Metabolic Heterogeneity Underlying Hypertriglyceridemia: Hepatic Triglyceride Biosynthesis in Humans With Different Insulin Resistance Phenotypes

Yale University

Status: Enrolling

Conditions: Hypertriglyceridemia; Insulin Resistance

Treatments: Behavioral: Premeal exercise; Behavioral: Standardized Dinner

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05743868

Vatner 012523

NL83166.018.22 (Other Identifier)

R01DK124272 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The focus of this cross-sectional study is to determine the effects of tissue-specific (adipose tissue or muscle) vs global (combined) insulin resistance (IR) on hepatic triglyceride biosynthesis in humans, and to determine differential effects of an acute exercise intervention on hepatic triglyceride biosynthesis in these groups.

Full description

Hypothesis: Patients who primarily have muscle IR will have a greater percentage of lipids derived from de novo lipogenesis (DNL) than patients with combined muscle and adipose IR, and these subjects will respond more robustly to the effects of premeal exercise.

With this study, the investigators will demonstrate that the mechanisms that drive triglyceride overproduction in insulin-resistant humans are dependent on which tissues are insulin resistant. To this end, investigators will determine whether subjects with muscle insulin resistance and adipose tissue insulin resistance utilize different mechanisms of triglyceride biosynthesis to assemble hepatic very low density lipoprotein (VLDL), as compared with individuals with muscle insulin resistance but relative adipose tissue insulin sensitivity. Additionally, investigators will see if adipose tissue insulin sensitivity predicts exercise responsiveness of hepatic triglyceride production.

Main study parameters/endpoints: Difference in %DNL between subjects with global vs muscle-only insulin resistance as well as the differential effects of premeal exercise on %DNL in these groups.

Enrollment: 40 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Ability to give informed consent
• Overweight, defined as BMI 25-30 kg/m2
• Modest hypertriglyceridemia, defined as fasting plasma triglycerides 1.5-3.0mM
• High risk of insulin resistance, defined as fasting plasma insulin >64pM
• Stable weight for at least 3mo prior to participation

Exclusion criteria

• Active or chronic liver disease, kidney disease, congestive heart failure, unstable angina, history of acute cardiovascular events within 6mo of screening, history of seizures or syncope, or an active infection requiring antimicrobial therapy;
• Use of insulin, thiazolidinediones, SGLT2 inhibitors, or sulfonylureas;
• Use of fibrates, omega 3 (fish oil), niacin, or PCSK9 antagonists;
• Use of systemic glucocorticoids within 60d prior to participation;
• Hematocrit <35%;
• Pregnancy of breastfeeding;
• Active tobacco use, excessive alcohol intake (>14U/wk), or history of drug abuse.

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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40 participants in 2 patient groups

IR participants with standardized dinner

Experimental group

Description:

Participants with global IR and tissue-specific IR. Participants with global IR (in both skeletal muscle and adipose tissue) and tissue-specific IR (in adipose tissue). Glucose tolerance, skeletal muscle/whole-body insulin sensitivity and adipose tissue insulin sensitivity will be evaluated prior to intervention. Contribution of DNL to hepatic VLDL will be measured using a deuterated water drink, to be ingested prior to the standardized dinner. Blood will be drawn the following morning for the measurement of deuterium incorporation into triglycerides. Plasma deuterium will be allowed to wash out over several weeks, and the 2nd deuterated water study will be performed.

Treatment:

Behavioral: Standardized Dinner

IR participants with standardized dinner and premeal exercise

Experimental group

Description:

Participants with global IR and tissue-specific IR. Participants with global IR (in both skeletal muscle and adipose tissue) and tissue-specific IR (in adipose tissue). Glucose tolerance, skeletal muscle/whole-body insulin sensitivity and adipose tissue insulin sensitivity will be evaluated prior to intervention. DNL will be assessed in all participants after a single day with short bouts of premeal exercise with a standardized dinner. Contribution of DNL to hepatic VLDL will be measured using a deuterated water drink, to be ingested prior to the standardized dinner. Blood will be drawn the following morning for the measurement of deuterium incorporation into triglycerides. Plasma deuterium will be allowed to wash out over several weeks, and the 2nd deuterated water study will be performed.

Treatment:

Behavioral: Standardized Dinner

Behavioral: Premeal exercise