Small Extracellular Vesicles and Insulin Action

Obesity Clinical Trial

— SEV  

Official title:

Effect of Small Extracellular Vesicles From Adipose Tissue on Insulin Action

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05933707
• Other study ID #: 202005117
• Status: Recruiting
• Phase: N/A
• Start date: June 14, 2023
• Est. completion date: December 2028

Study information

• Verified date: July 2023
• Source: Washington University School of Medicine
• Contact: Johanna Sonnenschein
• Phone: 3142731879
• Email: nutritionresearch[@]wustl.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 72
• Est. completion date: December 2028
• Est. primary completion date: October 2028
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 25 Years to 55 Years

Eligibility

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

Related Conditions & MeSH terms

• Insulin Resistance
• Metabolically Healthy Obesity
• Obesity
• Obesity, Metabolically Benign

Intervention

Behavioral:
• People with Metabolically Unhealthy Obesity - Low Calorie Diet
Consumption of a low-calorie diet with caloric intake reduced by ~25% to achieve ~10% weight loss in about 4 to 5 months.

Locations

Country	Name	City	State
United States	Washington University School of Medicine	Saint Louis	Missouri

Sponsors (1)

Lead Sponsor	Collaborator
Washington University School of Medicine

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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.	Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Primary	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.	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	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.	Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Secondary	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.	Baseline only (cross-sectional comparison of metabolically healthy lean, and of people with metabolically healthy or metabolically unhealthy obesity).
Secondary	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.	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	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.	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	Insulin sensitivity	Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure	Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Secondary	Change in insulin sensitivity	Whole-body insulin sensitivity will be assessed by using the hyperinsulinemic-euglycemic clamp procedure	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	Fat mass and fat free mass	Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)	Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Secondary	Change in fat mass and fat free mass	Fat mass and fat free mass will be assessed using dual-energy x-ray absorptiometry (DXA)	Before and after 10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	Abdominal adipose tissue volumes	Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)	Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Secondary	Change in abdominal adipose tissue volumes	Abdominal subcutaneous and intra-abdominal adipose tissue volumes will be assessed by magnetic resonance imagining (MRI)	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity
Secondary	Intra-hepatic triglyceride content	Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques	Baseline only (cross-sectional comparison of metabolically healthy lean, and people with metabolically healthy or metabolically unhealthy obesity).
Secondary	Change in intra-hepatic triglyceride content	Intra-hepatic triglyceride content will be assessed by magnetic resonance techniques	Before and after ~10% weight loss (~4-5 months) in people with metabolically abnormal obesity