- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06320951
VITAL-IMPACT: Improving Cardiometabolic Health in Black Individuals Through Therapeutic Augmentation of Cyclic Guanosine Mono-Phosphate Signaling Pathway (VITAL-IMPACT)
May 3, 2024 updated by: Pankaj Arora, MD, University of Alabama at Birmingham
Improving Cardiometabolic Health in Black Individuals Through Therapeutic Augmentation of Cyclic Guanosine Mono-Phosphate Signaling Pathway
This study investigates the potential of vericiguat, a soluble guanylate cyclase stimulator, to improve cardiometabolic health in obese Black individuals with insulin resistance by directly enhancing cyclic guanosine monophosphate (cGMP) activity.
Given that this population has been shown to have lower cGMP activity and the association of lower cGMP activity with increased cardiometabolic disease risk, the proposed study hypothesizes that augmenting cGMP activity in obese individuals will improve insulin sensitivity and energy expenditure.
This study is a placebo-controlled randomized trial involving 200 Black obese participants with insulin resistance, assessing the effects of vericiguat on insulin sensitivity, resting, and exercise-induced energy expenditure over 12 weeks.
Additionally, it will explore changes in brown adipose tissue and gene expression related to energy metabolism in white adipose tissue, aiming to provide insights into how increasing cGMP activity may improve cardiometabolic health in Black obese individuals.
Study Overview
Status
Not yet recruiting
Conditions
Detailed Description
Obese Black individuals have a higher prevalence of insulin resistance, which is linked to an elevated risk of cardiometabolic diseases and cardiovascular disease.
The reasons behind the increased insulin resistance in this group are not fully understood.
Key to regulating glucose metabolism and the overall balance of energy, the cyclic guanosine monophosphate (cGMP) pathway is crucial for maintaining cardiometabolic health.
Research indicates that both Black race and obesity are associated with reduced levels of upstream regulators of cGMP activity, including natriuretic peptides (NPs) and nitric oxide (NO).
This reduced level of NPs and NO predisposes Black obese individuals to decreased cGMP activity, potentially contributing to the higher occurrence of cardiometabolic diseases seen in this population.
Vericiguat, a drug that stimulates the soluble guanylate cyclase, thereby enhancing cGMP activity independently of NO, presents a novel approach to improving cardiometabolic health in those most at risk due to low cGMP activity.
This study hypothesizes that directly augmenting cGMP levels with vericiguat will improve cardiometabolic health parameters including insulin sensitivity and energy expenditure in Black obese adults with insulin resistance.
Investigators plan to execute a placebo-controlled randomized trial targeting Black obese participants with insulin resistance to examine whether vericiguat can (1) improve insulin sensitivity and (2) increase resting energy expenditure.
For the first aim, Investigators aim to enroll 200 Black obese (BMI≥30 kg/m^2) individuals with a HOMA-IR of ≥2.5, randomizing them to either vericiguat 10 mg once daily or a placebo once daily in a double-blind setup for 12 weeks.
Investigators will assess improvements in insulin sensitivity through euglycemic hyperinsulinemic clamp and compare the results between the vericiguat and placebo groups after 12 weeks.
For the second aim, Investigators will evaluate changes in resting and exercise energy expenditure across both groups over the same period.
An exploratory objective will investigate changes in brown adipose tissue volume and activity using PET-MRI, as well as UCP1 gene expression in white adipose tissue, in a subset of 100 participants after 12 weeks of vericiguat treatment.
This will offer insights into the mechanisms by which cGMP augmentation may facilitate improvements in cardiometabolic health.
By focusing on the direct enhancement of cGMP activity in Black obese individuals, this study proposes a novel targeted therapeutic strategy aimed at improving cardiometabolic health and addressing the increasing prevalence of cardiometabolic disease in the Black population.
Study Type
Interventional
Enrollment (Estimated)
200
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Nehal Vekariya, MS
- Phone Number: 2059347173
- Email: nvekariya@uabmc.edu
Study Contact Backup
- Name: Naman Shetty, MD
- Phone Number: 2059755826
- Email: nsshetty@uabmc.edu
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35294
- University of Alabama at Birmingham
-
-
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
- Adult
- Older Adult
Accepts Healthy Volunteers
Yes
Description
Inclusion Criteria:
- Adults: Age more than or equal to 18 years of age
- Self-identified race/ethnicity as African-American or Black
- BMI ≥ 30 kg/m2
- HOMA-IR ≥ 2.5
- Blood pressure: 120-160/80-100 mmHg (untreated or 1 week of washout in those treated with up to two classes of antihypertensives)
- Willing to adhere to study protocol
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, seizure or cardiac arrhythmia)
- BP more than 160/100 mmHg or those treated with three or more classes of antihypertensives
- BMI >45 kg/m2
- History of diabetes or fasting plasma glucose >=126 mg/dL or HbA1C>=6.5% or prior treatment with antidiabetics
- 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 (assessed using validated MINI questionnaire)
- Anemia (men, Hb<13 g/dL; women, Hb <12 g/dL)
- Inability to exercise on a treadmill
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: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental: Vericiguat
The subject will be randomized, in a double-blind manner to vericiguat 10 mg once daily for a period of 12 weeks.
|
The subject will be randomized, in a double-blind manner to vericiguat 10 mg once daily for a period of 12 weeks.
Other Names:
An assessment of the insulin sensitivity will be done using the Euglycemic Hyperinsulinemic Clamp, at baseline and after 12 weeks of pharmacological interventions.
Each participant's Energy Expenditure will be determined using a metabolic cart, at baseline and after 12 weeks of pharmacological interventions.
Other Names:
Participants who consent to participate in the exploratory aim will undergo WAT biopsy to assess UCP1 gene expression from the collected biospecimens, at baseline and after 12 weeks of pharmacological interventions.
Participants who consent to participate in the exploratory aim will undergo PET/MR to BAT volume at baseline and after 12 weeks of pharmacological interventions.
|
Placebo Comparator: Placebo
The subject will be randomized, in a double-blind manner to placebo once daily for a period of 12 weeks.
|
An assessment of the insulin sensitivity will be done using the Euglycemic Hyperinsulinemic Clamp, at baseline and after 12 weeks of pharmacological interventions.
Each participant's Energy Expenditure will be determined using a metabolic cart, at baseline and after 12 weeks of pharmacological interventions.
Other Names:
Participants who consent to participate in the exploratory aim will undergo WAT biopsy to assess UCP1 gene expression from the collected biospecimens, at baseline and after 12 weeks of pharmacological interventions.
Participants who consent to participate in the exploratory aim will undergo PET/MR to BAT volume at baseline and after 12 weeks of pharmacological interventions.
The subject will be randomized, in a double-blind manner to placebo once 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 vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in insulin sensitivity between baseline and post-intervention between two arms.
|
12 weeks
|
Change in resting energy expenditure (REE) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in REE between baseline and post-intervention between two arms.
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in BAT volume after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in BAT volume between baseline and post-intervention between two arms.
|
12 weeks
|
Change in BAT activity after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in BAT activity between baseline and post-intervention between two arms.
|
12 weeks
|
Change in UCP1 gene expression after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in UCP1 gene expression between baseline and post-intervention between two arms.
|
12 weeks
|
Change in exercise energy expenditure (EEE) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in EEE between baseline and post-intervention between two arms.
|
12 weeks
|
Change in glycosylated hemoglobin (HbA1C) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in HbA1C between baseline and post-intervention between two arms.
|
12 weeks
|
Change in Body Mass Index (BMI) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in BMI between baseline and post-intervention between two arms.
|
12 weeks
|
Change in Total Cholesterol (TC) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in TC between baseline and post-intervention between two arms.
|
12 weeks
|
Change in low-density lipoprotein-cholesterol (LDL-C) after vericiguat in Black obese individuals with insulin resistance.
Time Frame: 12 weeks
|
The difference in change in LDL-C between baseline and post-intervention between two arms.
|
12 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Pankaj Arora, MD, FAHA, University of Alabama at Birmingham
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 (Estimated)
May 1, 2025
Primary Completion (Estimated)
April 30, 2028
Study Completion (Estimated)
April 30, 2029
Study Registration Dates
First Submitted
March 13, 2024
First Submitted That Met QC Criteria
March 13, 2024
First Posted (Actual)
March 20, 2024
Study Record Updates
Last Update Posted (Actual)
May 6, 2024
Last Update Submitted That Met QC Criteria
May 3, 2024
Last Verified
May 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 300012681
- Pending (Other Identifier: Ceim HCSC (ERB of Hospital Clinico San Carlos)))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
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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