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Sex Differences in Myocardial Steatosis Induced Left Ventricular Dysfunction

Primary Purpose

Heart Diseases, Left Ventricular Dysfunction

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Estradiol patch
Cetrotide
Fasting
Lower Body Negative Pressure
Sponsored by
The University of Texas at Arlington
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Heart Diseases focused on measuring myocardial steatosis, fasting, estrogen, biological sex as a variable

Eligibility Criteria

18 Years - 30 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • blood pressure <140/90 mmHg
  • BMI between 18.5 and 30 kg/m2
  • sedentary or recreationally active (<3 days of vigorous aerobic exercise each week)
  • no use of oral contraceptives hormone therapy, or other medications that might influence cardiovascular function
  • nonsmokers.

Exclusion Criteria:

  • Women will be excluded with

    1. history of or active estrogen-dependent neoplasms, acute liver or gallbladder disease, vaginal bleeding, venous thromboembolism, hypertriglyceridemia, and CVD
    2. known allergy to transdermal patch, GnRHant (i.e., hypersensitivity to cetrorelix, extrinsic peptide hormones, mannitol, GnRH, benzyl alcohol - the vehicle for injection of cetrorelix)
    3. history of stomach ulcer or bleeding
    4. other contraindications to hormone replacement therapy or GnRHant, (i.e., taking Levodopa, medications that can inhibit folate metabolism including methotrexate).

Other conditions for which individuals will be excluded from the study include:

diabetes active infection history of seizures or disease that affects the nervous system sepsis an abnormal resting ECG contraindications to MRI pregnant or planning to become pregnant smoking history illicit drug use (excluding occasional marijuana).

Sites / Locations

  • University of Texas at ArlingtonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Fasting only

LBNP Only

Estrogen add back with GnRHant

Placebo add back with GnRHant

Arm Description

To acutely elevate myocardial triglyceride content, subjects will be asked to abstain from eating for 2 days (reproducibly causes a significant and physiological increase in myocardial fat deposition, transiently). Subjects will be allowed water and/or an isotonic saline solution in order to maintain hydration status.

Subjects undergo lower body negative pressure at 40 mmHg.

Subjects are given estradiol patch.

Subjects are given placebo patch.

Outcomes

Primary Outcome Measures

Change in left ventricular relaxation rate
Measured at each of the 4 MRIs by tissue tagging
Comprehensive plasma lipidomics
Measured from blood drawn at each of the 4 MRIs

Secondary Outcome Measures

Full Information

First Posted
December 3, 2020
Last Updated
March 15, 2023
Sponsor
The University of Texas at Arlington
Collaborators
University of Texas Southwestern Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT04671966
Brief Title
Sex Differences in Myocardial Steatosis Induced Left Ventricular Dysfunction
Official Title
Mechanism and Modulation of Sex Differences in Myocardial Steatosis Induced Left Ventricular Dysfunction
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 13, 2018 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The University of Texas at Arlington
Collaborators
University of Texas Southwestern Medical Center

4. Oversight

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

5. Study Description

Brief Summary
To test the specific research questions, healthy men and age-matched healthy premenopausal females will be enrolled. Subjects will undergo cardiac magnetic resonance imaging and spectroscopy (MRI/MRS) to evaluate cardiac morphology/function and fat metabolism. To acutely elevate myocardial triglyceride content, subjects will be asked to abstain from eating for 2 days (reproducibly causes a significant and physiological increase in myocardial fat deposition, transiently). Subjects will be allowed water and/or an isotonic saline solution in order to maintain hydration status. After screening, subjects will meet with the research coordinator or an investigator for a discussion, with opportunity for questions, before applicable consent forms are obtained. The subject will be screened for metal in or on their body and claustrophobia using a standard MR screening form. A venous blood sample will be taken for measurement of metabolic health, circulating hormones, and systemic inflammation. Imaging will include cine imaging for global morphology and function, tissue tagging for regional tissue deformation, spectroscopy for fat quantification. After baseline images of the heart are obtained, the subject will be asked to squeeze a MR-safe handgrip dynamometer at 30% of their maximum while images of the heart are obtained. Blood pressure will also be measured at rest and during stress. Each MRI will take approximately 90-120 minutes. Aim 1 will test the hypothesis that cardiac steatosis induced left ventricular dysfunction is sexually dimorphic, by comparing age-matched men and premenopausal women before and after 48 of fasting. Subjects will complete the MRI/MRS protocol described above before and after the fasting intervention. Aim 2 will test the hypothesis that estrogen is protective against cardiac steatosis-induced dysfunction, by suppressing ovarian sex hormones with a GnRH antagonist and repeating the fasting studies with and without estrogen add-back. 30 female subjects will be treated with GnRH antagonist and repeat the 48 hour fasting intervention and cardiac MRI/MRS protocol. 15 of the subjects will receive estrogen add-back using a transdermal patch, the other 15 subjects will receive a placebo patch. Aim 3 will test whether plasma and myocardial fatty acid composition is sexually dimorphic, by performing comprehensive plasma and myocardial lipidomics assessment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Heart Diseases, Left Ventricular Dysfunction
Keywords
myocardial steatosis, fasting, estrogen, biological sex as a variable

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Subjects are studied (bloods and MRI) before and after intervention (2 day fast or 2 day fast with GnRH antagonist and estrogen add back).
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Fasting only
Arm Type
Experimental
Arm Description
To acutely elevate myocardial triglyceride content, subjects will be asked to abstain from eating for 2 days (reproducibly causes a significant and physiological increase in myocardial fat deposition, transiently). Subjects will be allowed water and/or an isotonic saline solution in order to maintain hydration status.
Arm Title
LBNP Only
Arm Type
Experimental
Arm Description
Subjects undergo lower body negative pressure at 40 mmHg.
Arm Title
Estrogen add back with GnRHant
Arm Type
Experimental
Arm Description
Subjects are given estradiol patch.
Arm Title
Placebo add back with GnRHant
Arm Type
Experimental
Arm Description
Subjects are given placebo patch.
Intervention Type
Drug
Intervention Name(s)
Estradiol patch
Intervention Description
Brand name Climara for estrogen add back portion of study. Premenopausal women treated with a GnRH antagonist will be randomized to estrogen add-back or placebo. Thus, for women without contradictions to estrogen use, the risks associated with their use for the duration proposed in these studies (i.e., 6 days) are small. The respective estradiol regimen is a standard approved dose for treatment of hot flashes and the prevention of osteoporosis, and this dose will increase E2 to concentrations typically observed during the mid to late follicular phase of the menstrual cycle.
Intervention Type
Drug
Intervention Name(s)
Cetrotide
Intervention Description
Premenopausal women will be treated with the gonadotropin-releasing hormone (GnRH) antagonist Cetrorelix for 6 days in order to suppress ovarian sex hormones. Cetrorelix may cause an anaphylactic reaction in volunteers with hypersensitivity to cetrorelix, GnRH or any other GnRH analogs, or extrinsic peptide hormones or mannitol. It may also cause hot flashes, headaches, and nausea. These are typically transient and of mild intensity. These effects are all reversible upon cessation of cetrorelix. Absence of pregnancy will be confirmed before drug administration.
Intervention Type
Other
Intervention Name(s)
Fasting
Intervention Description
Subjects will abstain from food for 48 hours. Subjects will be allowed water and/or an isotonic saline solution in order to maintain hydration status.
Intervention Type
Other
Intervention Name(s)
Lower Body Negative Pressure
Other Intervention Name(s)
LBNP
Intervention Description
This test simulates Earth's gravity. The subject will rest on his/her back, with their lower body sealed in an air-tight chamber from the waist down. The chamber is connected to a vacuum that sucks air from the chamber and creates negative pressure inside and around the subject's lower body. As a result, the subject's blood pool shifts towards their legs, away from their chest and arms.
Primary Outcome Measure Information:
Title
Change in left ventricular relaxation rate
Description
Measured at each of the 4 MRIs by tissue tagging
Time Frame
1 week
Title
Comprehensive plasma lipidomics
Description
Measured from blood drawn at each of the 4 MRIs
Time Frame
1 week

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: blood pressure <140/90 mmHg BMI between 18.5 and 30 kg/m2 sedentary or recreationally active (<3 days of vigorous aerobic exercise each week) no use of oral contraceptives hormone therapy, or other medications that might influence cardiovascular function nonsmokers. Exclusion Criteria: Women will be excluded with history of or active estrogen-dependent neoplasms, acute liver or gallbladder disease, vaginal bleeding, venous thromboembolism, hypertriglyceridemia, and CVD known allergy to transdermal patch, GnRHant (i.e., hypersensitivity to cetrorelix, extrinsic peptide hormones, mannitol, GnRH, benzyl alcohol - the vehicle for injection of cetrorelix) history of stomach ulcer or bleeding other contraindications to hormone replacement therapy or GnRHant, (i.e., taking Levodopa, medications that can inhibit folate metabolism including methotrexate). Other conditions for which individuals will be excluded from the study include: diabetes active infection history of seizures or disease that affects the nervous system sepsis an abnormal resting ECG contraindications to MRI pregnant or planning to become pregnant smoking history illicit drug use (excluding occasional marijuana).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
manall jaffery, MS
Phone
14694264030
Email
manalljaffery@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
michael nelson, PhD
Organizational Affiliation
University of Texas at Arlington
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Texas at Arlington
City
Arlington
State/Province
Texas
ZIP/Postal Code
76019
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
manall jaffery, MS
Phone
469-426-4030
Email
manall.jaffery@uta.edu
First Name & Middle Initial & Last Name & Degree
michael nelson, PhD
Phone
8175130383
Email
michael.nelson3@uta.edu
First Name & Middle Initial & Last Name & Degree
michael nelson, PhD

12. IPD Sharing Statement

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Sex Differences in Myocardial Steatosis Induced Left Ventricular Dysfunction

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