Ketones, Muscle Metabolism, and SGLT2 Inhibitors
试验速览
- 阶段
- 早期 1 期
- 状态
- 招募中
- 入组人数
- 71
- 试验地点
- 1
- 主要终点
- Change in Adenosine Triphosphate (ATP)
研究概览
简要总结
The study team will examine the effects of elevated plasma ketone levels following initiation of SGLT2 inhibitor therapy in high-risk type 2 diabetes mellitus (T2DM) individuals with heart failure (HF) with reduced ejection fraction (HFrEF) providing an energy-rich fuel that is taken up with great avidity by the myocardium, to measure change in Left Ventricle diastolic and systolic function
详细描述
The study team will examine the effects of elevated plasma ketones caused by 12-week treatment with an SGLT2i (empagliflozin) treatment in participants with T2DM and HF. The study team will focus on three possible mechanisms of action for these effects and test the following:
(i) Skeletal muscle bioenergetics. Using 31P-MRS, the team will quantify phosphocreatine [PCr], ATP, inorganic phosphate, phosphodiester, and intracellular pH. With 1H-MRS, and will measure intramyocellular lipid content at rest and ATPmax production after exercise. The team will examine the relationships between phosphorous metabolite concentrations, intramyocellular lipid content, and ATP generation before and after 12 weeks of SGLT2 inhibition.
(ii) LV systolic and diastolic function using cardiac MRI in type 2 diabetic patients with Class II-III NYHA heart failure and reduced EF.
(iii) To examine the contribution of the SGLT2i-induced increase in plasma ketone concentration on myocardial function and myocardial blood flow by inhibiting the rise in plasma ketone concentration with acipimox while continuing empagliflozin.
(iv) Improvements in Patient-Reported Outcomes (PRO). Kansas City Cardiomyopathy Questionnaire ( KCCQ) scoring will be used to evaluate self-reported physical function and well-being. This tool is a well-developed and validated method to obtain patient self-reported parameters of health in adults.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Basic Science
- 盲法
- Double (Participant, Investigator)
盲法说明
Participants, and investigators will be blinded to the randomization
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Type 2 Diabetes Mellitus
- •Class II-III New York Heart Association (NYHA) heart failure and reduced ejection fraction (EF) <50%
- •Age 18-80 years
- •BMI 23-44 kg/m2
- •Glycated hemoglobin (HbA1c) 6.0-10.0%
- •Blood Pressure (BP) ≤ 145/85 mmHg
- •Estimated glomerular filtration rate (eGFR) ≥30 ml/min•1.73 m2
- •Only Type 2 diabetics treated with diet/exercise, metformin, sulfonylureas, metformin/sulfonylurea, Glucagon-like peptide-1 receptor agonist (GLP-1 RA), or insulin
- •Stable body weight (±4 pounds) over the previous 3 months prior to enrollment
- •Ability to understand study procedures and to comply with them for the entire length of the study.
排除标准
- •Heart failure due to restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, severe valvular heart disease, hypertrophic obstructive cardiomyopathy.
- •Significant change in diuretic management during the month prior to screening (defined by doubling of diuretic dose or addition of another heart failure medication)
- •Type 2 Diabetics treated with Dipeptidyl Peptidase-4 Inhibitor (DPP4i) or pioglitazone
- •Pregnancy, lactation, or plans to become pregnant. A negative pregnancy test will be performed before each MRI study to assess current status. For women of child-bearing age (WOCBA) willingness to use contraception, if applicable.
- •Allergy/sensitivity to study drugs or their ingredients.
- •Current drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
- •Inability or unwillingness of individual or legal guardian/representative to give written informed consent.
研究组 & 干预措施
Empagliflozin Group
Subjects will be randomized 2:1 to receive empagliflozin, 25mg/day for 3 months
干预措施: Empagliflozin 25 MG Oral Tablet (Drug)
Empagliflozin Group
Subjects will be randomized 2:1 to receive empagliflozin, 25mg/day for 3 months
干预措施: Acipimox 250 Mg Oral Capsule (Drug)
Placebo group
Subjects will be randomized to receive the empagliflozin placebo for 3 months
干预措施: Placebo (Drug)
Placebo group
Subjects will be randomized to receive the empagliflozin placebo for 3 months
干预措施: Acipimox 250 Mg Oral Capsule (Drug)
结局指标
主要结局
Change in Adenosine Triphosphate (ATP)
时间窗: Baseline to 3 months
A measure of ATP change from baseline to study end
Change in Phosphodiester
时间窗: Baseline to 3 months
A measure of phosphodiester change from baseline to study end
Change in Phosphocreatine
时间窗: Baseline to 3 months
A measure of phosphocreatine change from baseline to study end
Change in Inorganic Phosphate
时间窗: Baseline to 3 months
A measure of inorganic phosphate change from baseline to study end
ATPmax production
时间窗: Baseline to 3 months
Exercise induced ATPmax production change
次要结局
- Acetoacetate concentrations(baseline to 3 months)
- 6-min walking test(baseline to 3 months)
- Patient-Reported Outcomes Measure Information System(baseline to 3 months)
- Plasma Beta-hydroxybutyrate (β-OH-B)(baseline to 3 months)
- plasma ketone concentration on myocardial function(Baseline to 3months + 8 days)
- plasma ketone concentration on myocardial blood flow(Baseline to 3months + 8 days)