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The Relationship Between Irisin and Bone Health in Individuals With Spinal Cord Injury (IBSCI)

Primary Purpose

Spinal Cord Injury

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Acute Exercise
Sponsored by
VA Office of Research and Development
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Cord Injury focused on measuring Spinal cord injuries, Irisin, Bone mineral density, Exercise

Eligibility Criteria

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

Inclusion Criteria:

Participants with SCI:

  • age 18 years or older
  • traumatic SCI at the cervical level 4 or lower that occurred at least 12 months prior to the start of the study
  • American Spinal Injury Association Impairment Scale A, B or C
  • uses a manual wheelchair as primary means of mobility (30+ hours per week)
  • is able to perform a transfer independently to and from a wheelchair
  • has adequate strength and upper extremity function to operate an arm ergometer

Control Participants:

  • age and sex-matched to participant with SCI

Exclusion Criteria:

Participants with SCI:

  • active use of medications which potentially affect bone metabolism, including: parathyroid hormone and analogs, androgenic or estrogenic steroids, bisphosphonates, oral glucocorticoids (use for more than 3 months)
  • history of fractures or dislocations in the upper extremity from which the participant has not fully recovered
  • upper limb pain or injury that interferes with the ability to perform aerobic exercise
  • recent hospitalization for any reason (within the past three months)
  • history of coronary artery disease, coronary bypass surgery or other cardiorespiratory events or conditions
  • likely to experience clinically significant autonomic dysreflexia and/ or orthostatic hypotension in response to vigorous exercise
  • endocrinopathy or metabolic disorders of the bone

    • e.g. Paget's disease, renal bone disease
  • history of allergic reaction to lidocaine
  • any other conditions that the person's primary care physician deems is a contraindication to participation in arm ergometry exercise stress testing or vigorous exercise
  • pregnant
  • participation in another "Greater than Minimal Risk" study.

Control Participants:

  • active use of medications which potentially affect bone metabolism, including: parathyroid hormone and analogs, androgenic or estrogenic steroids, bisphosphonates, oral glucocorticoids (use for more than 3 months)
  • history of neuromuscular conditions which could influence muscle gene expression
  • history of lower body musculoskeletal injuries from which the participant has not fully recovered
  • recent hospitalization for any reason (within the past three months)
  • history of allergic reaction to lidocaine
  • any other conditions that the person's primary care physician deems is a contraindication to the performance of a vastus lateralis muscle biopsy
  • pregnant
  • participation in another "Greater than Minimal Risk" study

Sites / Locations

  • VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PARecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Individuals with SCI

Controls (No SCI)

Arm Description

Male and female, Veteran and non-Veteran participants with traumatic SCI will complete the baseline blood draw, muscle biopsy and DXA/HR-pQCT bone imaging. This group will complete blood draws before and after arm ergometer high-intensity interval exercise bout.

Male and female Veterans, age and sex-matched to participants with SCI will complete the baseline blood draw, muscle biopsy and DXA/HR-pQCT bone imaging. This group will complete blood draws before and after arm ergometer high-intensity interval exercise bout.

Outcomes

Primary Outcome Measures

Irisin - Bone measure correlations
Circulating irisin concentrations will be correlated with DXA and HR-pQCT bone measures
FNDC5 gene expression
FNDC5 gene expression will be measured in vastus lateralis skeletal muscle biopsies via RT-PCR to determine if potential differences in circulating irisin concentrations may be attributed to differential gene expression.
Exercise induced change in irisin concentration
Circulating irisin concentrations will be measured before and immediately following an arm ergometer high-intensity interval exercise bout to determine if this exercise modality can increased circulating irisin concentrations in individuals with SCI and controls

Secondary Outcome Measures

Full Information

First Posted
March 31, 2022
Last Updated
May 8, 2023
Sponsor
VA Office of Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT05319522
Brief Title
The Relationship Between Irisin and Bone Health in Individuals With Spinal Cord Injury
Acronym
IBSCI
Official Title
The Influence of Irisin/FNDC5 on Bone Mineral Density and Fracture Risk in Individuals With Spinal Cord Injury
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 5, 2023 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
December 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
VA Office of Research and Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will examine the relationship between circulating irisin and bone health individuals with spinal cord injury. Additionally, this study seeks to examine the influence of muscle fiber type on circulating irisin and identify an exercise-based means to increase irisin concentrations.
Detailed Description
After spinal cord injury (SCI), the severe sub-lesion bone loss increases lower-limb fracture risk. In addition to mechanical loading, bone homeostasis is mediated by myokines, skeletal muscle secreted factors, including irisin. This project aims to demonstrate that irisin is a key determinant of bone mineral density in sub-lesion bone, that impaired irisin mechanisms contribute to post-SCI bone loss, and identify novel modalities to leverage the osteogenic effects of irisin to improve musculoskeletal rehabilitation strategies for individuals with SCI. The first aim of this project seeks to determine the relationship between circulating irisin and bone mineral density (BMD) in sub-lesion bones of individuals with SCI. Past research has reported positive correlations between irisin and BMD indicating that irisin is important factor in bone homeostasis. To date, the relationship between irisin and BMD, absent mechanical loading, as seen in individuals with SCI, has not been examined. Of note, irisin increases have been demonstrated to increase bone mass in healthy mice and prevent or reduce bone loss in mouse SCI models. The second aim of this study seeks to determine if irisin concentrations are impaired as a result of pathologic changes in sub-lesion skeletal muscle after SCI. Irisin is released into circulation following cleavage of its precursor protein which is highly expressed in skeletal muscle. Generally, healthy human muscle demonstrates a mix of type I and type II muscle fibers, however, after SCI, there is a pathological transformation from type I to type II muscle. Given that irisin's precursor protein is more highly expressed in type I muscle, the post-SCI fiber type transformation could significantly attenuate circulating irisin concentrations and impair its downstream signaling effects. Understanding whether post-SCI fiber type shifts are associated with reduced circulating irisin could help explain the inefficacy of current rehabilitation methods. The third aim of this study seeks to measure the irisin response to arm ergometer high intensity interval exercise. If circulating irisin concentrations are important to bone health, as current research suggests, then identifying a means in increase circulating irisin is essential to developing better musculoskeletal rehabilitation methods. While exercise has been demonstrated to increase circulating irisin, the exercise modalities performed (running, whole body resistance training) are not feasible for individuals with SCI. Arm ergometry exercise could provide a means to increase circulating concentrations of this osteogenic factor.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injury
Keywords
Spinal cord injuries, Irisin, Bone mineral density, Exercise

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
44 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Individuals with SCI
Arm Type
Active Comparator
Arm Description
Male and female, Veteran and non-Veteran participants with traumatic SCI will complete the baseline blood draw, muscle biopsy and DXA/HR-pQCT bone imaging. This group will complete blood draws before and after arm ergometer high-intensity interval exercise bout.
Arm Title
Controls (No SCI)
Arm Type
Active Comparator
Arm Description
Male and female Veterans, age and sex-matched to participants with SCI will complete the baseline blood draw, muscle biopsy and DXA/HR-pQCT bone imaging. This group will complete blood draws before and after arm ergometer high-intensity interval exercise bout.
Intervention Type
Behavioral
Intervention Name(s)
Acute Exercise
Other Intervention Name(s)
Arm Ergometer Exercise; High-Intensity Interval Exercise
Intervention Description
Participants with and without SCI will complete an arm ergometer, high-intensity interval exercise bout. The exercise bout will be performed at a relative intensity based on previously determined peak power output during an arm ergometer graded exercise test.
Primary Outcome Measure Information:
Title
Irisin - Bone measure correlations
Description
Circulating irisin concentrations will be correlated with DXA and HR-pQCT bone measures
Time Frame
Baseline; at rest
Title
FNDC5 gene expression
Description
FNDC5 gene expression will be measured in vastus lateralis skeletal muscle biopsies via RT-PCR to determine if potential differences in circulating irisin concentrations may be attributed to differential gene expression.
Time Frame
Baseline; at rest
Title
Exercise induced change in irisin concentration
Description
Circulating irisin concentrations will be measured before and immediately following an arm ergometer high-intensity interval exercise bout to determine if this exercise modality can increased circulating irisin concentrations in individuals with SCI and controls
Time Frame
baseline and immediately post-exercise

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Participants with SCI: age 18 years or older traumatic SCI at the cervical level 4 or lower that occurred at least 12 months prior to the start of the study American Spinal Injury Association Impairment Scale A, B or C uses a manual wheelchair as primary means of mobility (30+ hours per week) is able to perform a transfer independently to and from a wheelchair has adequate strength and upper extremity function to operate an arm ergometer Control Participants: age and sex-matched to participant with SCI Exclusion Criteria: Participants with SCI: active use of medications which potentially affect bone metabolism, including: parathyroid hormone and analogs, androgenic or estrogenic steroids, bisphosphonates, oral glucocorticoids (use for more than 3 months) history of fractures or dislocations in the upper extremity from which the participant has not fully recovered upper limb pain or injury that interferes with the ability to perform aerobic exercise recent hospitalization for any reason (within the past three months) history of coronary artery disease, coronary bypass surgery or other cardiorespiratory events or conditions likely to experience clinically significant autonomic dysreflexia and/ or orthostatic hypotension in response to vigorous exercise endocrinopathy or metabolic disorders of the bone e.g. Paget's disease, renal bone disease history of allergic reaction to lidocaine any other conditions that the person's primary care physician deems is a contraindication to participation in arm ergometry exercise stress testing or vigorous exercise pregnant participation in another "Greater than Minimal Risk" study. Control Participants: active use of medications which potentially affect bone metabolism, including: parathyroid hormone and analogs, androgenic or estrogenic steroids, bisphosphonates, oral glucocorticoids (use for more than 3 months) history of neuromuscular conditions which could influence muscle gene expression history of lower body musculoskeletal injuries from which the participant has not fully recovered recent hospitalization for any reason (within the past three months) history of allergic reaction to lidocaine any other conditions that the person's primary care physician deems is a contraindication to the performance of a vastus lateralis muscle biopsy pregnant participation in another "Greater than Minimal Risk" study
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Adam J Sterczala, PhD
Phone
(617) 784-2831
Email
adam.sterczala@va.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Adam J. Sterczala, PhD
Organizational Affiliation
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Official's Role
Principal Investigator
Facility Information:
Facility Name
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15240
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Adam J Sterczala, PhD
Phone
617-784-2831
Email
adam.sterczala@va.gov
First Name & Middle Initial & Last Name & Degree
Adam J. Sterczala, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

The Relationship Between Irisin and Bone Health in Individuals With Spinal Cord Injury

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