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Effects of Morbid Obesity and Bariatric Surgery on Brain Inflammation, and Activation of Central Reward System (BARIBRAIN)

Primary Purpose

Morbid Obesity

Status
Unknown status
Phase
Not Applicable
Locations
Finland
Study Type
Interventional
Intervention
Bariatric Surgery (RYGB or LSG)
Sponsored by
Turku University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Morbid Obesity focused on measuring positron emission tomography, magnetic resonance imaging, euglycaemic hyperinsulinemic clamp, astrogliosis, central inflammation, bariatric surgery

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

For the morbidly obese subjects:

  1. BMI 35.0-45.0 kg/m2, or BMI 32.0-45.0 kg/m2 and diagnosed diabetes
  2. Eligible to bariatric surgery evaluated according to normal treatment paradigm

Exclusion Criteria:

  1. Metal objects in the body (including pacemakers, metallic artificial valve prostheses, inner ear implants, surgical clips, braces, foreign fragments)
  2. Previous participation in PET studies
  3. Pregnancy
  4. Poor compliance, alcohol or drug abuse
  5. Weight over 150 kg or waist circumference over 150 cm
  6. Diabetes with fasting glucose levels ≥7.0 mmol/L, or treatment with insulin
  7. Any chronic disease, medication or condition that could create a hazard to subject safety, endanger study procedures or interfere with the interpretation of results.

For the lean control subjects:

Inclusion Criteria:

  1. BMI 18-27 kg/m2
  2. Fasting plasma glucose ≤6.1 mmol/L
  3. Normal values in 2-hour oral glucose tolerance test

Exclusion Criteria:

  1. Metal objects in the body (including pacemakers, metallic artificial valve prostheses, inner ear implants, surgical clips, braces, foreign fragments)
  2. Previous participation in PET studies
  3. Pregnancy
  4. Poor compliance, alcohol or drug abuse
  5. Smoking
  6. History of eating disorders, drastic weight-gain or weight-loss
  7. History of psychiatric disorders
  8. Any chronic disease, medication or condition that could create a hazard to subject safety, endanger study procedures or interfere with the interpretation of results

Sites / Locations

  • Turku PET Centre
  • Turku University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

No Intervention

Arm Label

Bariatric surgery

No intervention

Arm Description

The effect of bariatric surgery (RYGB or LSG) on central inflammation

Healthy lean volunteers

Outcomes

Primary Outcome Measures

Obese have brain inflammation compared to healthy ones
Brain PET-[11C]-PK11195 imaging study of obese and healthy lean ones
Bariatric surgery decreases brain inflammation in obesity
PK11195 imaging results are compared before and 6 months after bariatric surgery in obese group studied before and after bariatric surgery

Secondary Outcome Measures

Tissue-specific and whole-body insulin sensitivity are decreased in obese
Glucose uptakes are measured using PET imaging in obese and leans
Tissue-specific and whole-body glucose improves after bariatric surgery
Comparison before and 6 months after surgery (obese group)
Brain neural activity decreased in obesity
Comparison between obese and lean ones using fMRI
Brain neural activity improves after bariatric surgery
Comparison between obese baseline and 6 months after operation
Brain metabolite concentrations are different in obese
MRS studies for obese and lean ones at baseline are compared
Brain metabolite concentrations normalize after bariatric surgery
MRS studies for obese before and 6 months postop compared

Full Information

First Posted
October 7, 2019
Last Updated
October 12, 2021
Sponsor
Turku University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04343469
Brief Title
Effects of Morbid Obesity and Bariatric Surgery on Brain Inflammation, and Activation of Central Reward System
Acronym
BARIBRAIN
Official Title
Effects of Morbid Obesity and Bariatric Surgery on Brain Inflammation, Insulin Resistance and Activation of Central Reward System Studied Using PET- and MRI-imaging
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 11, 2019 (Actual)
Primary Completion Date
September 2022 (Anticipated)
Study Completion Date
September 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Turku University Hospital

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
Background: The investigators have found that obesity and insulin resistance result in significantly increased brain insulin-stimulated glucose uptake, whereas in every other tissue glucose uptake is lower in the obese compared to lean individuals. One possible explanation to this could be central inflammation and activation of brain glial cells, which has been shown to occur in animal models of obesity. Aims: The objective of this study is to investigate whether there is brain inflammation in human obesity, and whether weight loss following bariatric surgery decreases brain inflammation. Methods: A total of 60 morbidly obese subjects, assigned for Roux-en-Y gastric bypass or for sleeve gastrectomy according to routine treatment protocols will be recruited for this study. A control group of 30 healthy subjects will also be recruited. The following studies will be performed to patients and healthy subjects: 1) structural MRI and MRS, 2) functional MRI, 3) PET imaging of cerebral inflammation and astrocyte activation using [11C]-PK11195, 4) measurement of whole-body and tissue insulin sensitivity by combining hyperinsulinemic, euglycemic clamp with [18F]-FDG-PET, 5) neuropsychological testing. The study procedures will be repeated for the morbidly obese 6 months postoperatively.
Detailed Description
This is a prospective study, where subjects for the morbidly obese group (N=60) will be recruited from the patients undergoing bariatric surgery according to normal treatment protocol and the bariatric procedure is decided on clinical data together with the bariatric surgeon and the patient. The morbidly obese patients are studied before and 6 months after bariatric surgery. Results of obese are compared to results of healthy subjects (N=30), who are studied once. MRI studies: Brain structural MRI and MRS Structural brain MRI will be performed to obtain anatomical reference. The MR part of a 3T PET-MR system will be used for the study . MR spectroscopy (MRS) will be used to determine levels of different metabolites.Brain activation studies (functional MRI) The aim of the fMRI is to assess how morbid obesity and weight loss influence the brain reward system in response to visual cues (not food related); resting state fMRI will also be performed. Brain inflammation: [¹¹C]-PK11195 tracer with PET/CT is used to determine activation of glial cells, or inflammation, in the brain. After intravenous injection of 500 MBq [¹¹C]-PK11195, a 60-minute dynamic scan on the brain using the same PET/CT cameras will be performed. Both ROI- and SPM based statistics will be used in the statistical analyses. Whole-body scan with [18F]-FDG and PET/CT during euglycemic hyperinsulinemia used to promote tissue glucose uptake and measure insulin sensitivity. After 60 minutes from the start of clamp, the subjects will be injected intravenously with 150 MBq of [18F]-fluorodeoxyglucose ([18F]-FDG) Thereafter [18F]-fluorodeoxyglucose uptake in the brain, abdomen, femoral region will be measured.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Morbid Obesity
Keywords
positron emission tomography, magnetic resonance imaging, euglycaemic hyperinsulinemic clamp, astrogliosis, central inflammation, bariatric surgery

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Obese and healthy ones are compared at baseline and obese are compered to healthy ones 6 months after bariatric surgery.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Bariatric surgery
Arm Type
Active Comparator
Arm Description
The effect of bariatric surgery (RYGB or LSG) on central inflammation
Arm Title
No intervention
Arm Type
No Intervention
Arm Description
Healthy lean volunteers
Intervention Type
Procedure
Intervention Name(s)
Bariatric Surgery (RYGB or LSG)
Intervention Description
Morbidly obese subjects will receive either RYGB or LSG, and the effect of bariatric surgery-induced weight loss on brain inflammation will be assessed
Primary Outcome Measure Information:
Title
Obese have brain inflammation compared to healthy ones
Description
Brain PET-[11C]-PK11195 imaging study of obese and healthy lean ones
Time Frame
Both groups at baseline
Title
Bariatric surgery decreases brain inflammation in obesity
Description
PK11195 imaging results are compared before and 6 months after bariatric surgery in obese group studied before and after bariatric surgery
Time Frame
Baseline and 6 months after operation (obese group only)
Secondary Outcome Measure Information:
Title
Tissue-specific and whole-body insulin sensitivity are decreased in obese
Description
Glucose uptakes are measured using PET imaging in obese and leans
Time Frame
Baseline obese and leans
Title
Tissue-specific and whole-body glucose improves after bariatric surgery
Description
Comparison before and 6 months after surgery (obese group)
Time Frame
PET imaging studies at baseline and 6 months after operation
Title
Brain neural activity decreased in obesity
Description
Comparison between obese and lean ones using fMRI
Time Frame
Baseline obese and leans
Title
Brain neural activity improves after bariatric surgery
Description
Comparison between obese baseline and 6 months after operation
Time Frame
Baseline and 6 months after operation (obese group)
Title
Brain metabolite concentrations are different in obese
Description
MRS studies for obese and lean ones at baseline are compared
Time Frame
Baseline obese and leans
Title
Brain metabolite concentrations normalize after bariatric surgery
Description
MRS studies for obese before and 6 months postop compared
Time Frame
Baseline and 6 months postop (obese group)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
For the morbidly obese subjects: BMI 35.0-45.0 kg/m2, or BMI 32.0-45.0 kg/m2 and diagnosed diabetes Eligible to bariatric surgery evaluated according to normal treatment paradigm Exclusion Criteria: Metal objects in the body (including pacemakers, metallic artificial valve prostheses, inner ear implants, surgical clips, braces, foreign fragments) Previous participation in PET studies Pregnancy Poor compliance, alcohol or drug abuse Weight over 150 kg or waist circumference over 150 cm Diabetes with fasting glucose levels ≥7.0 mmol/L, or treatment with insulin Any chronic disease, medication or condition that could create a hazard to subject safety, endanger study procedures or interfere with the interpretation of results. For the lean control subjects: Inclusion Criteria: BMI 18-27 kg/m2 Fasting plasma glucose ≤6.1 mmol/L Normal values in 2-hour oral glucose tolerance test Exclusion Criteria: Metal objects in the body (including pacemakers, metallic artificial valve prostheses, inner ear implants, surgical clips, braces, foreign fragments) Previous participation in PET studies Pregnancy Poor compliance, alcohol or drug abuse Smoking History of eating disorders, drastic weight-gain or weight-loss History of psychiatric disorders Any chronic disease, medication or condition that could create a hazard to subject safety, endanger study procedures or interfere with the interpretation of results
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pirjo Nuutila, MD, PhD
Organizational Affiliation
Turku UH
Official's Role
Principal Investigator
Facility Information:
Facility Name
Turku PET Centre
City
Turku
ZIP/Postal Code
20520
Country
Finland
Facility Name
Turku University Hospital
City
Turku
ZIP/Postal Code
20520
Country
Finland

12. IPD Sharing Statement

Plan to Share IPD
No

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Effects of Morbid Obesity and Bariatric Surgery on Brain Inflammation, and Activation of Central Reward System

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