Does supplementation with carnosine improve cardiometabolic health and cognitive function in patients with pre-diabetes and type 2 diabetes? study protocol for a randomised, double-blind, placebo-controlled trial

Estifanos Baye, Kirthi Menon, Maximilian Pj de Courten, Arul Earnest, James Cameron, Barbora de Courten, Estifanos Baye, Kirthi Menon, Maximilian Pj de Courten, Arul Earnest, James Cameron, Barbora de Courten

Abstract

Introduction: Carnosine, an over-the-counter food supplement, has a promising potential for the prevention and treatment of chronic diseases such as type 2 diabetes (T2DM), cardiovascular and neurodegenerative diseases through its anti-inflammatory, antiglycation, antioxidative and chelating effects. We have previously shown that supplementation with carnosine preserves insulin sensitivity and secretion in non-diabetic overweight and obese individuals. The effect of carnosine on cardiometabolic risk and related cognitive outcomes in patients with pre-diabetes and T2DM has thus far not been studied. We therefore aim to investigate whether supplementation with carnosine improves cardiometabolic health and cognitive function in patients with pre-diabetes and T2DM.

Methods and analysis: We will employ a parallel design randomised controlled trial. Fifty participants with pre-diabetes (impaired fasting glycaemia and impaired glucose tolerance) and T2DM (with HbA1c level < 8%) aged between 18 to 70 years will be randomly assigned to the intervention or control group. At baseline, participants will undergo a medical review and series of tests including anthropometric measurements (body mass index, a dual X-ray absorptiometry and peripheral quantitative computed tomography scan), an oral glucose tolerance test, cardiovascular measurements (central blood pressure, endothelial function and arterial stiffness), cognitive function, physical activity measurement, heart rate variability and liver fibroscan as well as questionnaires to assess dietary habits, sleep quality, depression and quality of life. The intervention group will receive 2 g of carnosine daily in two divided doses while the control group will receive identical placebo capsules for 14 weeks. All baseline measurements will be repeated at the end of the intervention. The change in glycaemic, cardiovascular and cognitive parameters as well as other measures will be compared between the groups.

Ethics and dissemination: This study is approved by the Human Research Ethics Committee of Monash Health and Monash University, Australia. The findings will be disseminated via peer-reviewed publications and conference presentations.

Trial registration: NCT02917928; Pre-results.

Keywords: general diabetes; lipid disorders; other metabolic, e.g. iron, porphyria.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study timeline. CANTAB, Cambridge neuropsychological test automated battery; CVD, cardiovascular disease; DEXA, dual energy X-ray absorptiometry; HbA1c, haemoglobin A1c; OGTT, oral glucose tolerance test; pQCT, peripheral quantitative CT scan.

References

    1. Danaei G, Finucane MM, Lu Y, et al. . National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. Lancet 2011;378:31–40.10.1016/S0140-6736(11)60679-X
    1. IDF. Diabetes Atlas Sixth Edition Update: international Diabetes Federation, 2014.
    1. Tabák AG, Herder C, Rathmann W, et al. . Prediabetes: a high-risk state for diabetes development. Lancet 2012;379:2279–90.10.1016/S0140-6736(12)60283-9
    1. Forouhi NG, Luan J, Hennings S, et al. . Incidence of type 2 diabetes in England and its association with baseline impaired fasting glucose: the Ely study 1990-2000. Diabet Med 2007;24:200–7.10.1111/j.1464-5491.2007.02068.x
    1. Fox CS, Pencina MJ, Wilson PW, et al. . Lifetime risk of cardiovascular disease among individuals with and without diabetes stratified by obesity status in the Framingham heart study. Diabetes Care 2008;31:1582–4.10.2337/dc08-0025
    1. Luchsinger JA. Type 2 diabetes and cognitive impairment: linking mechanisms. J Alzheimers Dis 2012;30(Suppl 2):S185–98.10.3233/JAD-2012-111433
    1. Sandyk R. The relationship between diabetes mellitus and Parkinson's disease. Int J Neurosci 1993;69:125–30.10.3109/00207459309003322
    1. Barbeau A, Pourcher E. New data on the genetics of Parkinson's disease. Can J Neurol Sci 1982;9:53–60.10.1017/S031716710004364X
    1. Boyd AE, Lebovitz HE, Feldman JM. Endocrine function and glucose metabolism in patients with Parkinson's disease and their alternation by L-Dopa. J Clin Endocrinol Metab 1971;33:829–37.10.1210/jcem-33-5-829
    1. Lipman IJ, Boykin ME, Flora RE. Glucose intolerance in Parkinson's disease. J Chronic Dis 1974;27:573–9.10.1016/0021-9681(74)90031-9
    1. de la Monte SM, Wands JR. Alzheimer's disease is type 3 diabetes-evidence reviewed. J Diabetes Sci Technol 2008;2:1101–13.10.1177/193229680800200619
    1. de Lau LM, Breteler MM. Epidemiology of Parkinson's disease. Lancet Neurol 2006;5:525–35.10.1016/S1474-4422(06)70471-9
    1. Hirsch MA, Farley BG. Exercise and neuroplasticity in persons living with Parkinson's disease. Eur J Phys Rehabil Med 2009;45:215–29.
    1. Jankovic J, Poewe W. Therapies in Parkinson's disease. Curr Opin Neurol 2012;25:433–47.10.1097/WCO.0b013e3283542fc2
    1. Marinus J, Visser M, Stiggelbout AM, et al. . Activity-based diary for Parkinson's disease. Clin Neuropharmacol 2002;25:43–50.10.1097/00002826-200201000-00008
    1. Marques-Aleixo I, Oliveira PJ, Moreira PI, et al. . Physical exercise as a possible strategy for brain protection: evidence from mitochondrial-mediated mechanisms. Prog Neurobiol 2012;99:149–62.10.1016/j.pneurobio.2012.08.002
    1. Singer C. Managing the patient with newly diagnosed Parkinson disease. Cleve Clin J Med 2012;79(Suppl 2):S3–S7.10.3949/ccjm.79.s2a.01
    1. Hobson RM, Saunders B, Ball G, et al. . Effects of β-alanine supplementation on exercise performance: a meta-analysis. Amino Acids 2012;43:25–37.10.1007/s00726-011-1200-z
    1. Sauerhöfer S, Yuan G, Braun GS, et al. . L-carnosine, a substrate of carnosinase-1, influences glucose metabolism. Diabetes 2007;56:2425–32.10.2337/db07-0177
    1. Lee YT, Hsu CC, Lin MH, et al. . Histidine and carnosine delay diabetic deterioration in mice and protect human low density lipoprotein against oxidation and glycation. Eur J Pharmacol 2005;513:145–50.10.1016/j.ejphar.2005.02.010
    1. Nagai K, Tanida M, Niijima A, et al. . Role of L-carnosine in the control of blood glucose, blood pressure, thermogenesis, and lipolysis by autonomic nerves in rats: involvement of the circadian clock and histamine. Amino Acids 2012;43:97–109.10.1007/s00726-012-1251-9
    1. Aldini G, Orioli M, Rossoni G, et al. . The carbonyl scavenger carnosine ameliorates dyslipidaemia and renal function in Zucker obese rats. J Cell Mol Med 2011;15:1339–54.10.1111/j.1582-4934.2010.01101.x
    1. Hipkiss AR, Michaelis J, Syrris P. Non-enzymatic glycosylation of the dipeptide L-carnosine, a potential anti-protein-cross-linking agent. FEBS Lett 1995;371:81–5.10.1016/0014-5793(95)00849-5
    1. Aldini G, Granata P, Carini M. Detoxification of cytotoxic alpha,beta-unsaturated aldehydes by carnosine: characterization of conjugated adducts by electrospray ionization tandem mass spectrometry and detection by liquid chromatography/mass spectrometry in rat skeletal muscle. J Mass Spectrom 2002;37:1219–28.10.1002/jms.381
    1. Pavlov AR, Revina AA, Dupin AM, et al. . The mechanism of interaction of carnosine with superoxide radicals in water solutions. Biochim Biophys Acta 1993;1157:304–12.10.1016/0304-4165(93)90114-N
    1. de Courten B, Jakubova M, de Courten MP, et al. . Effects of carnosine supplementation on glucose metabolism: pilot clinical trial. Obesity 2016;24:1027–34.10.1002/oby.21434
    1. Boldyrev A, Fedorova T, Stepanova M, et al. . Carnosine [corrected] increases efficiency of DOPA therapy of Parkinson's disease: a pilot study. Rejuvenation Res 2008;11:821–7.10.1089/rej.2008.0716
    1. Chengappa KN, Turkin SR, DeSanti S, et al. . A preliminary, randomized, double-blind, placebo-controlled trial of l-carnosine to improve cognition in schizophrenia. Schizophr Res 2012;142:145–52.10.1016/j.schres.2012.10.001
    1. Chez MG, Buchanan CP, Aimonovitch MC, et al. . Double-blind, placebo-controlled study of L-carnosine supplementation in children with autistic spectrum disorders. J Child Neurol 2002;17:833–7.10.1177/08830738020170111501
    1. Boldyrev AA, Aldini G, Derave W. Physiology and pathophysiology of carnosine. Physiol Rev 2013;93:1803–45.10.1152/physrev.00039.2012
    1. Liu Y, Cotillard A, Vatier C, et al. . A Dietary Supplement Containing Cinnamon, Chromium and Carnosine decreases fasting plasma glucose and increases lean mass in overweight or obese Pre-Diabetic subjects: a Randomized, Placebo-Controlled Trial. PLoS One 2015;10:e013864610.1371/journal.pone.0138646
    1. Lombardi C, Carubelli V, Lazzarini V, et al. . Effects of oral administration of orodispersible levo-carnosine on quality of life and exercise performance in patients with chronic heart failure. Nutrition 2015;31:72–8.10.1016/j.nut.2014.04.021
    1. Chengappa KN, Turkin SR, DeSanti S, et al. . A preliminary, randomized, double-blind, placebo-controlled trial of L-carnosine to improve cognition in schizophrenia. Schizophr Res 2012;142:145–52.10.1016/j.schres.2012.10.001
    1. Chez MG, Buchanan CP, Aimonovitch MC, et al. . Double-blind, placebo-controlled study of L-carnosine supplementation in children with autistic spectrum disorders. J Child Neurol 2002;17:833–7.10.1177/08830738020170111501
    1. Hisatsune T, Kaneko J, Kurashige H, et al. . Effect of Anserine/Carnosine supplementation on Verbal Episodic memory in Elderly People. J Alzheimers Dis 2015;50:149–59.10.3233/JAD-150767
    1. Chan AW, Tetzlaff JM, Gøtzsche PC, et al. . SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013;346:e758610.1136/bmj.e7586
    1. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998;15:539–53.10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>;2-S
    1. Svendsen OL, Haarbo J, Hassager C, et al. . Accuracy of measurements of body composition by dual-energy x-ray absorptiometry in vivo. Am J Clin Nutr 1993;57:605–8.
    1. Engelke K, Adams JE, Armbrecht G, et al. . Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 2008;11:123–62.10.1016/j.jocd.2007.12.010
    1. Zoungas S, Cameron JD, Kerr PG, et al. . Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD. Am J Kidney Dis 2007;50:622–30.10.1053/j.ajkd.2007.07.012
    1. Martin CA, Cameron JD, Chen SS, et al. . Two hour glucose post loading: a biomarker of cardiovascular risk in isolated clinic hypertension. J Hypertens 2011;29:749–57.10.1097/HJH.0b013e328342eeeb
    1. Narayan O, Davies JE, Hughes AD, et al. . Central Aortic Reservoir pressure analysis in the ANBP2 aortic mechanics Sub-study. Hypertension 2015. In Press.
    1. Cheng K, Cameron JD, Tung M, et al. . Association of left ventricular motion and central augmentation index in healthy young men. J Hypertens 2012;30:2395–402.10.1097/HJH.0b013e328358bee2
    1. Egerházi A, Berecz R, Bartók E, et al. . Automated neuropsychological test battery (CANTAB) in mild cognitive impairment and in Alzheimer's disease. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:746–51.10.1016/j.pnpbp.2007.01.011
    1. Afdhal NH. Fibroscan (transient elastography) for the measurement of liver fibrosis. Gastroenterol Hepatol 2012;8:605–7.
    1. Craig CL, Marshall AL, Sjöström M, et al. . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003;35:1381–95.10.1249/01.MSS.0000078924.61453.FB
    1. Buysse DJ, Reynolds CF, Monk TH, et al. . The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.10.1016/0165-1781(89)90047-4
    1. Hoddes E, Zarcone V, Smythe H, et al. . Quantification of sleepiness: a new approach. Psychophysiology 1973;10:431–6.10.1111/j.1469-8986.1973.tb00801.x
    1. Monk TH, Reynolds CF, Kupfer DJ, et al. . The Pittsburgh Sleep Diary. J Sleep Res 1994;3:111–20.10.1111/j.1365-2869.1994.tb00114.x
    1. Kroenke K, Strine TW, Spitzer RL, et al. . The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009;114:163–73.10.1016/j.jad.2008.06.026
    1. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208.
    1. Everaert I, Taes Y, De Heer E, et al. . Low plasma carnosinase activity promotes carnosinemia after carnosine ingestion in humans. Am J Physiol Renal Physiol 2012;302:F1537–F1544.10.1152/ajprenal.00084.2012
    1. Aldini G, Facino RM, Beretta G, et al. . Carnosine and related dipeptides as quenchers of reactive carbonyl species: from structural studies to therapeutic perspectives. Biofactors 2005;24:77–87.10.1002/biof.5520240109
    1. Forbes JM, Sourris KC, de Courten MP, et al. . Advanced glycation end products (AGEs) are cross-sectionally associated with insulin secretion in healthy subjects. Amino Acids 2014;46:321–6.10.1007/s00726-013-1542-9
    1. Thomas P, Holland N, Bolognesi C, et al. . Buccal micronucleus cytome assay. Nat Protoc 2009;4:825–37.10.1038/nprot.2009.53
    1. Fenech M. Cytokinesis-block micronucleus cytome assay. Nat Protoc 2007;2:1084–104.10.1038/nprot.2007.77
    1. Lan KKG, DeMets DL. Discrete Sequential Boundaries for clinical trials. Biometrika 1983;70:659–63.
    1. Brown BE, Kim CH, Torpy FR, et al. . Supplementation with carnosine decreases plasma triglycerides and modulates atherosclerotic plaque composition in diabetic apo E(-/-) mice. Atherosclerosis 2014;232:403–9.10.1016/j.atherosclerosis.2013.11.068
    1. Peters V, Schmitt CP, Zschocke J, et al. . Carnosine treatment largely prevents alterations of renal carnosine metabolism in diabetic mice. Amino Acids 2012;42:2411–6.10.1007/s00726-011-1046-4
    1. Li YF, He RR, Tsoi B, et al. . Anti-stress effects of carnosine on restraint-evoked immunocompromise in mice through spleen lymphocyte number maintenance. PLoS One 2012;7:e3319010.1371/journal.pone.0033190
    1. Riedl E, Pfister F, Braunagel M, et al. . Carnosine prevents apoptosis of glomerular cells and podocyte loss in STZ diabetic rats. Cell Physiol Biochem 2011;28:279–88.10.1159/000331740
    1. Pfister F, Riedl E, Wang Q, et al. . Oral carnosine supplementation prevents vascular damage in experimental diabetic retinopathy. Cell Physiol Biochem 2011;28:125–36.10.1159/000331721
    1. Kamei J, Ohsawa M, Miyata S, et al. . Preventive effect of L-carnosine on changes in the thermal nociceptive threshold in streptozotocin-induced diabetic mice. Eur J Pharmacol 2008;600:83–6.10.1016/j.ejphar.2008.10.002
    1. Mong MC, Chao CY, Yin MC. Histidine and carnosine alleviated hepatic steatosis in mice consumed high saturated fat diet. Eur J Pharmacol 2011;653:82–8.10.1016/j.ejphar.2010.12.001
    1. Barski OA, Xie Z, Baba SP, et al. . Dietary carnosine prevents early atherosclerotic lesion formation in apolipoprotein E-null mice. Arterioscler Thromb Vasc Biol 2013;33:1162–70.10.1161/ATVBAHA.112.300572
    1. Young H, Benton D, Carter N. The effect of chicken extract on mood, cognition and heart rate variability. Nutrients 2015;7:887–904.10.3390/nu7020887
    1. Ma J, Xiong JY, Hou WW, et al. . Protective effect of carnosine on subcortical ischemic vascular dementia in mice. CNS Neurosci Ther 2012;18:745–53.10.1111/j.1755-5949.2012.00362.x
    1. Corona C, Frazzini V, Silvestri E, et al. . Effects of dietary supplementation of carnosine on mitochondrial dysfunction, amyloid pathology, and cognitive deficits in 3xTg-AD mice. PLoS One 2011;6:e1797110.1371/journal.pone.0017971
    1. Baraniuk JN, El-Amin S, Corey R, et al. . Carnosine treatment for gulf war illness: a randomized controlled trial. Glob J Health Sci 2013;5:69–81.10.5539/gjhs.v5n3p69
    1. Minihane AM, Vinoy S, Russell WR, et al. . Low-grade inflammation, diet composition and health: current research evidence and its translation. Br J Nutr 2015;114:999–1012.10.1017/S0007114515002093
    1. Pham-Huy LA, He H, Pham-Huy C. Free radicals, antioxidants in disease and health. Int J Biomed Sci 2008;4:89–96.
    1. Tsai SJ, Kuo WW, Liu WH, et al. . Antioxidative and anti-inflammatory protection from carnosine in the striatum of MPTP-treated mice. J Agric Food Chem 2010;58:11510–6.10.1021/jf103258p
    1. Liu WH, Liu TC, Yin MC. Beneficial effects of histidine and carnosine on ethanol-induced chronic liver injury. Food Chem Toxicol 2008;46:1503–9.10.1016/j.fct.2007.12.013
    1. Alpsoy L, Akcayoglu G, Sahin H. Anti-oxidative and anti-genotoxic effects of carnosine on human lymphocyte culture. Hum Exp Toxicol 2011;30:1979–85.10.1177/0960327111404908
    1. Kim MY, Kim EJ, Kim YN, et al. . Effects of α-lipoic acid and L-carnosine supplementation on antioxidant activities and lipid profiles in rats. Nutr Res Pract 2011;5:421–8.10.4162/nrp.2011.5.5.421
    1. Ma XY, Jiang ZY, Lin YC, et al. . Dietary supplementation with carnosine improves antioxidant capacity and meat quality of finishing pigs. J Anim Physiol Anim Nutr 2010;94:e286–95.10.1111/j.1439-0396.2010.01009.x
    1. Dursun N, Taşkın E, Oztürk F. Protection against adriamycin-induced cardiomyopathy by carnosine in rats: role of endogenous antioxidants. Biol Trace Elem Res 2011;143:412–24.10.1007/s12011-010-8875-y
    1. Alhamdani MS, Al-Azzawie HF, Abbas FK. Decreased formation of advanced glycation end-products in peritoneal fluid by carnosine and related peptides. Perit Dial Int 2007;27:86–9.
    1. Burcham PC, Kaminskas LM, Fontaine FR, et al. . Aldehyde-sequestering drugs: tools for studying protein damage by lipid peroxidation products. Toxicology 2002;181-182:229–36.10.1016/S0300-483X(02)00287-1
    1. Yan H, Harding JJ. Carnosine protects against the inactivation of esterase induced by glycation and a steroid. Biochim Biophys Acta 2005;1741:120–6.10.1016/j.bbadis.2004.11.008
    1. Stinghen AE, Massy ZA, Vlassara H, et al. . Uremic toxicity of Advanced Glycation End Products in CKD. J Am Soc Nephrol 2016;27:354–70.10.1681/ASN.2014101047
    1. Baye E, Ukropcova B, Ukropec J, et al. . Physiological and therapeutic effects of carnosine on cardiometabolic risk and disease. Amino Acids 2016;48:1131–49.10.1007/s00726-016-2208-1

Source: PubMed

3
Abonneren