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Soluble Epoxide Hydrolase Inhibition and Insulin Resistance

Primary Purpose

Diabetes Mellitus, Endocrine System Diseases, Glucose Metabolism Disorders

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
GSK2256294
Placebo oral capsule
Sponsored by
Vanderbilt University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Diabetes Mellitus

Eligibility Criteria

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

Inclusion Criteria:

  1. Men and women,
  2. Age 21 to 50 years, and
  3. Pre-diabetes as defined by

    1. Fasting plasma glucose 100-125 mg/dL, or
    2. Two-hour plasma glucose 140-199 mg/dL, or
    3. HbA1c 5.7-6.4%
  4. BMI ≥ 30 kg/m2, inclusive
  5. For female subjects, the following conditions must be met:

    1. Postmenopausal status for at least one year, or
    2. Status-post surgical sterilization, or
    3. If of childbearing potential, utilization of adequate birth control and willingness to undergo serum β-hcg testing prior to drug treatment and on every study day.

Exclusion Criteria:

  1. Diabetes type 1 or type 2, as defined by a fasting plasma glucose of 126 mg/dL or greater, a two-hour plasma glucose of 200 mg/dL or greater, a HbA1c >6.4%, or the use of anti-diabetic medication
  2. Subjects who have participated in a weight-reduction program during the last six month or whose weight has increased or decreased more than two kg over the preceding six months
  3. Resistant hypertension, defined as hypertension requiring the administration of more than three anti-hypertensive agents including a diuretic to achieve control
  4. Use of spironolactone
  5. Pregnancy or breast-feeding
  6. Any history of smoking
  7. Any history of cancer including skin cancer, any history of a precancerous lesion, abnormal PSA, or lack of screening adherent to American Cancer Society Guidelines for the Early Detection of Cancer
  8. Cardiovascular disease such as myocardial infarction within six months prior to enrollment, presence of angina pectoris, significant arrhythmia, congestive heart failure (left ventricular hypertrophy acceptable), deep-vein thrombosis, pulmonary embolism, second- or third-degree heart block, mitral valve stenosis, aortic stenosis, or hypertrophic cardiomyopathy
  9. Abnormal corrected QT interval on screening ECG (QTc).
  10. Treatment with anticoagulants
  11. History of serious neurologic disease such as cerebral hemorrhage, stroke, or transient ischemic attack
  12. History or presence of immunological or hematological disorders
  13. Diagnosis of asthma requiring regular inhaler use
  14. Clinically significant gastrointestinal impairment that could interfere with drug absorption
  15. Impaired hepatic function (aspartate amino transaminase [AST] and/or alanine amino transaminase [ALT] >3.0 x upper limit of normal range)
  16. History of gastrointestinal bleed
  17. Estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2 or with an albumin-to-creatinine ratio (UACR) >300µg/mg, where eGFR is determined by the four-variable Modification of Diet in Renal Disease (MDRD) equation, where serum creatinine is expressed in mg/dL and age in years: eGFR (mL/min/1.73m2)=186 • Scr-1.154 • age-0.203 • (1.212 if black) • (0.742 if female)
  18. Hematocrit <35%
  19. Any underlying or acute disease requiring regular medication which could possibly pose a threat to the subject or make implementation of the protocol or interpretation of the study results difficult
  20. Treatment with chronic systemic glucocorticoid therapy
  21. Treatment with lithium salts
  22. History of alcohol or drug abuse
  23. Treatment with any investigational drug in the month preceding the study
  24. Mental conditions rendering a subject unable to understand the nature, scope, and possible consequences of the study
  25. Inability to comply with the protocol, e.g., uncooperative attitude, inability to return for follow-up visits, and unlikelihood of completing the study

Sites / Locations

  • Vanderbilt University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Placebo then GSK2256294

GSK2256294 then Placebo

Arm Description

Subjects will receive placebo oral capsule daily by mouth for 7 days, then seven week washout and then GSK2256294 daily by mouth for 7 days.

Subjects will receive GSK2256294 daily by mouth for 7 days, then seven week washout and then placebo oral capsule daily by mouth for 7 days.

Outcomes

Primary Outcome Measures

Insulin Sensitivity
Insulin sensitivity determined by Hyperinsulinemic-Euglycemic Clamp as the glucose infusion rate (GIR) per fat-free-mass (FFM) during high dose insulin infusion

Secondary Outcome Measures

Forearm Blood Flow (FBF)
Insulin stimulated forearm blood flow determined by strain-gauge plethysmography
Insulin Signaling in Tissue
Insulin stimulated phosphorylated AKT to total AKT ratio (pAKT/AKT) in adipose and muscle tissue sample. AKT is an insulin sensitive serine/threonine kinase also known as protein kinase B.
Blood Pressure
determined by non-invasive brachial blood pressure measurement (systolic blood pressure, SBP; diastolic blood pressure, DBP)
Renal Plasma Flow (RPF)
Renal plasma flow determined by PAH infusion, ml/min/per 1.73 m^2 body surface area

Full Information

First Posted
March 27, 2018
Last Updated
March 21, 2023
Sponsor
Vanderbilt University Medical Center
Collaborators
National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT03486223
Brief Title
Soluble Epoxide Hydrolase Inhibition and Insulin Resistance
Official Title
Effect of Inhibition Soluble Epoxide Hydrolase on Insulin Sensitivity in Humans
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
May 17, 2018 (Actual)
Primary Completion Date
November 18, 2021 (Actual)
Study Completion Date
November 18, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Vanderbilt University Medical Center
Collaborators
National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test how soluble epoxide hydrolase (sEH) inhibition with GSK2256294 affects tissue sEH activity and insulin sensitivity.
Detailed Description
We will test the hypothesis that soluble epoxide hydrolase (sEH) inhibition with GSK2256294 improves insulin sensitivity using the gold-standard, hyperinsulinemic-euglycemic clamps, with stable isotope dilution to assess hepatic gluconeogenesis. We will assess insulin-stimulated vasodilation in the forearm using plethysmography and in the renal vasculature using para-aminohippurate (PAH, IND#133828) clearance. We will obtain adipose and muscle tissue before and after clamp to assess insulin signaling in these tissues. Subjects are randomized to treatment with the sEH inhibitor GSK2256294 (10mg/day) or matching placebo for one week. On the seventh day of drug treatment, subjects will report to the CRC in the morning after an overnight fast to undergo a hyperinsulinemic-euglycemic clamp with adipose tissue biopsies. During the Hyperinsulinemic-euglycemic clamp, insulin will be infused for 2 hours at low dose (20 mU/m2/min) and 2 hours at high dose (80 mU/m2/min) to assess insulin sensitivity. The Glucose Infusion Rate (GIR) will be adjusted to maintain glucose near 95 mg/dL. The average GIR during the final 30 minutes of the high dose period will be used as the measure of insulin sensitivity. After completion of the study day, subjects will undergo a seven-week washout from study drug and then receive the opposite drug for one week. On the seventh day of treatment they will report to the CRC after an overnight fast and repeat the study day protocol.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Endocrine System Diseases, Glucose Metabolism Disorders, PreDiabetes, Obesity

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Arm 1 and 2 are crossover arms
Masking
ParticipantInvestigator
Masking Description
Arms 1/2 are placebo controlled and blinded to investigator and participant
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo then GSK2256294
Arm Type
Experimental
Arm Description
Subjects will receive placebo oral capsule daily by mouth for 7 days, then seven week washout and then GSK2256294 daily by mouth for 7 days.
Arm Title
GSK2256294 then Placebo
Arm Type
Experimental
Arm Description
Subjects will receive GSK2256294 daily by mouth for 7 days, then seven week washout and then placebo oral capsule daily by mouth for 7 days.
Intervention Type
Drug
Intervention Name(s)
GSK2256294
Other Intervention Name(s)
GSK2256294 10mg oral capsule
Intervention Description
Drug will be taken daily by mouth for 7 days.
Intervention Type
Drug
Intervention Name(s)
Placebo oral capsule
Other Intervention Name(s)
Placebo
Intervention Description
Placebo will be taken daily by mouth for 7 days.
Primary Outcome Measure Information:
Title
Insulin Sensitivity
Description
Insulin sensitivity determined by Hyperinsulinemic-Euglycemic Clamp as the glucose infusion rate (GIR) per fat-free-mass (FFM) during high dose insulin infusion
Time Frame
Day 7
Secondary Outcome Measure Information:
Title
Forearm Blood Flow (FBF)
Description
Insulin stimulated forearm blood flow determined by strain-gauge plethysmography
Time Frame
Day 7
Title
Insulin Signaling in Tissue
Description
Insulin stimulated phosphorylated AKT to total AKT ratio (pAKT/AKT) in adipose and muscle tissue sample. AKT is an insulin sensitive serine/threonine kinase also known as protein kinase B.
Time Frame
Day 7
Title
Blood Pressure
Description
determined by non-invasive brachial blood pressure measurement (systolic blood pressure, SBP; diastolic blood pressure, DBP)
Time Frame
Day 7
Title
Renal Plasma Flow (RPF)
Description
Renal plasma flow determined by PAH infusion, ml/min/per 1.73 m^2 body surface area
Time Frame
Day 7
Other Pre-specified Outcome Measures:
Title
Soluble Epoxide Hydrolase Activity
Description
soluble epoxide hydrolase (sEH) activity measured by 14,15-DHET conversion rate in plasma
Time Frame
Day 7
Title
Plasma Total Epoxyeicosatrienoic Acids (EETs)
Description
total Epoxyeicosatrienoic acids in plasma
Time Frame
Day 7
Title
Plasma IL-6
Description
Plasma cytokine interleukin-6 (IL-6)
Time Frame
Day 7
Title
Plasma VEGF
Description
Plasma vascular endothelial growth factor (VEGF)
Time Frame
Day 7
Title
Adipose Tissue Total Epoxyeicosatrienoic Acids (EETs)
Description
total Epoxyeicosatrienoic acids in adipose tissue (pmol per mg tissue)
Time Frame
Day 7
Title
Soluble Epoxide Hydrolase Activity in Tissue
Description
soluble epoxide hydrolase (sEH) activity measured by 14,15-DHET conversion rate in adipose and muscle, per mg tissue
Time Frame
Day 7

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Men and women, Age 21 to 50 years, and Pre-diabetes as defined by Fasting plasma glucose 100-125 mg/dL, or Two-hour plasma glucose 140-199 mg/dL, or HbA1c 5.7-6.4% BMI ≥ 30 kg/m2, inclusive For female subjects, the following conditions must be met: Postmenopausal status for at least one year, or Status-post surgical sterilization, or If of childbearing potential, utilization of adequate birth control and willingness to undergo serum β-hcg testing prior to drug treatment and on every study day. Exclusion Criteria: Diabetes type 1 or type 2, as defined by a fasting plasma glucose of 126 mg/dL or greater, a two-hour plasma glucose of 200 mg/dL or greater, a HbA1c >6.4%, or the use of anti-diabetic medication Subjects who have participated in a weight-reduction program during the last six month or whose weight has increased or decreased more than two kg over the preceding six months Resistant hypertension, defined as hypertension requiring the administration of more than three anti-hypertensive agents including a diuretic to achieve control Use of spironolactone Pregnancy or breast-feeding Any history of smoking Any history of cancer including skin cancer, any history of a precancerous lesion, abnormal PSA, or lack of screening adherent to American Cancer Society Guidelines for the Early Detection of Cancer Cardiovascular disease such as myocardial infarction within six months prior to enrollment, presence of angina pectoris, significant arrhythmia, congestive heart failure (left ventricular hypertrophy acceptable), deep-vein thrombosis, pulmonary embolism, second- or third-degree heart block, mitral valve stenosis, aortic stenosis, or hypertrophic cardiomyopathy Abnormal corrected QT interval on screening ECG (QTc). Treatment with anticoagulants History of serious neurologic disease such as cerebral hemorrhage, stroke, or transient ischemic attack History or presence of immunological or hematological disorders Diagnosis of asthma requiring regular inhaler use Clinically significant gastrointestinal impairment that could interfere with drug absorption Impaired hepatic function (aspartate amino transaminase [AST] and/or alanine amino transaminase [ALT] >3.0 x upper limit of normal range) History of gastrointestinal bleed Estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2 or with an albumin-to-creatinine ratio (UACR) >300µg/mg, where eGFR is determined by the four-variable Modification of Diet in Renal Disease (MDRD) equation, where serum creatinine is expressed in mg/dL and age in years: eGFR (mL/min/1.73m2)=186 • Scr-1.154 • age-0.203 • (1.212 if black) • (0.742 if female) Hematocrit <35% Any underlying or acute disease requiring regular medication which could possibly pose a threat to the subject or make implementation of the protocol or interpretation of the study results difficult Treatment with chronic systemic glucocorticoid therapy Treatment with lithium salts History of alcohol or drug abuse Treatment with any investigational drug in the month preceding the study Mental conditions rendering a subject unable to understand the nature, scope, and possible consequences of the study Inability to comply with the protocol, e.g., uncooperative attitude, inability to return for follow-up visits, and unlikelihood of completing the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James M Luther, MD
Organizational Affiliation
Vanderbilt University Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Nancy J Brown, MD
Organizational Affiliation
Vanderbilt University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Vanderbilt University Medical Center
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Available upon request.
Citations:
PubMed Identifier
27448715
Citation
Luther JM, Brown NJ. Epoxyeicosatrienoic acids and glucose homeostasis in mice and men. Prostaglandins Other Lipid Mediat. 2016 Sep;125:2-7. doi: 10.1016/j.prostaglandins.2016.07.010. Epub 2016 Jul 19.
Results Reference
background
PubMed Identifier
28352940
Citation
Gangadhariah MH, Dieckmann BW, Lantier L, Kang L, Wasserman DH, Chiusa M, Caskey CF, Dickerson J, Luo P, Gamboa JL, Capdevila JH, Imig JD, Yu C, Pozzi A, Luther JM. Cytochrome P450 epoxygenase-derived epoxyeicosatrienoic acids contribute to insulin sensitivity in mice and in humans. Diabetologia. 2017 Jun;60(6):1066-1075. doi: 10.1007/s00125-017-4260-0. Epub 2017 Mar 28.
Results Reference
background
PubMed Identifier
25173047
Citation
Ramirez CE, Shuey MM, Milne GL, Gilbert K, Hui N, Yu C, Luther JM, Brown NJ. Arg287Gln variant of EPHX2 and epoxyeicosatrienoic acids are associated with insulin sensitivity in humans. Prostaglandins Other Lipid Mediat. 2014 Oct;113-115:38-44. doi: 10.1016/j.prostaglandins.2014.08.001. Epub 2014 Aug 28.
Results Reference
background
PubMed Identifier
34455816
Citation
Luther JM, Ray J, Wei D, Koethe JR, Hannah L, DeMatteo A, Manning R, Terker AS, Peng D, Nian H, Yu C, Mashayekhi M, Gamboa J, Brown NJ. GSK2256294 Decreases sEH (Soluble Epoxide Hydrolase) Activity in Plasma, Muscle, and Adipose and Reduces F2-Isoprostanes but Does Not Alter Insulin Sensitivity in Humans. Hypertension. 2021 Sep;78(4):1092-1102. doi: 10.1161/HYPERTENSIONAHA.121.17659. Epub 2021 Aug 30.
Results Reference
result

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Soluble Epoxide Hydrolase Inhibition and Insulin Resistance

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