The Effect of Lifestyle-induced Hepatic Steatosis on Glucagon-stimulated Amino Acid Turnover

Non-Alcoholic Fatty Liver Disease Clinical Trial

Official title:

The Effect of Lifestyle-induced Hepatic Steatosis on Glucagon-stimulated Amino Acid Turnover

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04859322
• Other study ID #: SIRG-2
• Status: Completed
• Phase: N/A
• Start date: February 8, 2021
• Est. completion date: December 9, 2021

Study information

• Verified date: May 2023
• Source: University Hospital, Gentofte, Copenhagen
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Many patients with type 2 diabetes exhibit elevated plasma concentrations of the glucose-mobilising pancreatic hormone glucagon; i.e. hyperglucagonaemia. This contributes to the hyperglycaemic state of the patients and is considered an important component in the pathophysiology of type 2 diabetes; but the mechanisms underlying this phenomenon remain unclear. The liver constitutes the main target organ of glucagon, and studies have shown that hyperglucagonaemia goes hand in hand with hyperaminoacidaemia and that both are associated with non-alcoholic fatty liver disease (NAFLD), independently of the presence of type 2 diabetes. In line with this, several recent studies support the existence of a feedback-cycle between the liver and the pancreatic alpha cells, governed by circulating glucagon and amino acids. The investigators hypothesise that the presence of hepatic steatosis results in hepatic glucagon resistance at the level of amino acid turnover, i.e. impaired glucagon-induced suppression of circulating amino acid concentrations. If this hypothesis proves correct, it would establish build-up of fat in the liver as a core mechanism underlying hyperglucagonaemia and, since the hyperglucagonemia is at least partly responsible for the fasting hyperglycaemia, as an important contributor to the hyperglycaemia of type 2 diabetes.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: December 9, 2021
• Est. primary completion date: December 9, 2021
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Male
• Age group: 20 Years to 65 Years

Eligibility

Inclusion Criteria:

• Normal fasting plasma glucose and glycated haemoglobin (HbA1c) <42 mmol/mol
• Body mass index (BMI) between 18.5 and 25 kg/m2
• Haemoglobin >8.3 mmol/l
• Habitual diet in accordance with the Nordic Nutrition Recommendations
• Age between 20 and 65 years
• Oral and written informed consent

Exclusion Criteria:

• Diabetes
• First-degree relatives with diabetes
• Fasting plasma triacylglycerol indicating dyslipidemia (=2 mmol/l)
• Nephropathy (estimated glomerular filtration rate (eGFR) <60 ml/min and/or microalbuminuria with an albumin to creatinine ratio of 30-300 µg/mg)
• Known liver disease and/or alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) >2 × normal values
• Signs of liver fibrosis and/or steatosis evaluated by FibroScan (CAP value >2380 dB/m and/or kPa >65.0) and/or FIB-4 score (>1.45)
• >5% steatosis evaluated by MRI carried out before experimental Day A (see Methods)
• Use of medication
• Use of dietary protein supplementation or any other dietary supplements that cannot be paused during participation
• Excessive training habits, defined as >2 weekly strength and/or aerobic training sessions
• Pregnancy and/or breastfeeding
• Implanted metal objects incompatible with magnetic resonance imaging (MRI)
• Any condition that the investigator feels would interfere with trial completion

Related Conditions & MeSH terms

• Fatty Liver
• Liver Diseases
• Non-Alcoholic Fatty Liver Disease

Intervention

Drug:
• Glucagon
Pancreatic clamp

Locations

Country	Name	City	State
Denmark	Center for Clinical Metabolic Research	Hellerup	Copenhagen

Sponsors (6)

Lead Sponsor

Collaborator

Malte Palm Suppli, MD

Clinical Metabolomics Core Facility, Department of Clinical, Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, Department of Biomedical Sciences & NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health, and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark

Country where clinical trial is conducted

Denmark, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Nadir of the total amino acid concentration during a two-hour high physiological glucagon infusion during a pancreatic clamp with somatostatin	micromol/liter	depending on the nadir between time 60 minutes and time 180 minutes
Secondary	average slope of the curve describing the change in the total amino acid concentration during 'supraphysiological' glucagon infusion	micromol/liter/minute	between time 60 minutes and time 180 minutes
Secondary	the incremental area under the curve (iAUC) for total amino acid concentrations during 'supraphysiological' glucagon infusion	micromol/liter	between time 60 minutes and time 180 minutes
Secondary	the percentage change in amino acid concentration during the last hour of the 'supraphysiological' glucagon infusion as assessed by baseline subtracted AUC	micromol/liter	between time 60 minutes and time 180 minutes