Characterizing the Incretin Effect of Amino Acids and Defining GLP-1 Role on Skeletal Muscle

NCT ID: NCT02370745

Last Updated: 2018-05-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-11-30
• Study Completion Date: 2018-03-31

Brief Summary

This study has two protocols the aims of which are:

1. To identify age-related effects of AA on incretin secretion and whether and to what extent AA exhibit a true incretin effect (gut- mediated increases in plasma insulin) in younger individuals. (Protocol 1)

2. To define the extra-pancreatic ''novel'', insulin independent effects of glucagon like peptide-1 (GLP-1) on postprandial muscle protein and glucose metabolism and microvascular blood flow. (Protocol 2)

Detailed Description

Protocol 1:

This will explore the first aim. 8 Healthy younger volunteers will be recruited to under go 3 arms cross over studies. Interventions will include oral and intravenous amino acids, in addition to intravenous GLP-1 and glucose dependent insulinotropic polypeptide (GIP).

8 older subjects also will be recruited for comparison of the response of GI hormones to amino acids oral feed between young and older men.

Therefore the total number will be recruited to perform this protocol is 16.

Post intervention in all visits, measurements will be taken for:

Insulin, Amino acids, GLP-1, GIP, Ghrelin and peptide YY (PYY).

The measurable end points for this protocol are:

1. Gut hormones levels in response to the 2 methods of AA delivery (I.V and oral)

2. Differences in gut hormones levels between young and older subjects when AA's are delivered orally

Protocol 2:

This will explore the second aim. 16 healthy older subjects will be recruited and subdivided randomly into two groups to receive either post absorptive or postprandial insulin concentrations with or without GLP-1 at physiological ranges in a cross over fashion . During acute study parameters of muscle glucose and amino acids metabolism will be tested together with muscle microvascular recruitment and macro vascular flow in the tested leg.

The measurable end points for this protocol are:

1. Muscle Glucose uptake, assessed by measuring 2-deoxyglucose (2-DOG) phosphate in muscle biopsies

2. Myofibrillar protein synthesis, assessed via muscle biopsy fractional synthesis rate (FSR)

3. Whole Leg Muscle Protein Synthesis, assessed via Arterial-Venous difference (AV method)

4. Whole Leg Muscle Protein Breakdown, assessed via AV method

5. Whole Leg Net Protein Balance, assessed via AV method

6. Muscle microvascular recruitment, assessed via microvascular contrast bubbles filling and refilling post destruction by ultrasound waves.

Conditions

Sarcopenia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: SINGLE

Study Groups

Post absorptive insulin without GLP-1

Subjects with receive post absorptive insulin concentrations while measures of muscle metabolism and microvascular blood flow are taken through the acute study hours.

The intervention in this group is Insulin Actrapid to achieve post absorptive insulin levels and glucose infusion to achieve postprandial glucose levels of 7.0-7.5 mmol/L . This will form base line measurement for the next arm which will receive GLP-1 in addition.

Group Type: EXPERIMENTAL

Insulin Actrapid

Intervention Type: DRUG

Skeletal muscle metabolic and microvascular parameters will be tested under specified insulin concentrations with or without GLP-1

Postabsorptive insulin with GLP-1

Subjects will receive post absorptive insulin concentrations with GLP-1 while measures of muscle metabolism and microvascular blood flow are taken through the acute study hours. This arm will cross over with the previous arm.

The intervention in this group is in the form of GLP-1, Insulin Actrapid to achieve post absorptive insulin levels and glucose infusion to achieve postprandial glucose levels of 7.0-7.5 mmol/L .

Group Type: EXPERIMENTAL

GLP-1

Intervention Type: DRUG

GLP-1 effects on skeletal muscle glucose and amino acid metabolism and microvascular blood flow will be scrutinised under the specified insulin concentrations. It will also be used to test the effect of intravenous feed on insulin secretion.

Insulin Actrapid

Intervention Type: DRUG

Skeletal muscle metabolic and microvascular parameters will be tested under specified insulin concentrations with or without GLP-1

Postprandial insulin without GLP-1

Subjects will receive postprandial insulin concentrations without GLP-1 while measures of muscle metabolism and microvascular blood flow are taken through the acute study hours.

The intervention in this group is Insulin Actrapid to achieve postprandial insulin levels and glucose infusion to achieve postprandial glucose levels of 7.0-7.5 mmol/L . This will form base line measurement for the next arm which will receive GLP-1 in addition

Group Type: EXPERIMENTAL

Insulin Actrapid

Intervention Type: DRUG

Skeletal muscle metabolic and microvascular parameters will be tested under specified insulin concentrations with or without GLP-1

Postprandial insulin with GLP-1

Subjects with receive postprandial insulin concentrations with GLP-1 while measures of muscle metabolism and microvascular blood flow are taken through the acute study hours. This arm will cross over with the previous arm.

The intervention in this group is in the form of GLP-1, Insulin Actrapid to achieve postprandial insulin levels and glucose infusion to achieve postprandial glucose levels of 7.0-7.5 mmol/L .

Group Type: EXPERIMENTAL

GLP-1

Intervention Type: DRUG

GLP-1 effects on skeletal muscle glucose and amino acid metabolism and microvascular blood flow will be scrutinised under the specified insulin concentrations. It will also be used to test the effect of intravenous feed on insulin secretion.

Insulin Actrapid

Intervention Type: DRUG

Skeletal muscle metabolic and microvascular parameters will be tested under specified insulin concentrations with or without GLP-1

Oral amino acids-Young

Gut hormones will be measured post oral drink containing 15 g of amino acids in young persons. This will cross over with the following 2 arms.

The intervention here is: 15g of mixed essential amino acid drink.

Group Type: EXPERIMENTAL

Oral amino acids

Intervention Type: DIETARY_SUPPLEMENT

Oral amino acids containing 15 g of amino acids

Intravenous (IV) amino acids- Young

Gut hormones will be measured after intravenous amino acid infusion delivering iso equivalent amount of amino acids in young persons.

The intervention in this group: Intravenous amino acids delivering iso-equivalent amount of 15g mixed essential amino acids

Group Type: EXPERIMENTAL

Intravenous amino acids

Intervention Type: DRUG

This will aim to deliver iso equivalent amount to the amino acids administered orally

IV amino acids, GLP-1, GIP -Young

Gut hormones will be measured after intravenous amino acid infusion delivering iso equivalent amount of amino acids, GLP-1, GIP in young persons.

The intervention in this group: Intravenous amino acids iso-equivalent to oral 15 g mixed essential amino acids, GLP-1 infusion and GIP infusion

Group Type: EXPERIMENTAL

GLP-1

Intervention Type: DRUG

GLP-1 effects on skeletal muscle glucose and amino acid metabolism and microvascular blood flow will be scrutinised under the specified insulin concentrations. It will also be used to test the effect of intravenous feed on insulin secretion.

GIP

Intervention Type: DRUG

This will be co infused with GLP-1 and intravenous amino acids

Intravenous amino acids

Intervention Type: DRUG

This will aim to deliver iso equivalent amount to the amino acids administered orally

Oral amino acids- Older

Gut hormones will be measured post oral drink containing 15 g of mixed essential amino acids in older persons.

The intervention in this arm: 15 gram of oral mixed essential amino acid drink

Group Type: EXPERIMENTAL

Oral amino acids

Intervention Type: DIETARY_SUPPLEMENT

Oral amino acids containing 15 g of amino acids

Interventions

GLP-1

GLP-1 effects on skeletal muscle glucose and amino acid metabolism and microvascular blood flow will be scrutinised under the specified insulin concentrations. It will also be used to test the effect of intravenous feed on insulin secretion.

Intervention Type: DRUG

Insulin Actrapid

Skeletal muscle metabolic and microvascular parameters will be tested under specified insulin concentrations with or without GLP-1

Intervention Type: DRUG

Oral amino acids

Oral amino acids containing 15 g of amino acids

Intervention Type: DIETARY_SUPPLEMENT

GIP

This will be co infused with GLP-1 and intravenous amino acids

Intervention Type: DRUG

Intravenous amino acids

This will aim to deliver iso equivalent amount to the amino acids administered orally

Intervention Type: DRUG

Other Intervention Names

Incretin; Actrapid; mixed EAA; Incretin; IV AA

Eligibility Criteria

Inclusion Criteria

• For protocol 1: i. Aged between 18-40 or 65-75 years ii. A body mass index (BMI) >18 and <28 kg/m2

• For Protocol 2: i. Age 65-75 years ii. A body mass index (BMI) >18 and <28 kg/m2

Exclusion Criteria

• For protocol 1:

i. A BMI < 18 or > 28 kg·m2 ii. Active cardiovascular disease: uncontrolled hypertension (BP > 160/100), angina, heart failure (class III/IV), arrhythmia, right to left cardiac shunt or recent cardiac event iii. Cerebrovascular disease: previous stroke, aneurysm (large vessel or intracranial) iv. Respiratory disease including pulmonary hypertension, chronic obstructive pulmonary disease (COPD), asthma or an forced expiratory volume in 1 minute (FEV1) less than 1.5 litre.

v. Metabolic disease: hyper and hypo-parathyroidism, untreated hyper and hypothyroidism, Cushing's disease, types 1 or 2 diabetes vi. Active inflammatory bowel or renal disease vii. Malignancy viii. Recent steroid treatment (within 6 month), or hormone replacement therapy ix. Clotting dysfunction x. Musculoskeletal or neurological disorders xi. Family history of early (<55y) death from cardiovascular disease

• For protocol 2:

Same as protocol 1 in addition to:

i. Overt muscle wasting i.e. muscle mass is more than 1 standard deviation below normal muscle or fat-free mass for age.

ii. Taking beta-adrenergic blocking agents or non-steroidal anti-inflammatory drugs iii. Known sensitivity to SONOVUE or any other drug used in the study. iv. Subject deemed unsuitable for femoral cannulation at screening visit.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: Yes

Sponsors

University of Nottingham

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Philip Atherton, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Nottingham

Iskandar Idris, DM, FRCP

Role: PRINCIPAL_INVESTIGATOR

University of Nottingham

Locations

Division of Medical Sciences and Graduate Entry Medicine - School of Medicine - University of Nottingham

Derby, , United Kingdom

Countries

United Kingdom

References

Nilsson M, Holst JJ, Bjorck IM. Metabolic effects of amino acid mixtures and whey protein in healthy subjects: studies using glucose-equivalent drinks. Am J Clin Nutr. 2007 Apr;85(4):996-1004. doi: 10.1093/ajcn/85.4.996.

Reference Type: BACKGROUND

PMID: 17413098 (View on PubMed)

Hall WL, Millward DJ, Long SJ, Morgan LM. Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite. Br J Nutr. 2003 Feb;89(2):239-48. doi: 10.1079/BJN2002760.

Reference Type: BACKGROUND

PMID: 12575908 (View on PubMed)

Wilkes EA, Selby AL, Atherton PJ, Patel R, Rankin D, Smith K, Rennie MJ. Blunting of insulin inhibition of proteolysis in legs of older subjects may contribute to age-related sarcopenia. Am J Clin Nutr. 2009 Nov;90(5):1343-50. doi: 10.3945/ajcn.2009.27543. Epub 2009 Sep 9.

Reference Type: BACKGROUND

PMID: 19740975 (View on PubMed)

Sjoberg KA, Holst JJ, Rattigan S, Richter EA, Kiens B. GLP-1 increases microvascular recruitment but not glucose uptake in human and rat skeletal muscle. Am J Physiol Endocrinol Metab. 2014 Feb 15;306(4):E355-62. doi: 10.1152/ajpendo.00283.2013. Epub 2013 Dec 3.

Reference Type: BACKGROUND

PMID: 24302010 (View on PubMed)

Chai W, Dong Z, Wang N, Wang W, Tao L, Cao W, Liu Z. Glucagon-like peptide 1 recruits microvasculature and increases glucose use in muscle via a nitric oxide-dependent mechanism. Diabetes. 2012 Apr;61(4):888-96. doi: 10.2337/db11-1073. Epub 2012 Feb 22.

Reference Type: BACKGROUND

PMID: 22357961 (View on PubMed)

Abdulla H, Phillips B, Wilkinson D, Gates A, Limb M, Jandova T, Bass J, Lewis J, Williams J, Smith K, Idris I, Atherton P. Effects of GLP-1 Infusion Upon Whole-body Glucose Uptake and Skeletal Muscle Perfusion During Fed-state in Older Men. J Clin Endocrinol Metab. 2023 Mar 10;108(4):971-978. doi: 10.1210/clinem/dgac613.

Reference Type: DERIVED

PMID: 36260533 (View on PubMed)

Other Identifiers

G12122013 MSGEM

Identifier Type: -

Identifier Source: org_study_id