Brown Adipose Tissue in ALS (BATALS)

August 25, 2021 updated by: Institut National de la Santé Et de la Recherche Médicale, France

Energy Expenditure and Brown Adipose Tissue in Amyotrophic Lateral Sclerosis

Weight loss is a common phenomenon in ALS. During the course of the disease, difficulty in swallowing and mastication can be responsible for a decrease in caloric intake and thus for weight loss. However, significant weight loss can also be observed in patients with no feeding difficulties. About half of ALS patients have an increase in their resting energy consumption, but the origin of this "hypermetabolism" remains unknown. "Brown" fat is specialized in the production of heat. Unlike "white" fat that stores excess caloric intakes, brown fat consumes energy. In humans, brown fat has long been considered as absent in adults. However, recent imaging techniques have been able to detect brown fat deposits in some adult subjects. The aim of this study is thus to determine the role of brown fat on energy consumption in Amyotrophic Lateral Sclerosis.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder involving motor neurons of the cerebral cortex, brain stem and spinal cord. Motor neuron loss results in rapidly progressive muscle paralysis, usually leading to death from respiratory failure in 3-5 years.

Weight loss is a frequent phenomenon and an independent negative prognostic factor for survival in ALS. Involvement of bulbar muscles with dysphagia is likely to lead to decrease in energy intake resulting in negative energy balance. However, weight loss also occurs in non-dysphagic patients, and is not restricted to reduction in skeletal muscle mass but also involves fat mass reduction.

Hypermetabolism (i.e. elevation of resting energy expenditure, REE) have been reported in ALS in about 50% of ALS patients but the origin of this hypermetabolism remains unknown. Increase of REE seems paradoxical in the context of ALS because skeletal muscle mass, which accounts for a large proportion of energy consumption and heat production, is decreased in ALS patients. Brown adipose tissue (BAT) is another important organ for basal and inducible energy expenditure and thermogenesis. In humans, BAT is primarily found in infants and young children, and healthy adults has long been considered as almost devoid of functional BAT. However, a recent study using 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomographic (PET) scan showed that depots of functional BAT were present in about 5% of adult humans, most commonly localized in the cervical-supraclavicular region. In an autopsy series, depots of BAT in the periadrenal region were found in 19/20 ALS patients. It has been estimated that, if present, 50 g of maximally stimulated brown tissue could represent up to 20% of REE expenditure in an adult human. The presence of substantial, functional, depots of BAT could thus participate in the increase of REE observed in ALS patients.

The primary objective of this study is to identify and quantify potential depots of functional BAT in ALS patients. Secondary objectives will be to correlate amount of detectable BAT with measured REE, clinical parameters evaluating ALS progression and biological parameters.

This study will include 5 patients referred to the Paris ALS center with a diagnosis of ALS and "unexplained" (i.e. not explained by severe dysphagia) loss of 5 percent or more of normal body weight in the last 6 months. 5 ALS patients without significant weight loss will also be included in the study as controls.

For each patient, measurement of REE will be performed by indirect calorimetry. The volume and activity of BAT will be determined using 18F-FDG PET whole body scans. Data on concomitant and past disorders (including cancer and diabete mellitus), smoking history, medication use, height, current and normal body weight, age and site of onset of ALS symptoms will be recorded. Functional motor impairment will be assessed using manual muscle testing and the revised ALS Functional Rating Scale as in routine clinical practice.

This study will be the first to investigate, using non-invasive procedures, the role of depots of functional BAT in ALS patients' metabolic dysfunction. The results will provide new insights on the origin and consequences of the dysregulation of metabolic homeostasis in ALS.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
10

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • France
      • Paris, France, 75013
        • Paris Als Center, Salpetriere Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 85 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

10 ALS patients, fulfilling the following inclusion criteria:

  • Aged 18 to 85 (inclusive)
  • Possible, probable (clinically or laboratory) or definite ALS according to the revised version of the El Escorial World Federation of Neurology criteria
  • With unexplained significant loss of weight of 5 percent (or more) of normal body weight in the last 6 months (n=5 subjects) Or - without weight loss (n= 5 subjects)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: OTHER
  • Allocation: NON_RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
OTHER: ALS patients without weight loss.
18-FDG-PET. Indirect Calorimetry.
Other: Indirect Calorimetry.
REE measurement
Device: 18-FDG-PET
18-FDG-PET
OTHER: ALS patients with weight loss.
18-FDG-PET. Indirect Calorimetry.
Other: Indirect Calorimetry.
REE measurement
Device: 18-FDG-PET
18-FDG-PET

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Quantification of depots of functional brown adipose tissue in ALS patients (grams)
Time Frame: performed at the first visit (1 day)
measured by 18F-FDG-PET
performed at the first visit (1 day)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Institut National de la Santé Et de la Recherche Médicale, France

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
October 26, 2017

Primary Completion (ACTUAL)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 1, 2019

Study Completion (ACTUAL)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
April 1, 2019

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 9, 2017

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 11, 2017

First Posted (ACTUAL)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 12, 2017

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 26, 2021

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 25, 2021

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2021

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • C16-83
  • 2016-A01790-51 (REGISTRY: RCB)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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