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Postprandial Fatty Acid Metabolism in Subjects With Lipoprotein Lipase Deficiency (AGL12)

Primary Purpose

Lipoprotein Lipase Deficiency

Status
Recruiting
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Heparin
liquid meal
Sponsored by
Université de Sherbrooke
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Lipoprotein Lipase Deficiency

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • 8 healthy LPL-deficient individuals (LPLD subjects) with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation;
  • 8 control subjects (fasting glucose < 5.6, 2-hour post 75g OGTT glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l);
  • age 18 to 75 yo;
  • To be willing and able to adhere to the specifications of the protocol;
  • To have signed an informed consent document indicating that they understood the purpose

Exclusion Criteria:

  • age < 18 yo;
  • overt cardiovascular disease as assessed by medical history, physical exam, and abnormal ECG
  • Treatment with a fibrate, thiazolidinedione, beta-blocker or other drug known to affect lipid or carbohydrate metabolism (except statins, metformin, and other antihypertensive agents that can be safely interrupted);
  • Treatment with anti-hypertensive medication (only for LPL-deficient individuals);
  • presence of liver or renal disease; uncontrolled thyroid disorder;
  • previous diagnosis of heparin-induced thrombocytopenia;
  • Treatment with oral anticoagulation medication or platelet aggregation inhibiting drugs;
  • A history of major hemorrhagic event;
  • smoking (>1 cigarette/day) and/or consumption of >2 alcoholic beverages per day;;
  • Female of child-bearing potential who is pregnant, breast feeding or intends to become pregnant or pre-menopausal female with a positive serum pregnancy test at the time of enrollment.

Sites / Locations

  • Centre de recherche du CHUSRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Other

Other

Other

Other

Arm Label

Control group- A0

LPLD group-A0

Control group-A1

LPLD group-A1

Arm Description

Control group: Healthy subjects with fasting glucose < 5.6, 2-hour post 75g Oral Glucose Tolerance Test (OGTT) glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l); A0: without heparin administered

LPLD group: LPL deficient subjects with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation; A0: without heparin administered

Control group: Healthy subjects with fasting glucose < 5.6, 2-hour post 75g OGTT glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l); A1: with an intravenous (i.v.) heparin bolus (50 IU/kg i.v.) followed by 250 IU/h i.v. during 6 hours starting 15 minutes before ingestion of liquid meal.

LPLD group: LPL deficient subjects with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation; A1: with an intravenous (i.v.) heparin bolus (50 IU/kg i.v.) followed by 250 IU/h i.v. during 6 hours starting 15 minutes before ingestion of liquid meal.

Outcomes

Primary Outcome Measures

Organ-specific Dietary Fatty Acid (DFA) partitioning
will be determined using oral administration of [18F ]-Fluoro-6-Thia- Heptadecanoic Acid (FTHA ) during whole-body acquisition.
Myocardial DFA uptake
will be assessed using oral administration of [18F]-FTHA during dynamic PET acquisition.

Secondary Outcome Measures

Myocardial nonesterified fatty acids (NEFA) metabolism
will be determined using [11C]-palmitate during dynamic PET acquisition.
Dietary fatty acid oxidation rate
will be measured using breath [13C]-carbon dioxide enrichment
Total oxidation rate
will be determined by indirect calorimetry
postprandial plasma NEFA turnover
will be determined using stable isotope tracers of fatty acids
postprandial plasma glucose turnover
will be determined using stable isotope tracers of glucose
Left ventricular function by Positron Emitting Positron (PET) ventriculography
will be determined using [11C]-acetate PET/CT. 180 megabecquerel (MBq) will be administered by bolus injection
Myocardial oxidative metabolism
will be determined using i.v. [11C]-acetate during dynamic PET/CT scanning.
Insulin sensitivity
will be determined using a multiplex ELISA which will measure multiple analytes in a single experiment.
Liver nonesterified fatty acids (NEFA) metabolism
will be determined using [11C]-palmitate during dynamic PET acquisition.
Metabolites distribution in plasma
will be determined using oral administration of [18F]-FTHA

Full Information

First Posted
January 7, 2020
Last Updated
September 27, 2022
Sponsor
Université de Sherbrooke
Collaborators
Institut de Recherches Cliniques de Montreal
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1. Study Identification

Unique Protocol Identification Number
NCT04227678
Brief Title
Postprandial Fatty Acid Metabolism in Subjects With Lipoprotein Lipase Deficiency
Acronym
AGL12
Official Title
Postprandial Fatty Acid Metabolism in Subjects With Lipoprotein Lipase Deficiency
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Recruiting
Study Start Date
December 9, 2019 (Actual)
Primary Completion Date
December 30, 2023 (Anticipated)
Study Completion Date
December 30, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Université de Sherbrooke
Collaborators
Institut de Recherches Cliniques de Montreal

4. Oversight

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

5. Study Description

Brief Summary
Lipoprotein lipase (LPL) is an enzyme that plays an important role in removing triglycerides (TG) (molecules that transport dietary fat) from the blood. Patients with LPL deficiency (LPLD) display during their whole life very high plasma TG levels often associated with episodes of postprandial abdominal pain, malaise, blurred vision, dizziness (hyperchylomicronemia syndrome) that may lead to recurrent pancreatitis episodes. Because of their very slow clearance in blood of their chylomicron-TG, these patients need to severely restrict their dietary fat intake to avoid these complications. Fortunately, novel treatments are being developed to circumvent LPL deficiency (LPLD) metabolic effect on chylomicron-TG clearance. However, there is no data on how LPLD affect organ-specific dietary fatty acid metabolism nor how the novel therapeutic agents may change this metabolism. For example, it is currently not understood how subjects with LPLD store their DFA into adipose tissues and whether they are able to use DFA as a fuel to sustain their cardiac metabolism, as healthy individuals do. This study aims to better understand theses two questions.
Detailed Description
The study protocol includes 3 visits: the screening visit and 2 postprandial metabolic studies performed in random order at an interval of 7 to 14 days, and performed with (A1) and without (A0) an intravenous (i.v.) heparin bolus followed by 250 IU/h i.v during 6 hours. Each metabolic study will last 9 hours (with 6 hours postprandial) and will include PET and stable isotopic tracer methods. At time 0, a low fat liquid meal will be ingested over 20 minutes.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lipoprotein Lipase Deficiency

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
16 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control group- A0
Arm Type
Other
Arm Description
Control group: Healthy subjects with fasting glucose < 5.6, 2-hour post 75g Oral Glucose Tolerance Test (OGTT) glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l); A0: without heparin administered
Arm Title
LPLD group-A0
Arm Type
Other
Arm Description
LPLD group: LPL deficient subjects with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation; A0: without heparin administered
Arm Title
Control group-A1
Arm Type
Other
Arm Description
Control group: Healthy subjects with fasting glucose < 5.6, 2-hour post 75g OGTT glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l); A1: with an intravenous (i.v.) heparin bolus (50 IU/kg i.v.) followed by 250 IU/h i.v. during 6 hours starting 15 minutes before ingestion of liquid meal.
Arm Title
LPLD group-A1
Arm Type
Other
Arm Description
LPLD group: LPL deficient subjects with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation; A1: with an intravenous (i.v.) heparin bolus (50 IU/kg i.v.) followed by 250 IU/h i.v. during 6 hours starting 15 minutes before ingestion of liquid meal.
Intervention Type
Drug
Intervention Name(s)
Heparin
Intervention Description
an intravenous (i.v.) heparin bolus (50 IU/kg i.v.) followed by 250 IU/h i.v. during 6 hours, starting 15 minutes before ingestion of liquid meal
Intervention Type
Dietary Supplement
Intervention Name(s)
liquid meal
Intervention Description
low fat meal: (500 mL, 898 Kcal, 13% fat, 20.3% protein and 62.3% carbohydrates) will be ingested over 20 minutes
Primary Outcome Measure Information:
Title
Organ-specific Dietary Fatty Acid (DFA) partitioning
Description
will be determined using oral administration of [18F ]-Fluoro-6-Thia- Heptadecanoic Acid (FTHA ) during whole-body acquisition.
Time Frame
2 months
Title
Myocardial DFA uptake
Description
will be assessed using oral administration of [18F]-FTHA during dynamic PET acquisition.
Time Frame
2 months
Secondary Outcome Measure Information:
Title
Myocardial nonesterified fatty acids (NEFA) metabolism
Description
will be determined using [11C]-palmitate during dynamic PET acquisition.
Time Frame
2 months
Title
Dietary fatty acid oxidation rate
Description
will be measured using breath [13C]-carbon dioxide enrichment
Time Frame
6 months
Title
Total oxidation rate
Description
will be determined by indirect calorimetry
Time Frame
2 months
Title
postprandial plasma NEFA turnover
Description
will be determined using stable isotope tracers of fatty acids
Time Frame
6 months
Title
postprandial plasma glucose turnover
Description
will be determined using stable isotope tracers of glucose
Time Frame
6 months
Title
Left ventricular function by Positron Emitting Positron (PET) ventriculography
Description
will be determined using [11C]-acetate PET/CT. 180 megabecquerel (MBq) will be administered by bolus injection
Time Frame
2 months
Title
Myocardial oxidative metabolism
Description
will be determined using i.v. [11C]-acetate during dynamic PET/CT scanning.
Time Frame
2 months
Title
Insulin sensitivity
Description
will be determined using a multiplex ELISA which will measure multiple analytes in a single experiment.
Time Frame
6 months
Title
Liver nonesterified fatty acids (NEFA) metabolism
Description
will be determined using [11C]-palmitate during dynamic PET acquisition.
Time Frame
2 months
Title
Metabolites distribution in plasma
Description
will be determined using oral administration of [18F]-FTHA
Time Frame
2 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: 8 healthy LPL-deficient individuals (LPLD subjects) with history of fasting TG > 5 mmol/l and homozygote or compound heterozygote for a LPL-gene mutation; 8 control subjects (fasting glucose < 5.6, 2-hour post 75g OGTT glucose < 7.8 mmol/l and HbA1c < 5.8%; fasting TG < 1.5 mmol/l); age 18 to 75 yo; To be willing and able to adhere to the specifications of the protocol; To have signed an informed consent document indicating that they understood the purpose Exclusion Criteria: age < 18 yo; overt cardiovascular disease as assessed by medical history, physical exam, and abnormal ECG Treatment with a fibrate, thiazolidinedione, beta-blocker or other drug known to affect lipid or carbohydrate metabolism (except statins, metformin, and other antihypertensive agents that can be safely interrupted); Treatment with anti-hypertensive medication (only for LPL-deficient individuals); presence of liver or renal disease; uncontrolled thyroid disorder; previous diagnosis of heparin-induced thrombocytopenia; Treatment with oral anticoagulation medication or platelet aggregation inhibiting drugs; A history of major hemorrhagic event; smoking (>1 cigarette/day) and/or consumption of >2 alcoholic beverages per day;; Female of child-bearing potential who is pregnant, breast feeding or intends to become pregnant or pre-menopausal female with a positive serum pregnancy test at the time of enrollment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Frédérique Frisch
Phone
819-346-1110- ext12394
Email
frederique.frisch@usherbrooke.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
André Carpentier
Organizational Affiliation
Université de Sherbrooke
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre de recherche du CHUS
City
Sherbrooke
State/Province
Quebec
ZIP/Postal Code
J1H 5N4
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Frédérique Frisch
Phone
819-346-1110- ext12394
Email
frederique.frisch@usherbrooke.ca

12. IPD Sharing Statement

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Postprandial Fatty Acid Metabolism in Subjects With Lipoprotein Lipase Deficiency

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