- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04055428
NAUTICAL: Effect of Natriuretic Peptide Augmentation on Cardiometabolic Health in Black Individuals
The Effects of Natriuretic Peptide Augmentation on Cardiometabolic Health in Black Individuals (NAUTICAL)
Study Overview
Status
Conditions
Detailed Description
Black individuals are more likely to have a reduced insulin sensitivity which results in a greater risk for diabetes. However, the reasons for their decreased insulin sensitivity are not clearly understood. Natriuretic peptides (NPs) are hormones produced by the heart that is known to have a wide range of favorable metabolic effects. Studies indicate that lower NP levels are associated with a decreased insulin sensitivity and this may be causally related to the development of diabetes.
Evidence suggests that Black individuals have low levels of NPs. Increased clearance of NPs by neprilysin, an NP degrading enzyme, contributes to the low levels of NP among Black individuals. Since NPs play an important role in the regulation of insulin sensitivity and energy expenditure, one can infer that relatively low NP levels are an important biological contributor to the high prevalence rates of cardiometabolic disease in African Americans.
Sacubitril/valsartan is an FDA-approved inhibitor of neprilysin that augment NP levels. NP augmentation using sacubitril/valsartan has been shown to improve insulin sensitivity and lipid metabolism in a small clinical trial among obese White individuals. It can be postulated that NP augmentation in populations with relatively low NP levels will help in improving their metabolic health. Improvement in the metabolic health following NP augmentation will also help us to outline the relationship between the NP system and the risk of cardiometabolic disease among Black individuals.
We hypothesize that NP augmentation among Black individuals will show an improvement in their metabolic health as measured by insulin sensitivity and energy expenditure. We hypothesize that African American individuals will show an improvement in their insulin sensitivity and their resting & exercise energy expenditure after treatment with sacubitril/valsartan versus valsartan alone.
Our study will have the following aims. The first aim is to assess the change in the insulin sensitivity after NP augmentation therapy (using sacubitril/valsartan) as compared with NP neutral therapy (using valsartan) among Black individuals. We will measure the change in insulin sensitivity (assessed using IVGTT) after 12 weeks of intervention. We will also assess the change in NP levels (a marker of NP augmentation) & cyclic guanylate monophosphate (cGMP) levels after intervention and evaluate their relationship with the change in insulin sensitivity.
The second aim of our study is to examine the change in the energy expenditure after sacubitril/valsartan as compared to valsartan alone among Black individuals. The individuals enrolled in the first aim will also be examined for the change in resting as well as exercise energy expenditure. This will be assessed using standardized protocol performed using the metabolic cart and an exercise treadmill, at baseline and after 12 weeks of either sacubitril/valsartan or valsartan alone.
The secondary aim of our study is to assess the GLP-1 response to meals after treatment with sacubitril/valsartan in Black individuals. We will evaluate the change in postprandial GLP-1 response to meals at baseline and after 12 weeks of either sacubitril/valsartan or valsartan alone.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Leigh Powell, MSN, RN
- Phone Number: 205-975-9859
- Email: lcpowell@uabmc.edu
Study Contact Backup
- Name: Nehal Vekariya, MS
- Phone Number: 205-934-7173
- Email: nvekariya@uabmc.edu
Study Locations
-
-
Alabama
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Birmingham, Alabama, United States, 35294
- Recruiting
- University of Alabama at Birmingham
-
Principal Investigator:
- Pankaj Arora, MD
-
Contact:
- Nehal Vekariya, MS
- Phone Number: 205-934-7173
- Email: nvekariya@uabmc.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults: Age more than or equal to 18 years of age
- Self-identified race/ethnicity as African-American or Black
- Blood pressure: 120-160/80-100 mmHg
Exclusion Criteria:
- Women who are pregnant or breastfeeding or who can become pregnant and not practicing an acceptable method of birth control during the study (including abstinence)
- Have any past or present history of cardiovascular diseases (stroke, myocardial infarction, heart failure, transient ischemic attack, angina, or cardiac arrhythmia)
- BP more than 160/100 mmHg
- BMI >45 kg/m2
- History of diabetes or fasting plasma glucose >=126 mg/dL or HbA1C>=6.5%
- History of angioedema
- Current or past (<12 months) history of smoking
- Estimated GFR < 60 ml/min/1.73 m2; albumin-creatinine ratio ≥30 mg/g
- Hepatic Transaminase (AST and ALT) levels >3x the upper limit of normal
- Significant psychiatric illness or seizure disorder
- More than 2 Alcoholic drinks daily
- Anemia (men, Hct < 38%, Hb<13 g/dL; women, Hct <36%, Hb <12 g/dL)
- Inability to exercise on a treadmill
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Sacubitril/Valsartan
We will enroll 100 adult Black individuals.
Each participant will take the assigned dose of medication twice daily for 12 weeks.
We evaluate insulin sensitivity and energy expenditure at baseline and after 12 weeks of intervention.
|
The subject will be randomized, in a double-blind manner to sacubitril/valsartan 97/103 mg twice daily for a period of 12 weeks.
Other Names:
An assessment of the insulin sensitivity will be done using the IVGTT, at baseline and after 12 weeks of pharmacological interventions.
Participants will consume the standardized study mixed meal for the assessment of postprandial GLP-1 response to the meal.
Each participant's maximal oxygen capacity will be determined using modified Bruce treadmill protocol.
|
Active Comparator: Valsartan
We will enroll 100 adult Black individuals.
Each participant will take the assigned dose of medication twice daily for 12 weeks.
We evaluate insulin sensitivity and energy expenditure at baseline and after 12 weeks of intervention.
|
An assessment of the insulin sensitivity will be done using the IVGTT, at baseline and after 12 weeks of pharmacological interventions.
Participants will consume the standardized study mixed meal for the assessment of postprandial GLP-1 response to the meal.
Each participant's maximal oxygen capacity will be determined using modified Bruce treadmill protocol.
The subject will be randomized, in a double-blind manner to valsartan 160 mg twice daily for a period of 12 weeks.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in insulin sensitivity after natriuretic peptide augmentation
Time Frame: 12 weeks
|
An assessment of the insulin sensitivity will be done at baseline and after 12 weeks of pharmacological intervention.
|
12 weeks
|
Change in energy expenditure after natriuretic peptide augmentation
Time Frame: 12 weeks
|
An assessment of the resting energy expenditure will be done at baseline and after 12 weeks of pharmacological intervention.
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in exercise energy expenditure after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
During standardized protocol after 12 weeks of intervention, the energy expenditure will be calculated using metabolic cart.
|
12 weeks
|
Change in post-meal increase in GLP-1 levels
Time Frame: 12 weeks
|
Change in GLP-1 levels after a standardized meal after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in peak oxygen consumption after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
Change in the peak oxygen consumption (VO2 max) after 12 weeks of intervention.
|
12 weeks
|
Change in fasting GLP-1 levels
Time Frame: 12 weeks
|
Change in fasting GLP-1 levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in natriuretic peptide levels
Time Frame: 12 weeks
|
Change in natriuretic peptide levels (ANP, MRproANP, BNP, NTproBNP) after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in measures of insulin sensitivity
Time Frame: 12 weeks
|
Change in measures of insulin sensitivity (AIRg, Sg, Kg, Disposition Index) after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in HBA1c levels
Time Frame: 12 weeks
|
Change in HBA1c levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in fasting blood glucose levels
Time Frame: 12 weeks
|
Change in fasting blood glucose levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in HOMA-IR
Time Frame: 12 weeks
|
Change in HOMA-IR after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in fasting insulin levels
Time Frame: 12 weeks
|
Change in fasting insulin levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in measures of body mass index
Time Frame: 12 weeks
|
Change in the measures of body mass index after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in measures of hip circumference
Time Frame: 12 weeks
|
Change in the measures of hip circumference after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in measures of waist circumference
Time Frame: 12 weeks
|
Change in the measures of waist circumference after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in measures of adipose tissue mass
Time Frame: 12 weeks
|
Change in the measures of adipose tissue mass after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in total cholesterol levels
Time Frame: 12 weeks
|
Change in the total cholesterol levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in LDL-C levels
Time Frame: 12 weeks
|
Change in LDL-C levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in HDL-C levels
Time Frame: 12 weeks
|
Change in HDL-C levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Change in triglyceride levels
Time Frame: 12 weeks
|
Change in triglyceride levels after 12 weeks of pharmacological intervention
|
12 weeks
|
Correlation of change in MR-pro atrial natriuretic peptide levels with change in insulin sensitivity after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in MR-pro atrial natriuretic peptide levels with change in insulin sensitivity after 12 weeks of intervention will be examined.
|
12 weeks
|
Correlation of change in MR-pro atrial natriuretic peptide levels with change in energy expenditure after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in MR-pro atrial natriuretic peptide levels with change in resting and exercise energy expenditure after 12 weeks of intervention will be examined.
|
12 weeks
|
Correlation of change in B-type natriuretic peptide levels with change in insulin sensitivity after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in B-type natriuretic peptide levels with change in insulin sensitivity after 12 weeks of intervention will be examined.
|
12 weeks
|
Correlation of change in B-type natriuretic peptide levels with change in resting energy expenditure after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in B-type natriuretic peptide levels with change in resting energy expenditure after 12 weeks of intervention will be examined.
|
12 weeks
|
Correlation of change in NT-pro B-type natriuretic peptide levels with change in insulin sensitivity after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in NT-pro B-type natriuretic peptide levels with change in insulin sensitivity after 12 weeks of intervention will be examined.
|
12 weeks
|
Correlation of change in NT-pro B-type natriuretic peptide levels with change in energy expenditure after 12 weeks of pharmacological intervention.
Time Frame: 12 weeks
|
The exposure-response relationship of change in NT-pro B-type natriuretic peptide levels with change in resting and exercise energy expenditure after 12 weeks of intervention will be examined.
|
12 weeks
|
Impact of Natriuretic Peptide Genotype on Study Endpoints
Time Frame: 12 weeks
|
All study outcomes will be analyzed by natriuretic peptide genotypes
|
12 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Metabolomic Profile
Time Frame: 12 weeks
|
The change in the metabolomic profile examined using standardized platforms after 12 weeks of intervention.
|
12 weeks
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Pankaj Arora, MD, FAHA, University of Alabama at Birmingham
Publications and helpful links
General Publications
- Jordan J, Stinkens R, Jax T, Engeli S, Blaak EE, May M, Havekes B, Schindler C, Albrecht D, Pal P, Heise T, Goossens GH, Langenickel TH. Improved Insulin Sensitivity With Angiotensin Receptor Neprilysin Inhibition in Individuals With Obesity and Hypertension. Clin Pharmacol Ther. 2017 Feb;101(2):254-263. doi: 10.1002/cpt.455. Epub 2016 Nov 17.
- Arora P, Reingold J, Baggish A, Guanaga DP, Wu C, Ghorbani A, Song Y, Chen-Tournaux A, Khan AM, Tainsh LT, Buys ES, Williams JS, Heublein DM, Burnett JC, Semigran MJ, Bloch KD, Scherrer-Crosbie M, Newton-Cheh C, Kaplan LM, Wang TJ. Weight loss, saline loading, and the natriuretic peptide system. J Am Heart Assoc. 2015 Jan 16;4(1):e001265. doi: 10.1161/JAHA.114.001265.
- Seferovic JP, Claggett B, Seidelmann SB, Seely EW, Packer M, Zile MR, Rouleau JL, Swedberg K, Lefkowitz M, Shi VC, Desai AS, McMurray JJV, Solomon SD. Effect of sacubitril/valsartan versus enalapril on glycaemic control in patients with heart failure and diabetes: a post-hoc analysis from the PARADIGM-HF trial. Lancet Diabetes Endocrinol. 2017 May;5(5):333-340. doi: 10.1016/S2213-8587(17)30087-6. Epub 2017 Mar 18.
- Patel N, Cushman M, Gutierrez OM, Howard G, Safford MM, Muntner P, Durant RW, Prabhu SD, Arora G, Levitan EB, Arora P. Racial differences in the association of NT-proBNP with risk of incident heart failure in REGARDS. JCI Insight. 2019 Jun 4;5(13):e129979. doi: 10.1172/jci.insight.129979.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Glucose Metabolism Disorders
- Immune System Diseases
- Hyperinsulinism
- Hypersensitivity
- Cardiovascular Diseases
- Insulin Resistance
- Metabolic Diseases
- Molecular Mechanisms of Pharmacological Action
- Antihypertensive Agents
- Angiotensin II Type 1 Receptor Blockers
- Angiotensin Receptor Antagonists
- Valsartan
- Sacubitril and valsartan sodium hydrate drug combination
Other Study ID Numbers
- 300003702
- R01HL163852 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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