Effects of Niacin on Intramyocellular Fatty Acid Trafficking in Upper Body Obesity and Type 2 Diabetes Mellitus

Obesity Clinical Trial

Official title:

Effects of Niacin on Intramyocellular Fatty Acid Trafficking in Upper Body Obesity and Type 2 Diabetes Mellitus

Clinical Trial Details — Status: Suspended

Administrative data

• NCT number: NCT03867500
• Other study ID #: 17-009977
• Secondary ID: 5R01DK045343-27
• Status: Suspended
• Phase: Early Phase 1
• Start date: November 1, 2018
• Est. completion date: July 2024

Study information

• Verified date: April 2023
• Source: Mayo Clinic
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Muscle insulin resistance is a hallmark of upper body obesity (UBO) and Type 2 diabetes (T2DM). It is unknown whether muscle free fatty acid (FFA) availability or intramyocellular fatty acid trafficking is responsible for the abnormal response to insulin. Likewise, the investigators do not understand to what extent the incorporation of FFA into ceramides or diacylglycerols (DG) affect insulin signaling and muscle glucose uptake. The investigators will measure muscle FFA storage into intramyocellular triglyceride, intramyocellular fatty acid trafficking, activation of the insulin signaling pathway and glucose disposal rates under both saline control (high overnight FFA) and after an overnight infusion of intravenous niacin (lower/normal FFA) to provide the first integrated examination of the interaction between FFA and muscle insulin action from the whole body to the cellular/molecular level. By identifying which steps in the insulin signaling pathway are most affected, the investigators will determine the site-specific effect of ceramides and/or DG on different degrees of insulin resistance.

Hypothesis 1: Greater trafficking of plasma FFA into intramyocellular DG will impair proximal insulin signaling and reduce muscle glucose uptake.

Hypothesis 2: Lowering FFA in UBO and T2DM by using an intravenous infusion of niacin will alter trafficking of plasma FFA into intramyocellular ceramides in a way that will improve insulin signaling and increase muscle glucose uptake.

Hypothesis 3: Lowering FFA in UBO and T2DM by using an intravenous infusion of niacin will alter trafficking of plasma FFA into intramyocellular DG in a way that will improve insulin signaling and increase muscle glucose uptake.

Recruitment information / eligibility

• Status: Suspended
• Enrollment: 20
• Est. completion date: July 2024
• Est. primary completion date: July 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 55 Years

Eligibility

Inclusion criteria:

• Women and Men (Women premenopausal)

• BMI 29-37

• Weight stable

• Not pregnant/nursing

Exclusion criteria:

• Ischemic heart disease

• Atherosclerotic valvular disease

• Smokers (>20 cigarettes per week)

• Bilateral oophorectomy

• Concomitant use of medications that can alter serum lipid profile:

• High dose fish oil (>3g per day),

• STATINS (if yes hold for 6 weeks and receive PCP's approval),

• Niacin

• Fibrates

• thiazolidinediones

• Beta-blockers

• Atypical antipsychotics

• Lidocaine or Niacin/Niaspan allergy

• Subjects with 1.5 times upper limit of normal of serum creatinine, Alkaline phosphatase, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) unless participant has fatty liver disease, Total bilirubin (unless the patient has documented Gilbert's syndrome)

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Obesity
• Type 2 Diabetes Mellitus

Intervention

Drug:
• Niacin
All participants will receive intravenous Niacin and each participant will serve as their own saline control on the second study

Other:
• Saline
All participants will serve as their own controls with a saline infusion study day.

Locations

Country	Name	City	State
United States	Mayo Clinic in Rochester	Rochester	Minnesota

Sponsors (2)

Lead Sponsor	Collaborator
Mayo Clinic	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Difference in insulin-stimulated glucose disposal between overnight saline control study and overnight/insulin clamp niacin infusion study.	Glucose disposal rates will be measured in upper body obese and type 2 diabetic volunteers using hyperinsulinemic, euglycemic clamp under saline control conditions and during an intravenous infusion of niacin. Blood, muscle and fat samples will be collected on both study days, the first after an intravenous infusion of C13-labelled palmitate to measure enrichment in plasma palmitate and intramyocellular ceramides, diacylglycerols, long-chain acylcarnitines, and triglycerides under fasting conditions. The second biopsies will be at the end of the insulin clamp during which the volunteers will receive an intravenous infusion of D-9 palmitate to all enrichment measures during the insulin clamp. Measures of the insulin signaling (and other) pathway(s) will be made on both muscle and adipose biopsy samples collected on both study days. Adipose samples will be processed to measure morphology and function of adipocytes.	18 hours
Primary	Difference in insulin-stimulated phosphorylation of insulin-responsive signaling molecules between overnight saline control study and overnight/insulin clamp niacin infusion study.	Glucose disposal rates will be measured in upper body obese and type 2 diabetic volunteers using hyperinsulinemic, euglycemic clamp under saline control conditions and during an intravenous infusion of niacin. Blood, muscle and fat samples will be collected on both study days, the first after an intravenous infusion of C13-labelled palmitate to measure enrichment in plasma palmitate and intramyocellular ceramides, diacylglycerols, long-chain acylcarnitines, and triglycerides under fasting conditions. The second biopsies will be at the end of the insulin clamp during which the volunteers will receive an intravenous infusion of D-9 palmitate to all enrichment measures during the insulin clamp. Measures of the insulin signaling (and other) pathway(s) will be made on both muscle and adipose biopsy samples collected on both study days. Adipose samples will be processed to measure morphology and function of adipocytes.	18 hours
Primary	Difference in incorporation of 13-palmitate and D9-palmitate into intramyocellular lipid intermediates between overnight saline control study and overnight/insulin clamp niacin infusion study.	Glucose disposal rates will be measured in upper body obese and type 2 diabetic volunteers using hyperinsulinemic, euglycemic clamp under saline control conditions and during an intravenous infusion of niacin. Blood, muscle and fat samples will be collected on both study days, the first after an intravenous infusion of C13-labelled palmitate to measure enrichment in plasma palmitate and intramyocellular ceramides, diacylglycerols, long-chain acylcarnitines, and triglycerides under fasting conditions. The second biopsies will be at the end of the insulin clamp during which the volunteers will receive an intravenous infusion of D-9 palmitate to all enrichment measures during the insulin clamp. Measures of the insulin signaling (and other) pathway(s) will be made on both muscle and adipose biopsy samples collected on both study days. Adipose samples will be processed to measure morphology and function of adipocytes.	18 hours
Secondary	Effects of niacin on adipocyte lipolysis proteins	Glucose disposal rates will be measured in upper body obese and type 2 diabetic volunteers using hyperinsulinemic, euglycemic clamp under saline control conditions and during an intravenous infusion of niacin. Blood and fat samples will be collected on both study days, the first after an intravenous infusion of C13-labelled palmitate and the second at the end of the insulin clamp during which the volunteers will receive an intravenous infusion of D-9 palmitate during the insulin clamp. Measures of the insulin signaling (and other) pathway(s) will be made on both adipose biopsy samples collected on both study days. Adipose samples will be processed to measure morphology and function of adipocytes. We will measure the phosphorylation of insulin-regulated and niacin-regulated lipolysis proteins on both study days and on both adipose biopsies.	18 hours

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