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Small Extracellular Vesicles and Insulin Action (SEV)

Primary Purpose

Obesity, Insulin Resistance, Metabolically Healthy Obesity

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
People with Metabolically Unhealthy Obesity - Low Calorie Diet
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Obesity focused on measuring Obesity, Weight Loss, Exosomes, Extracellular vesicles

Eligibility Criteria

25 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Metabolically healthy lean subjects must have a BMI ≥18.5 and ≤24.9 kg/m2; Subjects with obesity must have a BMI ≥30.0 and ≤50.0 kg/m2 Metabolically healthy lean and people with metabolically healthy obesity must have intrahepatic triglyceride (IHTG) content ≤5%; fasting plasma glucose concentration <100 mg/dl, 2-hr oral glucose tolerance plasma glucose concentration <140 mg/dl, hemoglobin A 1C (HbA1c) ≤5.6% and HOMA-IR <2.5. People with metabolically unhealthy obesity must have intrahepatic triglyceride (IHTG) content ≥5.6%; HOMA-IR ≥2.5, and HbA1c 5.7%-6.4%, or fasting plasma glucose concentration ≥100 mg/dl, or 2-hr oral glucose tolerance test (OGTT) plasma glucose concentration ≥140 mg/dl. Exclusion Criteria: History of diabetes, liver disease other than NAFLD or other serious diseases, Consume excessive amounts of alcohol (>21 units/week for men and >14 units/week for women), Take medications that could affect the study outcome measures, engage in regular exercise (>120 min/week), Are pregnant or lactating

Sites / Locations

  • Washington University School of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

No Intervention

No Intervention

Experimental

Arm Label

Metabolically healthy lean - Baseline testing only

People with Metabolically Healthy Obesity - Baseline testing only

People with Metabolically Unhealthy Obesity - Low Calorie Diet

Arm Description

Metabolically healthy lean - Lean individuals that have good glucose (sugar) control (defined as normal fasting glucose, glucose tolerance and hemoglobin A1c), normal insulin sensitivity (defined as Homeostatic Model Assessment of Insulin Resistance [HOMA-IR] <2.5) and normal intrahepatic triglyceride (fat) levels. Dietary intervention - None.

People with Metabolically Healthy Obesity - Persons with obesity that have good glucose (sugar) control, normal insulin sensitivity and normal intrahepatic triglyceride (fat) levels. Dietary intervention - None.

People with Metabolically Unhealthy Obesity - Persons with obesity with plasma glucose and intrahepatic triglyceride (fat) levels higher than recommended in combination with insulin resistance (defined as HOMA-IR ≥2.5). Dietary intervention - Low calorie diet.

Outcomes

Primary Outcome Measures

Effect of exosomes on insulin sensitivity in cultured cells
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be tested in cultured cells and mice to determine their effect on insulin sensitivity.
Change in the effect of exosomes on insulin sensitivity
Exosomes obtained from the plasma and adipose tissue of participants with metabolically unhealthy obesity before and after 10% weight loss will be tested in cultured cells and mice to determine their effect on insulin sensitivity.

Secondary Outcome Measures

Differences in the content of microRNAs within exosomes obtained from plasma and adipose tissue
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be analyzed to determine their microRNA composition.
Differences in the content of lipids within exosomes obtained from plasma and adipose tissue
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be analyzed to determine their lipid composition.
Changes in the content of microRNAs within exosomes obtained from plasma and adipose tissue
Exosomes obtained from the plasma and adipose tissue of metabolically unhealthy obesity before and after weight loss will be analyzed to determine changes in their microRNA content after weight loss.
Changes in the content of lipids within exosomes obtained from plasma and adipose tissue
Exosomes obtained from the plasma and adipose tissue of metabolically unhealthy obesity before and after weight loss will be analyzed to determine changes in their lipid content after weight loss.
Insulin sensitivity
Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure
Change in insulin sensitivity
Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure
Fat mass and fat free mass
Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)
Change in fat mass and fat free mass
Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)
Abdominal adipose tissue volumes
Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)
Change in abdominal adipose tissue volumes
Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)
Intra-hepatic triglyceride content
Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques
Change in intra-hepatic triglyceride content
Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques

Full Information

First Posted
June 27, 2023
Last Updated
July 6, 2023
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT05933707
Brief Title
Small Extracellular Vesicles and Insulin Action
Acronym
SEV
Official Title
Effect of Small Extracellular Vesicles From Adipose Tissue on Insulin Action
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 14, 2023 (Actual)
Primary Completion Date
October 2028 (Anticipated)
Study Completion Date
December 2028 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

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

5. Study Description

Brief Summary
The goals of this research study are to: 1) understand why some people with obesity are protected from developing conditions such as type 2 diabetes and cardiovascular disease while others are more likely to develop obesity-related conditions; 2) assess the effect of small extracellular vesicles (sEVs also called exosomes), obtained from human participants, on metabolic function in cultured cells and in mice.
Detailed Description
Insulin resistance is commonly associated with obesity and is a major contributor to the development of obesity-related metabolic diseases, including nonalcoholic fatty liver disease, the metabolic syndrome, and type 2 diabetes (T2D). Most persons with obesity are "metabolically unhealthy" (MUO), often defined by having insulin resistance and the metabolic syndrome. However, a subset of people with obesity are metabolically healthy (MHO) and protected from the adverse metabolic effects of excess adiposity. The mechanisms that determine the differences in metabolic health between people with MUO and MHO are not unclear. This project will examine the effects of plasma and adipose tissue small extracellular vesicles (sEVs) on multi-organ insulin action. The investigators will isolate sEVs from subcutaneous abdominal adipose tissue biopsies and blood samples obtained from human participants with MHO, MUO or who are metabolically healthy and lean (MHL) and examine the effects of these sEVs on insulin resistance in muscle, liver and fat cells in culture and on multi-organ insulin sensitivity in lean and obese mice. The investigators will also identify differences in the potential bioactive molecules, namely miRNA and bioactive lipids, that are carried by sEVs. The results from this study will help determine whether plasma or adipose tissue sEVs in people who are MHL, MHO, or MUO are involved in regulating liver, muscle and adipose tissue insulin sensitivity. These results could identify novel pathways that regulate metabolic health in people and provide the foundation for exploring the potential of sEVs as a therapeutic target to prevent and treat the metabolic complications of obesity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity, Insulin Resistance, Metabolically Healthy Obesity, Obesity, Metabolically Benign
Keywords
Obesity, Weight Loss, Exosomes, Extracellular vesicles

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Metabolically healthy lean - Baseline testing only
Arm Type
No Intervention
Arm Description
Metabolically healthy lean - Lean individuals that have good glucose (sugar) control (defined as normal fasting glucose, glucose tolerance and hemoglobin A1c), normal insulin sensitivity (defined as Homeostatic Model Assessment of Insulin Resistance [HOMA-IR] <2.5) and normal intrahepatic triglyceride (fat) levels. Dietary intervention - None.
Arm Title
People with Metabolically Healthy Obesity - Baseline testing only
Arm Type
No Intervention
Arm Description
People with Metabolically Healthy Obesity - Persons with obesity that have good glucose (sugar) control, normal insulin sensitivity and normal intrahepatic triglyceride (fat) levels. Dietary intervention - None.
Arm Title
People with Metabolically Unhealthy Obesity - Low Calorie Diet
Arm Type
Experimental
Arm Description
People with Metabolically Unhealthy Obesity - Persons with obesity with plasma glucose and intrahepatic triglyceride (fat) levels higher than recommended in combination with insulin resistance (defined as HOMA-IR ≥2.5). Dietary intervention - Low calorie diet.
Intervention Type
Behavioral
Intervention Name(s)
People with Metabolically Unhealthy Obesity - Low Calorie Diet
Other Intervention Name(s)
Dietary weight loss
Intervention Description
Consumption of a low-calorie diet with caloric intake reduced by ~25% to achieve ~10% weight loss in about 4 to 5 months.
Primary Outcome Measure Information:
Title
Effect of exosomes on insulin sensitivity in cultured cells
Description
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be tested in cultured cells and mice to determine their effect on insulin sensitivity.
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Title
Change in the effect of exosomes on insulin sensitivity
Description
Exosomes obtained from the plasma and adipose tissue of participants with metabolically unhealthy obesity before and after 10% weight loss will be tested in cultured cells and mice to determine their effect on insulin sensitivity.
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary Outcome Measure Information:
Title
Differences in the content of microRNAs within exosomes obtained from plasma and adipose tissue
Description
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be analyzed to determine their microRNA composition.
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Title
Differences in the content of lipids within exosomes obtained from plasma and adipose tissue
Description
Exosomes obtained from the plasma and adipose tissue of metabolically healthy lean participants, and participants with metabolically healthy or metabolically unhealthy obesity will be analyzed to determine their lipid composition.
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Title
Changes in the content of microRNAs within exosomes obtained from plasma and adipose tissue
Description
Exosomes obtained from the plasma and adipose tissue of metabolically unhealthy obesity before and after weight loss will be analyzed to determine changes in their microRNA content after weight loss.
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Title
Changes in the content of lipids within exosomes obtained from plasma and adipose tissue
Description
Exosomes obtained from the plasma and adipose tissue of metabolically unhealthy obesity before and after weight loss will be analyzed to determine changes in their lipid content after weight loss.
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Title
Insulin sensitivity
Description
Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Title
Change in insulin sensitivity
Description
Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Title
Fat mass and fat free mass
Description
Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Title
Change in fat mass and fat free mass
Description
Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)
Time Frame
Before and after 10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Title
Abdominal adipose tissue volumes
Description
Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Title
Change in abdominal adipose tissue volumes
Description
Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Title
Intra-hepatic triglyceride content
Description
Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques
Time Frame
Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Title
Change in intra-hepatic triglyceride content
Description
Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques
Time Frame
Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Metabolically healthy lean subjects must have a BMI ≥18.5 and ≤24.9 kg/m2; Subjects with obesity must have a BMI ≥30.0 and ≤50.0 kg/m2 Metabolically healthy lean and people with metabolically healthy obesity must have intrahepatic triglyceride (IHTG) content ≤5%; fasting plasma glucose concentration <100 mg/dl, 2-hr oral glucose tolerance plasma glucose concentration <140 mg/dl, hemoglobin A 1C (HbA1c) ≤5.6% and HOMA-IR <2.5. People with metabolically unhealthy obesity must have intrahepatic triglyceride (IHTG) content ≥5.6%; HOMA-IR ≥2.5, and HbA1c 5.7%-6.4%, or fasting plasma glucose concentration ≥100 mg/dl, or 2-hr oral glucose tolerance test (OGTT) plasma glucose concentration ≥140 mg/dl. Exclusion Criteria: History of diabetes, liver disease other than NAFLD or other serious diseases, Consume excessive amounts of alcohol (>21 units/week for men and >14 units/week for women), Take medications that could affect the study outcome measures, engage in regular exercise (>120 min/week), Are pregnant or lactating
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Johanna Sonnenschein
Phone
3142731879
Email
nutritionresearch@wustl.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Beth Henk
Phone
3143628250
Email
bhenk@wustl.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dmitri Samovski, PhD
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Johanna Sonnenschein
Phone
314-273-1879
Email
nutritionresearch@wustl.edu
First Name & Middle Initial & Last Name & Degree
Beth Henk
Phone
3143628250
Email
bhenk@wustl.edu
First Name & Middle Initial & Last Name & Degree
Dmitri Samovski, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Currently there is no plan to share individual participant data.

Learn more about this trial

Small Extracellular Vesicles and Insulin Action

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