Rola inhibitorów fosfodiesterazy w wydzielaniu inkretyn
Background:
The drug Roflumilast (Daliresp) is used to treat Chronic Obstructive Pulmonary Disease (COPD). COPD is a lung disease that makes it difficult to breathe. Studies have shown that this drug decreased the blood sugar of people with type 2 diabetes. Sitagliptin (Januvia) is a medication presently used to treat diabetes. Researchers think that both of these drugs may decrease blood sugar by causing an increase in the hormone GLP-1.This hormone is secreted in the small intestines and stomach and is also known as an incretin. Researchers want to study how these drugs affect blood sugar, insulin, and other hormones in the blood.
Objectives:
- To study the effects of Roflumilast (Daliresp) and Sitagliptin (Januvia) on blood sugar and insulin.
- To better understand GLP-1 and other gut hormones. This may lead to new treatments for type 2 diabetes.
Eligibility:
- Healthy volunteers age 21 55.
- Body Mass Index (BMI) less than 30
Design:
-This study will require one screening visit and four study visits, scheduled about 3-weeks apart.
Screening visit requires participants to arrive after fasting for 10 hours and have the following:
- Medical history, physical exam, height, weight, blood pressure measurements and blood and urine tests.
- A 2-hour oral glucose tolerance test (OGTT). Participants will drink an orange-flavored drink containing 75 grams of sugar (300 calories). A blood sample will be taken prior to drinking the beverage and 2-hours later.
- An electrocardiogram (EKG) to measure the electrical activity of the heart.
- Questionnaires about risk for depression or suicide.
Study visits 1to 4:
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Participants will arrive the evening prior and blood work will be done to confirm eligibility. They will not eat or drink anything except water starting at 8:00 p.m.
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About 6:30 a.m. the following day, an I.V. (small plastic tube) will be placed in an arm vein and used to take 20 blood samples over a period of about 11 hours.
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Participants will receive one of the following study medication/placebo groupings in random order:
- Roflumilast (Daliresp) 500 mcg pill; and 1 placebo pill
- Sitaglipitin (Januvia) 100 mg pill; and 1 placebo pill
- Roflumilast (Daliresp) 500 mcg pill; and Sitagliptin (Januvia) 100 mg pill
- 2 placebo pills
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One hour later, they will have a 10-hour mixed meal test (MMT). They will be asked to drink a nutritional shake (Ensure Plus). Blood samples will be taken over the next 10 hours to measure blood sugar, insulin and other hormones. At the end of the test, they will be given a meal.
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Participants will answer questions about side effects and symptoms. They will receive a follow-up phone call within 10 days.
Przegląd badań
Status
Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Szczegółowy opis
Objectives and Specific Aims:
We plan to investigate whether phosphodiesterases are involved in the regulation of glucagon-like peptide-1 (GLP-1) secretion from L cells in humans. We hypothesize that: (1) phosphodiesterase-4D (PDE4D) inhibitor (roflumilast) enhance GLP-1 secretion from L cells; (2) PDE4D inhibitor (roflumilast) and DPP4 inhibitor (sitagliptin) have synergistic effect on increasing the amount of circulating active GLP-1.
Experimental Design and Methods:
Twenty healthy adults, age 21-55, will be recruited for this study. This is a randomized, double-blind, placebo-controlled cross-over study. Each subject will serve as his/her own control and each person will have four different study visits spaced about 3 weeks apart. During each visit, they will receive one of the following medications (oral route) in random order:
- Roflumilast (Daliresp) 500 mcg + Placebo
- Sitagliptin (Januvia) 100 mg + Placebo
- Roflumilast (Daliresp) 500 mcg + Sitagliptin (Januvia) 100 mg
- Placebo
A 10-hr mixed-meal test will be administered 1 hour after the medications and frequent blood-samplings will be done over 10 hours.
Medical Relevance and Expected Outcome:
Preliminary clinical data have shown that phosphodiesterase inhibitors improved glycemic control in type 2 diabetes, and pre-clinical animal data have shown that phosphodiesterase inhibitors enhanced GLP-1 secretion from L cells. The application of novel, pre-clinical findings to an understanding of human biology and pathobiology is of fundamental and critical importance. This study will give us a better understanding of the regulators of GLP-1 secretion in humans, and this new understanding may lead to new treatments for type 2 diabetes.
Typ studiów
Typ studiów
Zapisy (Rzeczywisty)
Zapisy
Faza
Faza
- Faza 1
Kontakty i lokalizacje
Lokalizacje studiów
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-
Maryland
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Baltimore, Maryland, Stany Zjednoczone, 21224
- National Institute of Aging, Clinical Research Unit
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Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
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INCLUSION CRITERIA:
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Age 21-55 (Age restriction is used to remove age as a confounding factor because (beta) cells function and insulin resistance tend to deteriorate with age and may affect GLP-1 and GIP levels.
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Screening laboratory evaluations with no clinically significant abnormal results (minor deviations from normal lab results will be at the discretion of the principal investigator):
- fasting comprehensive metabolic panel
- complete blood count with differential and platelet
- thyroid function test (TSH)
- urine drug screen
- Point of care urine pregnancy test (for women who are not surgically sterile)
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BMI < 30 (participants with BMI greater than or equal to 30 are excluded because obesity has been associated with attenuation in GLP-1 secretion.
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Have had a history of stable weight (maintained weight within +/- 5%) over the past year
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Have NOT participated in another clinical trial involving any pharmacologic agents within the past 30 days
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Able to complete an inform consent
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Agree to not participate in other clinical trials within the study period (at the discretion of the study investigator)
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EXCLUSION CRITERIA:
- FPG greater than or equal to 100 mg/dl or 2-hr OGTT greater than or equal to 140 mg/dL (evidence of glucose intolerance or diabetes)
- History of anemia, or Hemoglobin < 12.5 mg/dL for men and < 11.5 mg/dL for women during screening visit
- Weight < 110 pounds (due to blood volume requirement)
- Evidence of illicit drug use
- History of substance abuse including marijuana within the past 6 months
- History of smoking any tobacco products within six months prior to screening
- Alcohol intake > 30 grams (drink more than 2 beers per day OR equivalent amount of alcohol)
- History of Human Immunodeficiency Virus (HIV) infection
- History of active or chronic Hepatitis B and/or C infection
- History of psychiatric illnesses including major depressive disorder, schizophrenia, bipolar disorder
- Any lifetime history of suicide attempt
- History of any suicidal ideation of type 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS) in the last year
- Any suicidal ideation of type 4 or 5 on the C-SSRS during any follow-up visits.
- Patient Health Questionnaire-9 (PHQ-9) score greater than or equal to 10 during screening visit or any follow-up study visits
- Generalized Anxiety Disorder-7 (GAD-7) score greater than or equal to 10 during screening visit or any follow-up visits
- History of pancreatitis
- History of liver or renal diseases
- History of gastrointestinal or endocrine disorders
- History of malignancy (unless P.I. determines that there is no impact of the prior malignancy on study outcomes, i.e. basal cell skin cancer)
- History of coronary disease or clinically significant abnormalities on electrocardiogram
- History of seizures or other neurologic diseases
- History of glucocorticoid use (over one month) or other immunosuppressive agents (any), i.e. Imuran, Neoral, Sandimmune, SangCya, basiliximab (Simulect), daclizumab (Zenapax), muromonab (Orthocolone OKT(3)) prednisone (Deltasone, Orasone) within the past six months
- Use of proton pump inhibitors (PPI s), i.e. Prilosec, Prevacid, Achiphex, Protonix, Nexium, Zegarid
- Women who are pregnant or nursing/breast-feeding a child
- Any medical history that, in the opinion of the investigator(s), may make participation of the subject in the study unsafe
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Podstawowa nauka
- Przydział: Randomizowane
- Model interwencyjny: Przypisanie czynnikowe
- Maskowanie: Podwójnie
Liczba ramion
Broń i interwencje
Grupa uczestników / ArmGrupa uczestników / Arm |
Interwencja / LeczenieInterwencja / Leczenie |
|---|---|
|
Komparator placebo: Placebo
randomized, double-blind, placebo-controlled cross-over study |
mixed meal |
|
Eksperymentalny: Roflumilast
randomized, double-blind, placebo-controlled cross-over study |
mixed meal This is already known to increase GLP-1 & GIP secretion |
|
Eksperymentalny: Roflumilast/Sitaglip
randomized, double-blind, placebo-controlled cross-over study |
mixed meal Both Roflumilast and Sitagliptin together |
|
Eksperymentalny: Sitagliptin
randomized, double-blind, placebo-controlled cross-over study |
mixed meal This is already known to increase GLP-1 & GIP secretion. |
Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
PDE4 inhibitor roflumilast enhances GLP-1 secretion from L cells.
Ramy czasowe: 1-10 hours after ingestion
|
GIP & GLP-1 response to a mixed meal. |
1-10 hours after ingestion
|
Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
5.PDE4 inhibitor roflumilast and DPP4 inhibitor sitagliptin have synergistic effect on glucose metabolism involving plasma glucose, insulin, ghrelin, glucagon, pancreatic polypeptide, C-peptide and fibroblast growth factor (FGF) 19, 21, 23.
Ramy czasowe: 1-10 hours after ingestion
|
The hormones listed are measured by ELISA |
1-10 hours after ingestion
|
|
4.PDE4 inhibitor roflumilast has an effect on glucose metabolism involving plasma glucose, insulin, ghrelin, glucagon, pancreatic polypeptide, C-peptide and fibroblast growth factor (FGF) 19, 21, 23.
Ramy czasowe: 1-10 hours after ingestion
|
The hormones listed are measured by ELISA |
1-10 hours after ingestion
|
|
3.PDE4 inhibitor roflumilast and DPP4 inhibitor sitagliptin have synergistic effect on elevating circulating active GIP levels.
Ramy czasowe: 1-10 hours after ingestion
|
GIP secretion in response to a mixed meal |
1-10 hours after ingestion
|
|
2.PDE4 inhibitor roflumilast enhances GIP secretion from K cells.
Ramy czasowe: 1-10 hours after ingestion
|
GIP secretion in response to a mixed meal |
1-10 hours after ingestion
|
|
1.PDE4 inhibitor roflumilast and DPP4 inhibitor sitagliptin have synergistic effect on elevating circulating active GLP-1 levels.
Ramy czasowe: 1-10 hours after ingestion
|
GLP-1 secretion in response to mixed meal |
1-10 hours after ingestion
|
Współpracownicy i badacze
Sponsor
Sponsor
Śledczy
Śledczy
- Główny śledczy: Chee W Chia, M.D., National Institute on Aging (NIA)
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów
Rozpoczęcie studiów
Zakończenie podstawowe (Rzeczywisty)
Zakończenie podstawowe
Ukończenie studiów (Rzeczywisty)
Ukończenie studiów
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Szacowany)
Pierwszy wysłany
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia wysłana aktualizacja
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
Inne numery identyfikacyjne badania
- 999915074
- 15-AG-N074
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Opis planu IPD
NIA IRP are in discussion and a plan has not been finalized.
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Bada produkt urządzenia regulowany przez amerykańską FDA
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