Healthy Clinical Trial
Official title:
Dynamic Connectivity Under Metabolic Constraints
The investigators are studying the impact of insulin resistance on the acceleration of brain
aging and testing whether increased neuron insulin resistance can be counteracted by
utilization of alternate metabolic pathways (e.g., ketones rather than glucose). This study
has three Arms, which together provide synergistic data. For all three Arms, subjects are
tested in a within-subjects design that consists of 2-3 testing sessions, 1-14 days apart,
and counter-balanced for order. Impact of fuel (glucose in one session, ketones in the other)
on brain metabolism and associated functioning is measured during each session. For Arms 1-2,
the primary experimental measure is functional magnetic resonance imaging (fMRI), which is
used to trace the self-organization of functional networks following changes in energy supply
and demand. Arm 1 tests the impact of endogenous ketones produced by switching to a low
carbohydrate diet, while Arm 2 tests the impact of exogenous ketones consumed as a
nutritional supplement. For Arm 3, simultaneous magnetic resonance
spectroscopy/positron-emission tomography (MR/PET) is used to quantify the impact of
exogenous ketones on production of glutamate and GABA, key neurotransmitters.
Subjects will be given the option to participate in more than one of the Arms, but doing so
is not expected nor required.
Prior to scans, subjects will receive a clinician-administered History and Physical (H&P),
which includes vital signs, an oral glucose tolerance test (OGTT), and the comprehensive
metabolic blood panel. These will be used to assess diabetes, kidney disease, and
electrolytes. If subjects pass screening, they will be provided the option to participate in
one or more Arms, which include neuroimaging. To provide a quantitative measure of
time-varying metabolic activity throughout the scan, based upon quantitative models of
glucose and ketone regulation, as well as to be able to implement safety stopping rules (see
below), the investigators will obtain pin-prick blood samples three times: prior to the scan,
following consumption of the glucose or ketone drink, and following completion of the scan.
To assess effects of increased metabolic demand, the investigators measure brain response to
cognitive load, transitioning from resting-state to spatial reasoning through a spatial
navigation video task. To assess effects of increased metabolic supply, the investigators
measure brain response to glucose or ketone bolus.
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