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Role of BCAA in Glucose Homeostasis (NaPB2)

Primary Purpose

Type 2 Diabetes

Status
Not yet recruiting
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
4.8 g/m^2/day NaPB
4.8 g/m^2/day placebo
Sponsored by
Maastricht University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes focused on measuring type 2 Diabetes, branched-chain amino acid metabolism, glucose homeostasis, sodium-phenylbutyrate, insulin resistance

Eligibility Criteria

40 Years - 76 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients are able to provide signed and dated written informed consent prior to any study specific procedures Women are post-menopausal (defined as at least 1 year post cessation of menses) and aged ≥ 45 and ≤ 76 years. Males are aged ≥ 40 years and ≤ 76 years Patients should have suitable veins for cannulation or repeated venipuncture Caucasians BMI: 25-38 kg/m2 Diagnosed with T2D at least 1.5 years before the start of the study Relatively well-controlled T2D: HbA1c < 8.5% Oral glucose lowering medication: metformin only or in combination with sulfonylurea agents and/or on stable dose of a DPPIV inhibitor treatment for at least the last 3 months No signs of active diabetes-related co-morbidities like active cardiovascular diseases, active diabetic foot, polyneuropathy or retinopathy No signs of active liver or kidney malfunction Exclusion Criteria: Previous enrolment in a clinical study with an investigational product during the last 3 months or as judged by the Investigator Participate in physical activity more than 3 times a week Unstable body weight (weight gain or loss > 5 kg in the last three months) Insulin dependent T2D Patients with congestive heart failure and and/or severe renal and or liver insufficiency or known sodium retention with oedema Patients using Probalan (probenecid), Haldol (haloperidol), Depakene (valproate) or medical products containing corticosteroids Men: Hb <8.4 mmol/L, Women: Hb <7.8 mmol/l Any contra-indication MRI scanning. These contra-indications include patients with e.g. the following: Central nervous system aneurysm clip Implanted neural stimulator Implanted cardiac pacemaker of defibrillator Cochlear implant Metal containing corpora aliena in the eye or brains

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Placebo Comparator

    Arm Label

    4.8 g/m^2/day NaPB

    4.8 g/m^2/day Placebo

    Arm Description

    12-week oral administration of 4.8 g/m^2/day Sodium-phenylbutyrate (NaPB) (in the form of Pheburane)

    12-week oral administration of 4.8 g/m2/day identical placebo granules.

    Outcomes

    Primary Outcome Measures

    fasting plasma glucose levels
    Glucose levels will be measured after an overnight fast expressed in mmol/l.

    Secondary Outcome Measures

    whole-body insulin sensitivity
    glucose clearance in ml/kg determined during an OGTT at 6 weeks glucose disposal rate (delta Rd) in umol/kg/min measured with the clamp at 12 weeks
    muscle mitochondrial function
    O2-flux will be measured with high-resolution respirometry
    whole-body metabolic flexibility
    insulin-stimulated change in respiratory exchange ratio will be determined with use of indirect calorimetry during the clamp
    energy status of the heart
    PCr/ATP-ratio will be determined with phosphorus magnetic resonance spectroscopy
    cardiac function: ejection fraction
    The cardiac function will be measured via ejection fraction (microL) with the use of cine-MRI
    cardiac function: left atrial maximum volume
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Left atrial maximum volume (ml)
    cardiac function: peak A-wave velocity (cm/sec)
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Peak A-wave velocity (cm/sec)
    cardiac function: pulsed wave TDI velocity (cm/sec) at lateral and septal basal regions
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Pulsed wave TDI velocity (cm/sec) at lateral and septal basal regions
    cardiac function: peak E-wave velocity
    The cardiac function will be measured via diastolic cardiac function with the use of of ultrasound (transthoracic echocardiography) will be assessed with the following parameters: Peak E-wave velocity (cm/sec)
    cardiac function: tricuspid regurgitation systolic jet velocity
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Tricuspid regurgitation systolic jet velocity (m/sec)

    Full Information

    First Posted
    April 7, 2023
    Last Updated
    April 26, 2023
    Sponsor
    Maastricht University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05836350
    Brief Title
    Role of BCAA in Glucose Homeostasis
    Acronym
    NaPB2
    Official Title
    Targeting Branched-chain Amino Acid Oxidation to Improve Glycaemic Control in Patients With Type 2 Diabetes
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 2023 (Anticipated)
    Primary Completion Date
    October 2025 (Anticipated)
    Study Completion Date
    May 2026 (Anticipated)

    3. Sponsor/Collaborators

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

    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 clinical trial study aims to evaluate the effects of prolonged NaPB treatment in a maximum of 20 patients with T2D. The primary objective is: to investigate if prolonged boosting of ing BCAA oxidation will substantially lower plasma glucose levels in patients with T2D. Participants will undergo a Clinical randomized controlled trial (RCT) with a double-blinded, placebo-controlled, cross-over design, including a wash-out period of 12 weeks. The trial will contain 2 treatment arms, with each a duration of 12 weeks. Participants will have a 12-week oral administration of 4.8 g/m2/day NaPB (in the form of Pheburane) or placebo per day. Although depending on body surface area, ~21 g Pheburane needs to be administered spread over the day 3 times taken with a meal.
    Detailed Description
    Several studies identified branched-chain amino acids (BCAA; leucine, isoleucine, and valine) to be substantially elevated in people with T2D, possibly caused by lower BCAA oxidation rates. Plasma BCAA levels are strongly associated with insulin resistance and other key metabolic disarrangements as seen in T2D, including mitochondrial function, liver fat content, and metabolic flexibility. We, recently, showed that stimulating BCAA oxidation for 2 weeks with sodium-phenylbutyrate (NaPB) treatment -a drug known to accelerate BCAA oxidation- decreased BCAA plasma levels in patients with T2D. This reduction in plasma BCAA levels was paralleled with a robust improvement in peripheral insulin sensitivity and muscle mitochondrial oxidative capacity. Interestingly, a strong tendency was found for lower fasting glucose levels, an indication of better glucose control. These findings form lead to further evaluating this treatment strategy to improve glucose homeostasis and lower hyperglycaemic conditions in patients with T2D. So far, this strategy has been tested only in several rodent models reporting promising, beneficial outcomes on glucose homeostasis and heart function. The aim of the present study is to evaluate the effects of prolonged treatment: patients with T2D will undergo a 12-week NaPB intervention with the aim of substantially lower fasting plasma glucose levels. The outcomes of this project evaluate a novel strategy to treat patients with T2D.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Type 2 Diabetes
    Keywords
    type 2 Diabetes, branched-chain amino acid metabolism, glucose homeostasis, sodium-phenylbutyrate, insulin resistance

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Crossover Assignment
    Model Description
    Clinical randomized controlled trial (RCT) with a double-blinded, placebo-controlled, cross-over design, including a wash-out period of 12 weeks. The trial will contain 2 treatment arms, with each a duration of 12 weeks.
    Masking
    ParticipantInvestigator
    Allocation
    Randomized
    Enrollment
    20 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    4.8 g/m^2/day NaPB
    Arm Type
    Active Comparator
    Arm Description
    12-week oral administration of 4.8 g/m^2/day Sodium-phenylbutyrate (NaPB) (in the form of Pheburane)
    Arm Title
    4.8 g/m^2/day Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    12-week oral administration of 4.8 g/m2/day identical placebo granules.
    Intervention Type
    Drug
    Intervention Name(s)
    4.8 g/m^2/day NaPB
    Other Intervention Name(s)
    Pheburane, NaPB
    Intervention Description
    12-week oral administration of 4.8 g/m^2/day NaPB (in the form of Pheburane) per day. Although depending on body surface area, ~21 g Pheburane needs to be administered spread over the day in 3 times taken with a meal.
    Intervention Type
    Drug
    Intervention Name(s)
    4.8 g/m^2/day placebo
    Other Intervention Name(s)
    Placebo
    Intervention Description
    12-week oral administration of 4.8 g/m^2/day NaPB (in the form of Pheburane) or placebo per day. Although depending on body surface area, ~21 g Pheburane needs to be administered spread over the day in 3 times taken with a meal.
    Primary Outcome Measure Information:
    Title
    fasting plasma glucose levels
    Description
    Glucose levels will be measured after an overnight fast expressed in mmol/l.
    Time Frame
    at week 12 of each intervention period
    Secondary Outcome Measure Information:
    Title
    whole-body insulin sensitivity
    Description
    glucose clearance in ml/kg determined during an OGTT at 6 weeks glucose disposal rate (delta Rd) in umol/kg/min measured with the clamp at 12 weeks
    Time Frame
    at week 6 and week 12 of each intervention period
    Title
    muscle mitochondrial function
    Description
    O2-flux will be measured with high-resolution respirometry
    Time Frame
    at week 6 and week 12 of each intervention period
    Title
    whole-body metabolic flexibility
    Description
    insulin-stimulated change in respiratory exchange ratio will be determined with use of indirect calorimetry during the clamp
    Time Frame
    at week 12 of each intervention period
    Title
    energy status of the heart
    Description
    PCr/ATP-ratio will be determined with phosphorus magnetic resonance spectroscopy
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: ejection fraction
    Description
    The cardiac function will be measured via ejection fraction (microL) with the use of cine-MRI
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: left atrial maximum volume
    Description
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Left atrial maximum volume (ml)
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: peak A-wave velocity (cm/sec)
    Description
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Peak A-wave velocity (cm/sec)
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: pulsed wave TDI velocity (cm/sec) at lateral and septal basal regions
    Description
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Pulsed wave TDI velocity (cm/sec) at lateral and septal basal regions
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: peak E-wave velocity
    Description
    The cardiac function will be measured via diastolic cardiac function with the use of of ultrasound (transthoracic echocardiography) will be assessed with the following parameters: Peak E-wave velocity (cm/sec)
    Time Frame
    at week 12 of each arm
    Title
    cardiac function: tricuspid regurgitation systolic jet velocity
    Description
    The cardiac function will be measured via diastolic cardiac function with the use of ultrasound (transthoracic echocardiography) with the following parameter: Tricuspid regurgitation systolic jet velocity (m/sec)
    Time Frame
    at week 12 of each arm

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    40 Years
    Maximum Age & Unit of Time
    76 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Patients are able to provide signed and dated written informed consent prior to any study specific procedures Women are post-menopausal (defined as at least 1 year post cessation of menses) and aged ≥ 45 and ≤ 76 years. Males are aged ≥ 40 years and ≤ 76 years Patients should have suitable veins for cannulation or repeated venipuncture Caucasians BMI: 25-38 kg/m2 Diagnosed with T2D at least 1.5 years before the start of the study Relatively well-controlled T2D: HbA1c < 8.5% Oral glucose lowering medication: metformin only or in combination with sulfonylurea agents and/or on stable dose of a DPPIV inhibitor treatment for at least the last 3 months No signs of active diabetes-related co-morbidities like active cardiovascular diseases, active diabetic foot, polyneuropathy or retinopathy No signs of active liver or kidney malfunction Exclusion Criteria: Previous enrolment in a clinical study with an investigational product during the last 3 months or as judged by the Investigator Participate in physical activity more than 3 times a week Unstable body weight (weight gain or loss > 5 kg in the last three months) Insulin dependent T2D Patients with congestive heart failure and and/or severe renal and or liver insufficiency or known sodium retention with oedema Patients using Probalan (probenecid), Haldol (haloperidol), Depakene (valproate) or medical products containing corticosteroids Men: Hb <8.4 mmol/L, Women: Hb <7.8 mmol/l Any contra-indication MRI scanning. These contra-indications include patients with e.g. the following: Central nervous system aneurysm clip Implanted neural stimulator Implanted cardiac pacemaker of defibrillator Cochlear implant Metal containing corpora aliena in the eye or brains
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Esther Phielix, PhD.
    Phone
    043- 388 1311
    Email
    esther.phielix@maastrichtuniversity.nl
    First Name & Middle Initial & Last Name or Official Title & Degree
    Elnaz Daraei, MSc.
    Email
    elnaz.daraei@maastrichtuniversity.nl

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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