Angiotensin Receptors and Age Related Mitochondrial Decline in HIV Patients (RAS-HIV)

This study is designed to evaluate specific factors in mitochondria that may precipitate premature aging and physical weakness in HIV patients. Angiotensin receptors 1 and 2 (AT1R and AT2R) are found in virtually every cell type. This study will evaluate how the relationships among these receptors in immune and skeletal muscle cells change with HIV, and how these changes might trigger mitochondrial dysfunction, declines in muscle strength, and cellular decline in people living with HIV.

Study Overview

• Status: Terminated
• Conditions: HIV; Sarcopenia; Aging; Angiotensin Receptor Antagonists
• Intervention / Treatment: Other: Placebo; Drug: valsartan

Detailed Description

HIV related premature cellular aging and declines in mitochondrial function are closely linked. Dysfunctional mitochondria generate higher levels of reactive oxygen species (ROS) and provide less ATP supply cellular energy. Impaired turnover of damaged mitochondria leads to gradual but progressive decline in energy metabolism, increases in muscle fibrosis and clinically apparent weakness. The Renin Angiotensin System (RAS) is a central hormonal system that contributes to mitochondrial dysfunction and impacts both lifespan and function across multiple organ systems. Deletion of the angiotensin type 1 receptor (AT1R) results in a 25-30% extension of lifespan in mouse models, partly through increasing mitochondrial numbers. Blocking of AT1R reduces a number of age-related morbidities in mice, and in human studies. A plethora of data implicates RAS modulation in marked effects on fitness, frailty and beneficial responses to exercise in older adults. Despite this, there are virtually no data examining RAS biology in HIV+ vs. age-matched HIVsubjects, no data of RAS in relation to key HIV-specific variables (duration of HIV, treatment history, immune markers), and no data examining the effects of blocking AT1R on physical function in HIV infected subjects. In this study, we will examine the RAS and its contribution to premature mitochondrial failure in HIV patients. We will begin to fill this void by enrolling 40 HIV+ subjects in a randomized, double-blinded, placebo controlled pilot study of treatment with AT1R blocker to determine the feasibility of a larger trial, estimate effect size, assess the correlation of angiotensin receptor (AR) expression in peripheral blood cells and muscle cells, and the association of AR expression with physical function measures and immunity.

• Study Type: Interventional
• Enrollment (Actual): 1
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Winston-Salem, North Carolina, United States, 27157
      • Wake Forest University Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• able to provide informed consent
• able to attend an extended (~4 hour) Clinical Research Visit
• documented HIV seropositivity
• on a stable anti-retroviral therapy (ART) regimen for at least 12 months
• HIV plasma viral load < 50 copies/ml for at least 6 months
• Systolic blood pressure >110

Exclusion Criteria:

• creatinine > 1.5 ULN (or creatinine clearance < 60 ml/min)
• anti-hypertensive therapy with ACE-I or AT1R-blockers
• inability to perform functional measures (e.g. non-ambulatory without assistance, requires a prosthesis)
• recent (within 30 days) acute illness requiring medical therapy or hospitalization
• immunosuppressive agents (e.g. > 20 mg/d x 2 or more weeks of prednisone or equivalent, chemotherapy) in the last 6 months
• cancer requiring treatment w/in 3 yrs (except for non-melanoma skin cancer)
• blood thinning medications such as Coumadin or Plavix or a bleeding disorder such as hemophilia that could cause complications during muscle biopsies
• pregnancy (will provide urine test for females of child bearing potential)
• regular use of non-steroidal anti-inflammatory drugs or other immune modulating agents.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo control; 20 HIV-infected participants will be randomized into a blinded arm where they will receive 24 weeks of placebo therapy. During this time, they will undergo the same study procedures as the intervention arm.	Other: Placebo
Experimental: Valsartan; 20 HIV-infected participants will be randomized into a blinded arm where they receive 24 weeks of valsartan therapy. For those subjects randomized to the valsartan group, they will receive valsartan 40 mg by mouth daily for 2 weeks, then increase to 80 mg by mouth daily for the remaining 22 weeks. During this time, they will undergo the same study procedures as the placebo arm.	Drug: valsartan; Valsartan will be given in increasing doses (from 40 mg to 80 mg) to those in the valsartan arm.; Other Names: Diovan

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in 400m Walk	Measured by time to finish 400 meter walk	3, 6, and 9 months post-enrollment
Change From Baseline in Grip Strength	Measured by dynamometer measurement of grip strength	3, 6, and 9 months post-enrollment
Change From Baseline in Quantity of AT1R and AT2R on Monocytes	Measured by using qPCR and western blot. (Units are arbitrary units)	3, 6, and 9 months post-enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Frailty Status	Evaluated by measurements of grip strength, walking speed and questionnaires	3, 6, and 9 months post-enrollment

Collaborators and Investigators

• Sponsor: Wake Forest University Health Sciences
• Collaborators: Johns Hopkins University
• Investigators: Principal Investigator: Katherine R Schafer, MD, Wake Forest University Health Sciences

Study record dates

Study Major Dates

• Study Start: July 1, 2014
• Primary Completion (Actual): August 4, 2016
• Study Completion (Actual): August 4, 2016

Study Registration Dates

• First Submitted: August 31, 2015
• First Submitted That Met QC Criteria: November 12, 2015
• First Posted (Estimate): November 17, 2015

Study Record Updates

• Last Update Posted (Actual): August 28, 2018
• Last Update Submitted That Met QC Criteria: July 30, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Sarcopenia; Molecular Mechanisms of Pharmacological Action; Antihypertensive Agents; Angiotensin II Type 1 Receptor Blockers; Angiotensin Receptor Antagonists; Valsartan
• Other Study ID Numbers: WFUHS-28769

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
• product manufactured in and exported from the U.S.: No