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Exercise-mediated Rescue of Mitochondrial Dysfunctions Driving Insulin Resistance (EX-MITO-DYS-IR)

Primary Purpose

Mitochondrial Myopathies, Mitochondrial Diseases, Mitochondrial Disorders

Status
Recruiting
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
High-intensity exercise training
Sponsored by
Rigshospitalet, Denmark
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Mitochondrial Myopathies focused on measuring Mitochondrial disease, Muscle metabolism, Insulin resistance, Exercise training, Mitochondrial dysfunction

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Known m.3243A>G mutation in the MT-TL1 gene encoding the mitochondrial leucyl-tRNA 1 gene Other known mtDNA point mutations Exclusion Criteria: Use of antiarrhythmic medications or other medications which, in the opinion of the investigators, have the potential to affect outcome measures. Diagnosed severe heart disease, dysregulated thyroid gland conditions, or other dysregulated endocrinopathies, or other conditions which, in the opinion of the investigators, have the potential to affect outcome measures. Pregnancy

Sites / Locations

  • RigshospitaletRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Exercise leg

Control leg

Arm Description

High-intensity exercise training for one leg

No exercise training for the controlateral leg

Outcomes

Primary Outcome Measures

Skeletal muscle insulin sensitivity
Insulin-stimulated muscle glucose uptake is determined by the hyperinsulinemic-euglycemic clamp method integrated with measurements of femoral artery blood flow and arteriovenous difference of glucose
Muscle mitochondrial respiration
Mitochondrial O2 flux is measured by high-resolution respirometry in permeabilized fibers from muscle biopsy samples
Muscle mitochondrial reactive oxygen species (ROS) production
Mitochondrial H2O2 emission rates are measured by high-resolution fluorometry in permeabilized fibers from muscle biopsy samples
Muscle mitochondrial proteome
Mitochondrial proteome signatures are determined by mass spectrometry-based proteomics in muscle biopsy samples

Secondary Outcome Measures

Muscle mtDNA heteroplasmy
mtDNA mutation load is measured in muscle biopsy samples from the patients with mitochondrial myopathy
Muscle insulin signaling
Insulin-mediated changes in the abundance of (phosphorylated) proteins modulating insulin action are measured by immunoblotting in muscle and fat biopsy samples
Muscle integrated stress response signaling proteins
Abundance of (phosphorylated) proteins governing the integrated stress response pathway is measured by immunoblotting in muscle biopsy samples.
Muscle integrated stress response genes
mRNA content of genes governing the integrated stress response pathway is measured by Real-Time PCR in muscle biopsy samples.
Muscle release of FGF21 and GDF15
Skeletal muscle production of FGF21 and GDF15 is determined by measurements of femoral artery blood flow and arteriovenous difference of plasma FGF21 and GDF15
Whole-body insulin sensitivity
Whole-body insulin sensitivity is determined by the hyperinsulinemic-euglycemic clamp method

Full Information

First Posted
September 29, 2023
Last Updated
October 16, 2023
Sponsor
Rigshospitalet, Denmark
Collaborators
University of Copenhagen
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1. Study Identification

Unique Protocol Identification Number
NCT06080594
Brief Title
Exercise-mediated Rescue of Mitochondrial Dysfunctions Driving Insulin Resistance
Acronym
EX-MITO-DYS-IR
Official Title
Exercise-mediated Rescue of Mitochondrial Derangements Driving Insulin Resistance in Humans (EX-MITO-DYS-IR)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 2023 (Anticipated)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Rigshospitalet, Denmark
Collaborators
University of Copenhagen

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
The overarching aim of this intervention study is to interrogate the interconnection between the muscle mitochondrial adaptations and the changes in muscle insulin sensitivity elicited by exercise training in individuals harbouring pathogenic mitochondrial DNA mutations associated with an insulin-resistant phenotype. In a within-subject parallel-group longitudinal design, participants will undergo an exercise training intervention with one leg, while the contralateral leg will serve as an inactive control. After the exercise intervention, patients will attend an experimental trial including: A hyperinsulinemic-euglycemic clamp combined with measurements of femoral artery blood flow and arteriovenous difference of glucose Muscle biopsy samples
Detailed Description
Background: Peripheral insulin resistance is a major risk factor for metabolic diseases such as type 2 diabetes. Skeletal muscle accounts for the majority of insulin-stimulated glucose disposal, hence restoring insulin action in skeletal muscle is key in the prevention of type 2 diabetes. Mitochondrial dysfunction is implicated in the etiology of muscle insulin resistance. Also, as mitochondrial function is determined by its proteome quantity and quality, alterations in the muscle mitochondrial proteome may play a critical role in the pathophysiology of insulin resistance. However, insulin resistance is multifactorial in nature and whether mitochondrial derangements are a cause or a consequence of impaired insulin action is unclear. In recent years, the study of humans with genetic mutations has shown enormous potential to establish the mechanistic link between two physiological variables; indeed, if the mutation has a functional impact on one of those variables, then the direction of causality can be readily ascribed. Mitochondrial myopathies are genetic disorders of the mitochondrial respiratory chain affecting predominantly skeletal muscle. Mitochondrial myopathies are caused by pathogenic mutations in either nuclear or mitochondrial DNA (mtDNA), which ultimately lead to mitochondrial dysfunction. Although the prevalence of mtDNA mutations is just 1 in 5,000, the study of patients with mtDNA defects has the potential to provide unique information on the pathogenic role of mitochondrial derangements that is disproportionate to the rarity of affected individuals. The m.3243A>G mutation in the MT-TL1 gene encoding the mitochondrial leucyl-tRNA 1 gene is the most common mutation leading to mitochondrial myopathy in humans. The m.3243A>G mutation is associated with impaired glucose tolerance and insulin resistance in skeletal muscle. Most importantly, insulin resistance precedes impairments of β-cell function in carriers of the m.3243A>G mutation, making these patients an ideal human model to study the causative nexus between muscle mitochondrial dysfunction and insulin resistance. Exercise training is a potent stimulus to enhance muscle insulin action, improve mitochondrial function, and promote mitochondrial proteome remodeling. Accordingly, rescue of mitochondrial dysfunction has been proposed to play a role in the insulin-sensitizing effect of exercise. Yet, numerous mechanisms may contribute to the pathophysiology of insulin resistance and the beneficial effects of exercise may be linked to amelioration of multiple factors, thus challenging the interpretation of the functional significance of improved muscle mitochondrial function per se. Nevertheless, since mitochondrial dysfunction is likely the primary cause of muscle insulin resistance in carriers of the m.3243A>G mutation, prospective studies including an in-depth analysis of the mitochondrial adaptations elicited by exercise training in this cohort of patients may offer a unique opportunity to identify those mitochondrial derangements that, once rescued, drive enhancements in insulin sensitivity. Objective: To study the effects of exercise training on muscle insulin sensitivity, muscle mitochondrial function, and the muscle mitochondrial proteome in individuals harboring pathogenic mitochondrial DNA (mtDNA) mutations associated with an insulin-resistant phenotype. Study design: Within-subject parallel-group longitudinal study in individuals with pathogenic mtDNA mutations undergoing an exercise training intervention with one leg (contralateral leg as inactive control). Endpoint: Differences between the trained and the untrained leg.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mitochondrial Myopathies, Mitochondrial Diseases, Mitochondrial Disorders
Keywords
Mitochondrial disease, Muscle metabolism, Insulin resistance, Exercise training, Mitochondrial dysfunction

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
In a within-subject parallel-group longitudinal design, participants sustain an exercise training intervention with one leg, while the contralateral leg serves as an inactive control.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Exercise leg
Arm Type
Experimental
Arm Description
High-intensity exercise training for one leg
Arm Title
Control leg
Arm Type
No Intervention
Arm Description
No exercise training for the controlateral leg
Intervention Type
Behavioral
Intervention Name(s)
High-intensity exercise training
Other Intervention Name(s)
High-intensity interval training
Intervention Description
Eight sessions of high-intensity knee extensor exercise are conducted on separate days over a 2-week period.
Primary Outcome Measure Information:
Title
Skeletal muscle insulin sensitivity
Description
Insulin-stimulated muscle glucose uptake is determined by the hyperinsulinemic-euglycemic clamp method integrated with measurements of femoral artery blood flow and arteriovenous difference of glucose
Time Frame
90-150 minutes after initiation of a hyperinsulinemic euglycemic clamp
Title
Muscle mitochondrial respiration
Description
Mitochondrial O2 flux is measured by high-resolution respirometry in permeabilized fibers from muscle biopsy samples
Time Frame
Baseline
Title
Muscle mitochondrial reactive oxygen species (ROS) production
Description
Mitochondrial H2O2 emission rates are measured by high-resolution fluorometry in permeabilized fibers from muscle biopsy samples
Time Frame
Baseline
Title
Muscle mitochondrial proteome
Description
Mitochondrial proteome signatures are determined by mass spectrometry-based proteomics in muscle biopsy samples
Time Frame
Baseline
Secondary Outcome Measure Information:
Title
Muscle mtDNA heteroplasmy
Description
mtDNA mutation load is measured in muscle biopsy samples from the patients with mitochondrial myopathy
Time Frame
Baseline
Title
Muscle insulin signaling
Description
Insulin-mediated changes in the abundance of (phosphorylated) proteins modulating insulin action are measured by immunoblotting in muscle and fat biopsy samples
Time Frame
Before (baseline) and 150 minutes after initiation of the hyperinsulinemic-euglycemic clamp
Title
Muscle integrated stress response signaling proteins
Description
Abundance of (phosphorylated) proteins governing the integrated stress response pathway is measured by immunoblotting in muscle biopsy samples.
Time Frame
Baseline
Title
Muscle integrated stress response genes
Description
mRNA content of genes governing the integrated stress response pathway is measured by Real-Time PCR in muscle biopsy samples.
Time Frame
Baseline
Title
Muscle release of FGF21 and GDF15
Description
Skeletal muscle production of FGF21 and GDF15 is determined by measurements of femoral artery blood flow and arteriovenous difference of plasma FGF21 and GDF15
Time Frame
Before (baseline) and 0-150 minutes after initiation of the hyperinsulinemic-euglycemic clamp
Title
Whole-body insulin sensitivity
Description
Whole-body insulin sensitivity is determined by the hyperinsulinemic-euglycemic clamp method
Time Frame
90-150 minutes after initiation of a hyperinsulinemic euglycemic clamp
Other Pre-specified Outcome Measures:
Title
Leg muscle mass
Description
Leg muscle mass is determined by dual-energy X-ray absorptiometry
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Known m.3243A>G mutation in the MT-TL1 gene encoding the mitochondrial leucyl-tRNA 1 gene Other known mtDNA point mutations Exclusion Criteria: Use of antiarrhythmic medications or other medications which, in the opinion of the investigators, have the potential to affect outcome measures. Diagnosed severe heart disease, dysregulated thyroid gland conditions, or other dysregulated endocrinopathies, or other conditions which, in the opinion of the investigators, have the potential to affect outcome measures. Pregnancy
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Matteo Fiorenza, Ph.D.
Phone
+4535458748
Email
matteo.fiorenza@regionh.dk
First Name & Middle Initial & Last Name or Official Title & Degree
Tue Leth Nielsen, MD
Phone
+4535458748
Email
tue.leth.nielsen.01@regionh.dk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matteo Fiorenza, Ph.D.
Organizational Affiliation
Rigshospitalet, Denmark
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John Vissing, MD
Organizational Affiliation
Rigshospitalet, Denmark
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rigshospitalet
City
Copenhagen
ZIP/Postal Code
2100
Country
Denmark
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tue Leth Nielsen, MD
Phone
+4535458748
Email
tue.leth.nielsen.01@regionh.dk

12. IPD Sharing Statement

Plan to Share IPD
No
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Exercise-mediated Rescue of Mitochondrial Dysfunctions Driving Insulin Resistance

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