Intranasal Insulin and Olanzapine Study in Healthy Volunteers

NCT ID: NCT03741478

Last Updated: 2023-07-17

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE1
• Total Enrollment: 64 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-10-22
• Study Completion Date: 2024-07-30

Brief Summary

Antipsychotic (AP) medications are considered to be the gold standard treatment for psychotic disorders including schizophrenia. However, APs have also been commonly associated with serious metabolic adverse effects including weight gain and Type 2 Diabetes, with younger populations disproportionately affected. In addition, young individuals treated with these agents have also been found to be at high risk for glucose dysregulation, including higher rates of prediabetes, with significant associations found between AP use and insulin resistance. Due to the concerning prevalence of these AP metabolic effects, it becomes important to further elucidate the mechanisms underlying AP effects on glucose metabolism, which are still poorly understood. One potential underlying mechanism is insulin which has been found to regulate hepatic (liver) glucose production through insulin receptors in the brain. These insulin receptors also play a role in neuronal growth and memory, or more broadly, cognition. Preliminary data in rat models has demonstrated that the AP olanzapine (OLA) inhibits the ability of a central insulin stimulus (acting at the level of the brain) to decrease endogenous glucose production (EGP), making this mechanism a prime target to translate from rodent models to human research. Furthermore, intranasal insulin (INI) administration (an analogous central insulin stimulus) has been repeatedly associated with improved cognitive performance for verbal memory and visuospatial functions in humans. Given these findings and with the goal of translational research, the present study will investigate OLA's effects in healthy human volunteers including: (a) the ability of INI to reduce EGP during a pancreatic euglycemic clamp (PEC; a glucose metabolism and insulin procedure); and (b) the ability of INI to improve cognitive performance. More specifically, the present study hypothesizes that:

1. INI will be associated with a decrease in EGP relative to intranasal placebo (INP) as measured by the PEC. This effect will be inhibited if OLA is co-administered.

2. OLA administration will be associated with decrements in cognitive measures (i.e., visuospatial, and verbal memory) as compared to placebo (PL). Additionally, OLA co-administration will block the beneficial effects of INI on cognition previously supported by other studies.

3. INI will result in adaptive changes in neurochemical and neurohemodynamic measures as studied using MRI imaging techniques.

Detailed Description

The primary objective of the study is to examine whether a single dose of OLA given to young healthy volunteers during PECs can inhibit the activity of a central insulin stimulus (i.e, INI) to reduce endogenous glucose production. Secondarily, in an exploratory arm, this study seeks to examine whether a single dose of OLA can inhibit improvements associated with INI administration on specific cognitive domains (visuospatial, and verbal memory). Further, the study will also explore the effects of insulin and OLA on neurochemical and neurohemodynamic measures obtained through MRI imaging techniques.

To accomplish these objectives, this study will have two separate and parallel arms - a metabolic PEC arm to study the primary hypothesis, and an MRI imaging and cognitive testing arm to study the two secondary hypotheses.

Conditions

Healthy Controls

Study Design

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

Study Groups

Metabolic Arm

This arm includes a screening visit 1 and screening visit 2 to assess eligibility.

This arm then includes the pancreatic euglycemic clamp procedure at visits 1 to 3. Visits 1 to 3 each consist of 3 days (day 0, day 1, and day 2).

Olanzapine 2.5mg (or placebo) will be administered in doses of 5mg on day 0, 7.5mg on day 1, and 10mg on day 2.

Day 2 consists of the final dose of olanzapine (or placebo) and the pancreatic euglycemic clamp procedure and other assessment procedures.

On day 2, the participant is also randomized to and administered either intranasal insulin/Insulin Lispro 100 UNT/ML (or saline placebo) during the pancreatic euglycemic clamp procedure.

Group Type: EXPERIMENTAL

OLANZapine 2.5 MG

Intervention Type: DRUG

Olanzapine capsules (2.5mg) will be administered with the following dosing schedules for each arm:

1. Metabolic arm - 5mg on Day 0, 7.5mg on Day 1, and 10mg on Day 2

2. Cognitive arm - 5mg on Day 0, 10mg on Day 1

Placebo

Intervention Type: DRUG

Placebo capsules visually identical to those containing olanzapine will be administered according to the same dosing schedule for each arm.

Insulin Lispro 100 UNT/ML

Intervention Type: DRUG

Intranasal insulin spray (or placebo) will be administered on day 2 for each arm.

For the metabolic arm: 40 IU of intranasal insulin lispro will be administered at timepoint 0 during the pancreatic euglycemic clamp procedure.

For the cognitive arm: 160 IU of intranasal insulin lispro will be administered at about 11 am on day 2 prior to the MRI imaging and cognitive testing procedures.

Saline

Intervention Type: OTHER

Placebo saline spray visually identical to the intranasal insulin spray will be administered on day 2 for each arm according the same dosing schedules.

Cognitive and MRI Arm

This arm includes a screening visit 1 and screening visit 2 to assess eligibility. This arm includes an MRI scan and cognitive testing at visits 1 to 4. Visits 1 to 4 each consist of 3 days (day 0, day 1, and day 2).

Olanzapine 2.5mg (or placebo) will be administered in doses of 5mg on day 0, and 10mg on day 1. Cognitive testing and MRI scanning then occur on day 2. On day 2, the participant is also randomized to and administered either intranasal insulin/Insulin Lispro 100 UNT/ML (or saline placebo) prior to conducting the MRI imaging and cognitive testing.

Group Type: EXPERIMENTAL

OLANZapine 2.5 MG

Intervention Type: DRUG

Olanzapine capsules (2.5mg) will be administered with the following dosing schedules for each arm:

1. Metabolic arm - 5mg on Day 0, 7.5mg on Day 1, and 10mg on Day 2

2. Cognitive arm - 5mg on Day 0, 10mg on Day 1

Placebo

Intervention Type: DRUG

Placebo capsules visually identical to those containing olanzapine will be administered according to the same dosing schedule for each arm.

Insulin Lispro 100 UNT/ML

Intervention Type: DRUG

Intranasal insulin spray (or placebo) will be administered on day 2 for each arm.

For the metabolic arm: 40 IU of intranasal insulin lispro will be administered at timepoint 0 during the pancreatic euglycemic clamp procedure.

For the cognitive arm: 160 IU of intranasal insulin lispro will be administered at about 11 am on day 2 prior to the MRI imaging and cognitive testing procedures.

Saline

Intervention Type: OTHER

Placebo saline spray visually identical to the intranasal insulin spray will be administered on day 2 for each arm according the same dosing schedules.

Interventions

OLANZapine 2.5 MG

Olanzapine capsules (2.5mg) will be administered with the following dosing schedules for each arm:

1. Metabolic arm - 5mg on Day 0, 7.5mg on Day 1, and 10mg on Day 2

2. Cognitive arm - 5mg on Day 0, 10mg on Day 1

Intervention Type: DRUG

Placebo

Placebo capsules visually identical to those containing olanzapine will be administered according to the same dosing schedule for each arm.

Intervention Type: DRUG

Insulin Lispro 100 UNT/ML

Intranasal insulin spray (or placebo) will be administered on day 2 for each arm.

For the metabolic arm: 40 IU of intranasal insulin lispro will be administered at timepoint 0 during the pancreatic euglycemic clamp procedure.

For the cognitive arm: 160 IU of intranasal insulin lispro will be administered at about 11 am on day 2 prior to the MRI imaging and cognitive testing procedures.

Intervention Type: DRUG

Saline

Placebo saline spray visually identical to the intranasal insulin spray will be administered on day 2 for each arm according the same dosing schedules.

Intervention Type: OTHER

Other Intervention Names

Mylan-Olanzapine; Olanzapine Placebo; Intranasal Insulin

Eligibility Criteria

Inclusion Criteria

• Healthy non-obese volunteers
• Age: 17 to 45 (Cognitive Arm) OR Ages 17-65 (Metabolic Arm)

Exclusion Criteria

• History of current or past psychiatric illness (according to the Mini International Neuropsychiatric Interview [MINI]).[As an exception for the Metabolic Arm only, anxiety disorders will not be exclusionary (including, but not limited to: agoraphobia, social anxiety disorder, generalized anxiety disorder, and panic disorder)].
• Left-handedness (only for the cognitive and MRI arm)
• Pre-diabetes or diabetes (fasting glucose ≥6.0mmol/L or use of anti-diabetic drug);
• Evidence of impaired glucose tolerance on screening OGTT
• Family history of diabetes
• Use of weight reducing agents or other medications based on the discretion of the PI
• History of liver disease or AST> 2 times upper limit of normal
• History of kidney disease
• Major medical or surgical event within the last 6 months
• Any condition that interferes with safe acquisition of MRI data such as metal implants, pacemakers, cochlear implants, claustrophobia, etc. (only for the cognitive and MRI component)
• Pregnancy and/or breastfeeding

• Minimum Eligible Age: 17 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University Health Network, Toronto

OTHER

Sponsor Role: collaborator

Centre for Addiction and Mental Health

OTHER

Sponsor Role: lead

Responsible Party

Margaret Hahn

Clinician Scientist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Margaret K Hahn, PhD, MD

Role: PRINCIPAL_INVESTIGATOR

Centre for Addiction and Mental Health

Satya Dash, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University Health Network, Toronto General Hospital

Locations

University Health Network - Toronto General Hospital

Toronto, Ontario, Canada

Site Status: ACTIVE_NOT_RECRUITING

Center for Addiction and Mental Health

Toronto, Ontario, Canada

Site Status: RECRUITING

Countries

Canada

Central Contacts

Margaret K Hahn, PhD, MD

Role: CONTACT

margaret.hahn@camh.ca

416-535-8501 ext. 34368

Mahavir Agarwal, MBBS, MD

Role: CONTACT

mahavir.agarwal@camh.ca

416-535-8501 ext. 30546

Facility Contacts

Margaret Hahn, MD, PhD

Role: primary

margaret.hahn@camh.ca

416-535-8501 ext. 34368

Mahavir Agarwal, MD, MBBS

Role: backup

mahavir.agarwal@camh.ca

416-535-8501 ext. 30546

References

Stogios N, Hamel L, Smith E, Sanches M, Remington G, Voineskos A, Dash S, Graff-Guerrero A, Hahn M, Agarwal SM. Investigating the effects of antipsychotics on brain insulin action: Study protocol for a multi-modality magnetic resonance imaging (MRI) study in healthy controls. PLoS One. 2022 Nov 28;17(11):e0277211. doi: 10.1371/journal.pone.0277211. eCollection 2022.

Reference Type: DERIVED

PMID: 36441736 (View on PubMed)

Other Identifiers

075/2017

Identifier Type: -

Identifier Source: org_study_id