Trial of Oral Glutamine on Mitochondrial Function in CKD

University of Washington

Status and phase: Completed; Phase 2

Conditions: Endothelial Dysfunction; Muscle Mitochondrial Function; Sarcopenia; Kidney Disease; Cardiovascular Disease

Treatments: Dietary Supplement: First Intervention (14 days); Other: Washout (3 weeks); Dietary Supplement: Second Intervention (14 days)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02838979

5K23DK099442 (U.S. NIH Grant/Contract)

47861

Details and patient eligibility

About

The primary goal of proposed investigation is to study the impact of oral glutamine supplementation on muscle mitochondrial and endothelial cell function measured mitochondrial energetics and vascular function using 31P magnetic resonance spectroscopy and optical spectroscopy (MRS/OS) among persons with moderate-severe CKD. The secondary objective is to describe the impact of oral glutamine supplementation on mitochondrial metabolic profile as well as inflammatory and oxidative stress biomarkers among persons with chronic kidney disease.

Full description

Chronic kidney disease is associated with endothelial cell dysfunction and muscle wasting contributing to the heightened risk of cardiovascular morbidity, mortality and functional limitation. Accumulation of toxins in renal disease may adversely impact endothelial cell nitric oxide bioavailability and endothelial Nitric Oxide Synthase (eNOS) function consequently heightening oxidative stress and suppressing mitochondrial biogenesis. To date no studies have investigated potential therapies for endothelial and muscle dysfunction in renal disease target mitochondrial metabolic and energetic processes.

Animal studies of uremia underscore mitochondrial dysfunction as a potential precursor for endothelial dysfunction. In particular, uremia has been linked to a proteomic signature indicative of metabolic blockage of TCA cycle activity and fatty acid beta-oxidation. Both of these processes are localized to the mitochondria and may suggest that decreased mitochondrial mass or function may augur endothelial dysfunction in renal disease.

Glutamine, an anaplerotic agent and precursor to the antioxidant glutathione, is a potential therapeutic agent bypassing the metabolic block associated with reduced TCA cycle and improving antioxidant reserve. The primary goal of proposed investigation is to study the impact of oral glutamine supplementation on muscle mitochondrial and endothelial cell function measured mitochondrial energetics and vascular function using 31P MRS/OS among persons with moderate-severe CKD. The secondary objective is to describe the impact of oral glutamine supplementation on mitochondrial metabolic profile as well as inflammatory and oxidative stress biomarkers among persons with chronic kidney disease.

Enrollment: 11 patients

Sex: All

Ages: 20 to 69 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults between 20 and 69 years of age
• Diagnosis of moderate-severe CKD, defined in this study as an estimated glomerular filtration rate (eGFR) of ≤60ml/min/1.73m2 using the Chronic Kidney Disease Epidemiology Collaboration equation
• Ability to understand and provide informed consent to participate in the study

Exclusion criteria

• On chronic dialysis
• Expectation to start dialysis within 6 months or dialysis access in place.
• Pregnant
• Have physical immobility (defined by wheelchair use)
• Insulin dependent diabetes
• Have implants incompatible with MRI
• Exercise limiting cardiopulmonary disease (e.g. angina, severe heart valve disease, severe COPD, coronary ischemia)
• Use of anticoagulation (i.e. warfarin)
• Baseline systolic blood pressure >160 or diastolic blood pressure >100
• Inflammatory conditions (e.g. autoimmune disease, HIV)
• Thyroid disease
• Dementia or inability to consent
• Cirrhosis, active/chronic hepatitis
• Use medications interfering with muscle or mitochondrial function, including steroids, anti-psychotic, Coenzyme Q-10, immunosuppresssives, antivirals, and muscle relaxants
• Weight >300 lbs
• Personal history or family history of deep vein thrombosis, pulmonary embolism
• Active malignancy
• Patients hospitalized within the past 60 days for any reason.
• Patients with a history of a major atherosclerotic event (defined as combined incidence of myocardial infarction, urgent target-vessel revascularization, coronary bypass surgery, and stroke) within 3 months

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Triple Blind

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11 participants in 2 patient groups

Oral L-Glutamine first, then Maltodextrin

Experimental group

Description:

Subjects will receive 0.4 g/kg/day of L-glutamine (Nutrestore, EMMAUS Life Sciences, Inc Torrance, CA) in three divided daily doses OR identical appearing maltodextrin powder. Duration 2 weeks

Treatment:

Dietary Supplement: First Intervention (14 days)

Dietary Supplement: Second Intervention (14 days)

Other: Washout (3 weeks)

Maltodextrin first, then L-glutamine

Experimental group

Description:

Subjects will crossover to receiving the study product which they did not receive in the first period. Either 0.4 g/kg/day of L-glutamine in three divided daily doses OR identical appearing maltodextrin powder. Duration 2 weeks

Treatment:

Dietary Supplement: First Intervention (14 days)

Dietary Supplement: Second Intervention (14 days)

Other: Washout (3 weeks)