Identifying Therapeutic Targets of Accelerated Sarcopenia

Diabetes Mellitus Clinical Trial

Official title:

Identifying Therapeutic Targets of Accelerated Sarcopenia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03118050
• Other study ID #: 15-0229
• Secondary ID: R01AG049611
• Status: Completed
• Phase: N/A
• Start date: May 28, 2017
• Est. completion date: August 21, 2023

Study information

• Verified date: December 2023
• Source: The University of Texas Medical Branch, Galveston
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The proposed research is designed to identify the mechanisms that can accelerate loss of muscle size, strength and physical function in type 2 diabetes and with hospitalization in older persons. About ⅓ of older Americans have type 2 diabetes, and about ⅓ of the hospitalizations in the USA involve persons older than 65 year of age. The proposed research is relevant to the part of NIH's mission that pertains to development of the fundamental knowledge that will improve health and reduce the burdens of disability, because this work will provide the fundamental evidence to identify new targets for the development of innovative treatments to slow down muscle loss and disability in our aging society.

Description:

Sarcopenia is a major contributor to frailty and increases the risk of falls, physical dependence, disability and mortality in older adults. It advances slowly with healthy aging. However, diseases or other insults and injuries can accelerate sarcopenia and lead to catastrophic declines in mobility and independence. For example, chronic diseases such as Type 2 Diabetes Mellitus (T2DM) are associated with accelerated loss of muscle mass and function in seniors; hospitalization with bed rest inactivity acutely accelerates sarcopenia. What it is not know is how concurrent diseases, inactivity or other insults and injuries accelerate sarcopenia in older adults. This knowledge gap hinders the development of innovative, targeted treatments for this disabling condition. The objective of this research is to examine the basic mechanisms that underlie accelerated sarcopenia in older adults and identify potential targets for interventions. The central hypothesis is that a global and fundamental mechanism of acute or chronic acceleration of sarcopenia is a reduction in skeletal muscle amino acid transport, which decreases muscle protein anabolism, and can be reversed by activation of the mammalian/mechanistic Target of Rapamycin Complex 1 (mTORC1) signaling with a non-amino acid stimulus, such as exercise. Amino acid transport is an active process that controls intracellular amino acid availability and the activation of protein synthesis in skeletal muscle. It is regulated by amino acid concentrations and non-amino acid stimuli that activate mTORC1 signaling, such as resistance exercise and insulin.The central hypothesis will be tested with the following specific aims: 1) Determine the effect of T2DM on the sensitivity of skeletal muscle amino acid transport to dietary amino acids. 2) Determine the effect of short-term bed rest inactivity on the sensitivity of skeletal muscle amino acid transport to dietary amino acids. 3) Determine the effect of resistance exercise on the sensitivity of amino acid transport to dietary amino acids in acute and chronic accelerated sarcopenia induced by inactivity or T2DM. Amino acid transport and protein metabolism in muscle will be measured using integrative molecular, imaging and stable isotope methodologies, identifying specific upstream regulators involved in the anabolic resistance of accelerated sarcopenia that can be targeted with novel treatments to reduce sarcopenia and improve independence in older adults.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 95
• Est. completion date: August 21, 2023
• Est. primary completion date: August 21, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 60 Years to 85 Years

Eligibility

Inclusion Criteria:

• Body mass index: <40 kg/sq meter

• Score =26 on the 30-item Mini Mental State Examination

• Stable body weight for at least 3 months

• Non-diabetic or with Type 2 Diabetes Mellitus

Exclusion Criteria:

• Pre-diabetes per American Diabetes Association criteria

• Insulin therapy, significant diabetic complications, or A1c>8%

• Impairment in Activities of Daily Living

• >2 falls/year

• weight loss >5% in the past 6 months

• Exercise training (=2 sessions/week) or =10,000 steps/day

• Significant cardiovascular, liver, renal, blood, or respiratory disease

• Active cancer or infection

• Recent (within 3 months) treatment with anabolic steroids, systemic corticosteroids or estrogen.

• Alcohol or drug abuse

Related Conditions & MeSH terms

• Aging
• Diabetes Mellitus
• Sarcopenia

Intervention

Behavioral:
• Resistance exercise training
Supervised resistance exercise training, 3 times a week for 3 months
• Bed rest
Bed rest for 5 days, followed by standard rehabilitation for 2 days
• Intensive physical therapy
Intensive weight bearing PT, daily, during bed rest

Locations

Country	Name	City	State
United States	Sealy Center on Aging, University of Texas Medical Branch	Galveston	Texas

Sponsors (2)

Lead Sponsor	Collaborator
The University of Texas Medical Branch, Galveston	National Institute on Aging (NIA)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Amino acid transporter expression	Measurement of change in amino acid transporter expression	Change from baseline to up to 3 months
Secondary	Leg lean mass	Measurement of change in leg lean mass by DEXA	Change from baseline to up to 3 months
Secondary	Knee extension strength	Measurement of change in maximum strength by standard method	Change from baseline to up to 3 months
Secondary	Muscle protein synthesis	Measurement of change in muscle protein synthesis by standard stable isotope methodology	Change from baseline to up to 3 months