Exercise Training Decreases Alcohol Consumption and Tissue Injury by an FGF21-dependent Mechanism
Panoramica dello studio
Stato
Intervento / Trattamento
Descrizione dettagliata
Alcohol use disorder is a major driver of continued liver injury in alcohol-related liver disease. Patients with ALD also commonly develop sarcopenia, impaired skeletal muscle function, fatigue, mitochondrial dysfunction, reduced exercise capacity, and physical frailty. Exercise may improve muscle and metabolic function and may also reduce alcohol craving and consumption. FGF21 has been proposed as a mechanistic link among exercise, skeletal muscle, liver injury, metabolism, and alcohol-related behavior.
This is a randomized, controlled, unblinded study of 30 adults with AUD/ALD. Participants will be randomized 1:1 to endurance exercise plus standard of care (EE+SOC) or standard of care alone (SOC). Participants assigned to EE+SOC will complete a 12-week home-based supervised cycling program three days per week, with a target of approximately 60 minutes per session and intensity adjusted for safety, tolerance, and beta-blocker use. Exercise sessions will be remotely monitored, and fitness testing will occur at Cleveland Clinic. Participants in the SOC arm will continue usual clinical care and their usual physical activity without the structured exercise intervention.
The study will assess alcohol consumption and craving; circulating and skeletal muscle FGF21; liver injury measures; exercise capacity and physical performance; body composition; fatigue; skeletal muscle metabolism and mitochondrial function; and exploratory transcriptomic, proteomic, metabolomic, microbiome, amino acid, protein synthesis, TCA intermediate, and cell-signaling responses.
Tipo di studio
Iscrizione (Stimato)
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
- Nome: Annette Bellar, PhD
- Numero di telefono: 216-445-6268
- Email: bellara@ccf.org
Backup dei contatti dello studio
- Nome: Research Coordinator
- Numero di telefono: 216-445-6268
Luoghi di studio
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Ohio
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Cleveland, Ohio, Stati Uniti, 44195
- Reclutamento
- Cleveland Clinic
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Investigatore principale:
- Srinivasan Dasarathy, MD
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Contatto:
- Annette Program Manager, PhD
- Numero di telefono: 216-445-6268
- Email: bellara@ccf.org
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
Inclusion Criteria:
• Adults age 18 years or older, of either sex.
- Clinical diagnosis of alcohol use disorder (AUD) / alcohol-related liver disease (ALD).
- Meets NIAAA hazardous-drinking criteria: at least 7 drinks/week for women or 14 drinks/week for men for more than 6 months, with ongoing alcohol use within 2 months of evaluation.
- MELD score less than 21.
- Able to safely participate in exercise testing and endurance exercise.
- Able to provide informed consent.
- No concurrent renal, cardiac, pulmonary, cerebrovascular, or malignant illness that affects skeletal muscle mass; no diabetes mellitus; and no use of medications that affect skeletal muscle mass/protein turnover as described in the protocol, including anabolic steroids, high-dose corticosteroids, or anticoagulants.
Exclusion Criteria:
• Pedal edema above the ankle or grade 2 pedal edema.
- Liver transplant.
- Active malignancy.
- Gastrointestinal bleed within the previous 4 weeks.
- Hepatic encephalopathy within the previous 6 months.
- Grade 2 or greater active esophageal varices.
- Active infection.
- Large ascites by clinical and/or imaging criteria.
- Advanced cardiac disease (NYHA class 3 or 4) or advanced pulmonary disease (GOLD class 3 or 4).
- Use of medications affecting muscle protein turnover, including corticosteroids, or medications used to prevent clotting.
- Prior orthopedic surgery or chronic joint pain that, in the opinion of the PI, may inhibit participation.
- INR greater than 1.7 or platelet count less than 60,000/mL.
- Unable to provide informed consent; judged likely to be unable to perform exercise or unlikely to complete the study in the opinion of the investigators.
- End-stage kidney disease defined as eGFR less than 15 mL/min/1.73 m² or dialysis.
- Considered unsafe for exercise in the opinion of the PI.
- Failure to pass the exercise stress test.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
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Sperimentale: Endurance Exercise
Participants will receive standard of care and complete a 12-week supervised home-based endurance exercise program using a recumbent exercise bike.
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Stationary/recumbent cycling three days per week for approximately 60 minutes per session for 12 weeks.
Exercise intensity is targeted at approximately 60-70% heart rate reserve and adjusted for safety, tolerance, and beta-blocker use.
Sessions are remotely monitored by the study team.
Participants who cannot exercise continuously may use rest breaks and complete the prescribed exercise within the limits described in the protocol.
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Nessun intervento: Standard of Care
Participants will continue usual clinical care and their current pattern of physical activity and will not participate in the structured endurance exercise intervention
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Change in Alcohol Consumption Measured by Timeline Follow Back (TLFB)
Lasso di tempo: Baseline to 12 weeks
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Alcohol consumption will be assessed using the Timeline Follow Back (TLFB).
The primary comparison is change over 12 weeks between the EE+SOC and SOC groups.
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Baseline to 12 weeks
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Change in Alcohol Cravings Measured by the Penn Alcohol Cravings Scale (PACS)
Lasso di tempo: Baseline to 12 weeks
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Alcohol craving will be assessed using the Penn Alcohol Craving Scale (PACS).
The primary comparison is change over 12 weeks between the EE+SOC and SOC groups.
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Baseline to 12 weeks
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Collaboratori e investigatori
Sponsor
Investigatori
- Investigatore principale: Srinivasan Dasarathy, MD, The Cleveland Clinic
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Altri numeri di identificazione dello studio
- 26-528
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