritional supply. During fasting and caloric restriction GH predominantly promotes fat metabolism. GH counteracts the effect of insulin in many tissues, of which insulin-stimulated glucose uptake in skeletal muscle has been most extensively studied. Substrate competition between elevated free fatty acids and glucose is suggested as a mechanism, and this hypothesis can be tested mechanistically by means of acipimox, which is a nicotinic acid that suppresses the fat metabolizing effects of GH. The hypothesis is, that the suppressive effect of GH on insulin-stimulated glucose uptake in skeletal muscle is obviated by acipimox-induced inhibition of fat metabolism. In order to investigate this, eight adult hypopituitary patients with documented GH-deficiency will be studied in the presence and absence of GH and acipimox, respectively, and biopsies from skeletal muscle and subcutaneous adipose tissue will be analyzed. Knowledge of the effects of growth hormone and fat metabolism can in shot-sight as well as in long-sight have great importance for the understanding of growth disorders from overweight and type 2 diabetes to malnutrition and eating disorders.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypopituitarism, Insulin Resistance, Endocrine System Diseases, Glucose Metabolism Disorders, Metabolic Diseases, Pituitary Diseases, Brain Diseases

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Factorial Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Acipimox/GH substitution
Arm Type
Active Comparator
Arm Description
Drug: Acipimox Tablet Acipimox 250 mg administered 4 times previous to and during the investigation day Other Name: Tablet Olbetam 250 mg Continue GH substitution as usually.
Arm Title
Acipimox/GH pause
Arm Type
Active Comparator
Arm Description
Drug: Acipimox Tablet Acipimox 250 mg administered 4 times previous to and during the investigation day Other Name: Tablet Olbetam 250 mg Pause GH substitution to days prior to the study day.
Arm Title
Placebo/GH substitution
Arm Type
Placebo Comparator
Arm Description
Drug: Placebo tablets Continue GH substitution as usually.
Arm Title
Placebo/GH pause
Arm Type
Placebo Comparator
Arm Description
Drug: Placebo tablets Pause GH substitution to days prior to the study day.
Intervention Type
Drug
Intervention Name(s)
Acipimox
Other Intervention Name(s)
Olbetam
Intervention Description
Acipimox is administered 4 times previous to and during the investigation day. Acipimox is used to suppress the lipolytic effect of GH.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo is administered 4 times previous to and during the investigation day.
Intervention Type
Drug
Intervention Name(s)
GH substitution
Intervention Description
GH substitution as usually
Intervention Type
Other
Intervention Name(s)
GH pause
Intervention Description
GH substitution pause two days prior to the experimental day
Primary Outcome Measure Information:
Title
Lipolytic activity measured as area under the curve (AUC) for FFA (free fatty acid) before and during clamp-conditions.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
GH signaling proteins and gene targets in adipose and skeletal muscle tissues measured by western blotting and qPCR
Time Frame
1,5 years
Title
Insulin sensitivity as measured by M value and GIR (glucose infusion rate)
Time Frame
6 months
Title
Substrate metabolism as measured by indirect calorimetry, tritiated glucose and circulating hormones and metabolites
Time Frame
1 year
Title
PDH (pyruvate dehydrogenase) activity in skeletal muscle measured by an PDH activity assay
Time Frame
1 year

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: hypopituitary patients with documented GH-deficiency Exclusion Criteria: other significant disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jens Otto L Jørgensen, Professor
Organizational Affiliation
University Hospital of Aarhus
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital of Aarhus
City
Aarhus
ZIP/Postal Code
8000
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
12563315
Citation
Tunaru S, Kero J, Schaub A, Wufka C, Blaukat A, Pfeffer K, Offermanns S. PUMA-G and HM74 are receptors for nicotinic acid and mediate its anti-lipolytic effect. Nat Med. 2003 Mar;9(3):352-5. doi: 10.1038/nm824. Epub 2003 Feb 3.
Results Reference
background
PubMed Identifier
24148194
Citation
Nellemann B, Vendelbo MH, Nielsen TS, Bak AM, Hogild M, Pedersen SB, Bienso RS, Pilegaard H, Moller N, Jessen N, Jorgensen JO. Growth hormone-induced insulin resistance in human subjects involves reduced pyruvate dehydrogenase activity. Acta Physiol (Oxf). 2014 Feb;210(2):392-402. doi: 10.1111/apha.12183. Epub 2013 Nov 22.
Results Reference
background
PubMed Identifier
25050904
Citation
Clasen BF, Poulsen MM, Escande C, Pedersen SB, Moller N, Chini EN, Jessen N, Jorgensen JO. Growth hormone signaling in muscle and adipose tissue of obese human subjects: associations with measures of body composition and interaction with resveratrol treatment. J Clin Endocrinol Metab. 2014 Dec;99(12):E2565-73. doi: 10.1210/jc.2014-2215.
Results Reference
background
PubMed Identifier
21613350
Citation
Krusenstjerna-Hafstrom T, Clasen BF, Moller N, Jessen N, Pedersen SB, Christiansen JS, Jorgensen JO. Growth hormone (GH)-induced insulin resistance is rapidly reversible: an experimental study in GH-deficient adults. J Clin Endocrinol Metab. 2011 Aug;96(8):2548-57. doi: 10.1210/jc.2011-0273. Epub 2011 May 25.
Results Reference
background
PubMed Identifier
24577718
Citation
Nielsen TS, Jessen N, Jorgensen JO, Moller N, Lund S. Dissecting adipose tissue lipolysis: molecular regulation and implications for metabolic disease. J Mol Endocrinol. 2014 Jun;52(3):R199-222. doi: 10.1530/JME-13-0277. Epub 2014 Feb 27.
Results Reference
background
PubMed Identifier
19240267
Citation
Moller N, Jorgensen JO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev. 2009 Apr;30(2):152-77. doi: 10.1210/er.2008-0027. Epub 2009 Feb 24.
Results Reference
background
PubMed Identifier
11574412
Citation
Nielsen S, Moller N, Christiansen JS, Jorgensen JO. Pharmacological antilipolysis restores insulin sensitivity during growth hormone exposure. Diabetes. 2001 Oct;50(10):2301-8. doi: 10.2337/diabetes.50.10.2301.
Results Reference
background
PubMed Identifier
32945898
Citation
Hjelholt AJ, Charidemou E, Griffin JL, Pedersen SB, Gudiksen A, Pilegaard H, Jessen N, Moller N, Jorgensen JOL. Insulin resistance induced by growth hormone is linked to lipolysis and associated with suppressed pyruvate dehydrogenase activity in skeletal muscle: a 2 x 2 factorial, randomised, crossover study in human individuals. Diabetologia. 2020 Dec;63(12):2641-2653. doi: 10.1007/s00125-020-05262-w. Epub 2020 Sep 18.
Results Reference
derived

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Lipolytic Effects of GH in Hypopituitary Patients in Vivo

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