Short Interval Resveratrol Trial in Cardiovascular Surgery (SIRT-CVS)

March 24, 2023 updated by: Douglas B. Sawyer, MaineHealth

Major Problem

People with diabetes have an increased risk of heart disease, heart failure, and death from a cardiovascular cause. Diabetes prevents efficient metabolism of fuel, causes inflammation and vascular disease that blocks normal blood flow, and inhibits the function of the heart after injury. These changes make diabetics more susceptible to heart attacks and heart failure.

Resveratrol is found in grapes and red wine and has been shown to have beneficial effects in diabetic patients. In previous studies the investigators have shown that resveratrol can improve heart metabolism and function in pigs with diabetes and chronic lack of blood flow to the heart.

Questions

The investigators believe resveratrol will help reverse the negative effects of diabetes on the heart. The questions are: 1.How does the molecular machinery in the hearts of patients with diabetes differ from patients without diabetes? 2.Will resveratrol have an effect on heart metabolism, intracellular signaling, inflammation and blood vessel function? 3.Will resveratrol improve the number and function of cardiac stem cells, cells involved in heart repair? The investigators have been safely collecting tissue from the hearts of patients undergoing heart surgery. Preliminary studies show the investigators can isolate and study cells. The investigators have collected and assessed the function of endothelial cells, a measure of vascular health and can measure the level of endothelial injury and have studied the make-up of caveolae, structures on the cell membrane that are important for cell signaling and are negatively impacted by diabetes. This study is a unique collaboration among cardiologists, cardiac surgeons, and basic scientists.

Study Overview

Detailed Description

Patients with diabetes and metabolic diseases such as obesity, hypertension and dyslipidemia have a myocardial environment that results in endothelial dysfunction, altered metabolism and little potential for regeneration by intrinsic or extrinsically delivered therapies. Based upon work in animal and cell culture models of human disease, caveolae, lipid rafts found on the cell membrane of endothelial cells and myocytes, are important in cell signaling and metabolism. A growing body of literature suggests that disruption of membrane lipid microdomains in diabetes can lead to altered signaling that contributes to cardiovascular pathology. One possible method to improve the "endothelial health" of the heart could involve normalizing metabolic processes and decreasing signals that lead to inflammation and pathways that lead to fibrosis in the myocardium. This presents an opportunity to improve outcomes in our diabetic patients and improve the success of future therapies aimed at improving endothelial function.

Resveratrol, a polyphenol found in abundance in red wine, activates sirtuin 1 (SIRT1), an NAD+-dependent deacetylase, which influences a diverse array of metabolic pathways. Studies in cultured cells, small animal models, and humans demonstrate that SIRT1 is involved in endothelial function, mitochondrial biogenesis, insulin production, inflammation, and glucose and lipid homeostasis. These processes are often dysfunctional in patients with diabetes and other metabolic diseases.

The central hypothesis of this proposal is that molecular pathology of diabetes on cardiac endothelium can be corrected with orally supplemented resveratrol.

The investigators propose to test this hypothesis in by first assessing endothelial function, lipidomic signatures, and cell signaling in patients with and without diabetes mellitus undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). The second Aim of this proposal is a pilot placebo-controlled, double-blind clinical trial that will assess the effects of supplemental resveratrol in diabetic patients undergoing CABG with CPB. The goal will be to better understand the influence of resveratrol on key molecular signals that determine endothelial function, calveolar makeup and function, as well as cytoprotective signaling and responses in the heart.

The Specific Aims of this proposal are to:

Aim 1: Define the molecular pathology of diabetes on cardiac cells and tissues in non-diabetic and diabetic patients undergoing surgical revascularization. We will assess the effects of DM on endothelial function and damage, lipidomics, caveolar expression, disrupted receptor expression and neuregulin signaling.

Aim 2: Determine the effect of resveratrol on the microvascular function of diabetic patients undergoing surgical revascularization. Through a pilot randomized placebo-controlled clinical trial, the investigators will evaluate the effect of resveratrol on endothelial damage at the time of cardiopulmonary bypass, endothelial function, and cell signaling.

This study will further our understanding of how resveratrol impacts patients in a controlled setting, and will allow for a thorough and complete investigation of how the supplement affects this patient population clinically and on a molecular level. The data will inform the development of larger studies examining the benefits of resveratrol in diabetes and metabolic syndrome. Finally, the investigators successful completion of this trial will inform the study of other therapeutics where direct myocardial effects are being considered.

Study Type

Interventional

Enrollment (Anticipated)

40

Phase

  • 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

    • Maine
      • Portland, Maine, United States, 04102
        • Maine Medical Center

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

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult patients (age >18 years)
  • Type 2 diabetes (controlled by either oral agents or insulin)
  • Coronary artery disease referred for elective CABG with CPB

Exclusion Criteria:

  • Known decompensated congestive heart failure or systolic heart failure with an ejection fraction < 45% at the time of evaluation
  • Liver Function Tests (LFT) greater than 2 times normal
  • Renal dysfunction (GFR less than 60 mL/min)
  • Abnormal coagulation profile (PT/PTT and INR)
  • Alcohol consumption more than 3 grams (equivalent to 2.5 glasses of wine) daily
  • Positive HIV, Hepatitis B or C testing
  • Severe ventricular arrhythmias
  • Significant hypotension (SBP < 90 mmHg) at the time of enrollment
  • Patients who are pregnant
  • Known malignancy other than non-melanoma skin cancers
  • Expected survival less than one year.
  • Allergy or intolerance to the ingredients of the supplement or the placebo
  • Inability to comply with the study requirements.

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: Basic Science
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Placebo Comparator: Placebo
Placebo
Experimental: Resveratrol
1 gram, twice a day by mouth Transmax (Biotivia)
Other Names:
  • resveratrol

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in endothelial function
Time Frame: 6 weeks
Serum levels of nitric oxide (ELISA assay)
6 weeks
Change in endothelial function
Time Frame: 14 days
Nitric oxide synthase levels in heart tissue (Western blot assay)
14 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Effects of resveratrol on caveolar function
Time Frame: 14 days
Lipidomic changes in cell membranes (Mass spectrometry)
14 days
Effects of resveratrol on molecular signaling
Time Frame: 14 days
Serum and tissue levels of pathways associated with glucose metabolism (Western blot assay)
14 days

Collaborators and Investigators

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

Sponsor

Investigators

  • Principal Investigator: Douglas Sawyer, Maine Health

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)

March 6, 2018

Primary Completion (Actual)

April 16, 2021

Study Completion (Anticipated)

December 31, 2023

Study Registration Dates

First Submitted

November 30, 2018

First Submitted That Met QC Criteria

November 30, 2018

First Posted (Actual)

December 3, 2018

Study Record Updates

Last Update Posted (Actual)

March 27, 2023

Last Update Submitted That Met QC Criteria

March 24, 2023

Last Verified

March 1, 2023

More Information

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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