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Effect of Intact GLP-1 (7-36) and GLP-1 Metabolite (9-36) on Coronary and Peripheral Vascular Function in Adults

Information source: Bispebjerg Hospital
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Coronary Microvascular Dysfunction

Intervention: Exenatide (Drug); GlucagonLikePeptide-1 (7-36) (Drug); GlucagonLikePeptide-1 (9-36) (Drug); Saline (Drug)

Phase: Phase 4

Status: Not yet recruiting

Sponsored by: Mette Zander

Official(s) and/or principal investigator(s):
Mette Zander, PhD, MD, Principal Investigator, Affiliation: Department of Endocrinology, Bispebjerg University Hospital

Overall contact:
Malin Nilsson, MD, Phone: +4540259871, Email: mnil0028@regionh.dk

Summary

GLP-1 is an agent for treatment of type 2 diabetes and may have protective effects on the cardiovascular system. The mechanism is complex and there seems to be a dual function with intact GLP-1 (7-36), acting through the GLP-1 receptor, and the GLP-1 (9-36) metabolite acting independently of the GLP-1 receptor. Coronary flow reserve (CFR) is the ratio of flow through the coronary arteries during stress to during rest and it reflects coronary microcirculation. Impaired CFR is a strong predictor of poor prognosis of cardiovascular disease. The aim of the study is to investigate the acute effects of GLP-1 on coronary microcirculation and endothelial function in adults with obesity.

Clinical Details

Official title: Effect of Intact GLP-1 (7-36) and GLP-1 Metabolite (9-36) on Coronary and Peripheral Vascular Function in Adults

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Basic Science

Primary outcome: Coronary Flow Reserve

Secondary outcome: Endothelial function (Assessed by Flow Mediated Dilation)

Detailed description: Several studies have shown beneficial effects of glucagon-like-peptide-1 (GLP-1) on the cardiovascular system. Native GLP-1 is secreted from L-cells in the intestine as GLP-1(7-36) 1 but is rapidly metabolised by the ubiquitous enzyme dipeptidyl-peptidase-4 (DPP4) to the metabolite GLP-1(9-36). However, the physiological effect of GLP-1 on the cardiovascular system is complex and there seems to be a dual function with intact GLP-1 (7-36), acting through the GLP-1 receptor, and the GLP-1 (9-36) metabolite acting independently of the GLP-1 receptor. The aim of the study is to investigate the acute effects of intact GLP-1, GLP-1 metabolite and GLP-1 receptor agonist on coronary microcirculation and endothelial function in adults. Method 20 adults will be recruited to a double-blinded randomized cross-over study of 4 x 2½ hours infusion of 1. Exenatide alternating with 2. GLP-1 metabolite 3. intact GLP-1 together with a DPP4 inhibitor, and 4. saline. End point measurements will be performed at baseline and after 1 and 2 hours of infusion. The effect of GLP-1 infusions on microvascular function is evaluated by coronary flow reserve (CFR), the ratio between echocardiographic measured coronary flow velocity in LAD during adenosine induced myocardial hyperaemia and rest. The effect on endothelial function is assessed by flow mediated dilation (FMD).

Eligibility

Minimum age: 35 Years. Maximum age: 70 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Age 35-70 years

- BMI > 25 kg/m2.

- Central obesity (measured by waist circumference, defined as ≥ 94cm for men and ≥ 80

cm for women)

- Non smokers (6 months abstinent is required)

- Normal creatinine

- For fertile women; negative pregnancy test and use of safe anticonception.

- Speak and understand Danish or English

- Mental ability to follow and understand the study

Exclusion Criteria:

- Known Diabetes

- Known hypertension (untreated hypertension ≤ 160/100 at inclusion is accepted)

- Haemoglobin < 6. 5 mmol/l

- Allergy towards Januvia or Exenatide, Adenosin or Glycerylnitrate

- Documented significant stenosis of the left anterior descending artery (LAD) at

coronary angiography or CT-angiography or regional dysfunction documented during dipyridamol stress-echocardiography. If stress test at baseline shows significant stenosis the patient will be excluded from the study.

- Pregnancy

- Severe asthma

- Active cancer, severe co-morbidity with limited life-expectancy, severe hepatic

co-morbidity, chronic alcohol abuse, atrial fibrillation, chronic or previous acute pancreatitis, inflammatory bowel disease.

Locations and Contacts

Malin Nilsson, MD, Phone: +4540259871, Email: mnil0028@regionh.dk

Additional Information

Starting date: February 2015
Last updated: January 22, 2015

Page last updated: August 23, 2015

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