Clinical trial

The Role of Hepatic Denervation in the Dysregulation of Glucose Metabolism in Liver Transplant Recipients

Name
2018-9506
Description
It is believed that important brain centers send signals through the vagus nerve to the liver to suppress the amount of glucose (sugar) that gets produced. People who have received liver transplants have had their vagus nerve cut during transplantation, and many of these individuals have diabetes at one year post-transplant. The goals of this study are: to see whether metabolic control centers in the brain can still be activated normally with the medication diazoxide in patients who have had a liver transplant, and to understand whether disrupting the vagus nerve would result in excess glucose being produced by the liver (ie. a potential mechanism for why these patients develop diabetes).
Trial arms
Trial start
2019-04-21
Estimated PCD
2023-04-21
Trial end
2023-04-21
Status
Withdrawn
Phase
Early phase I
Treatment
Diazoxide
MRI studies: Non-diabetic and T2D participants will receive diazoxide (up to 7 mg/kg) between baseline MRI scan and second MRI scan. Clamp studies: Non-diabetic participants will not require an overnight admission. They will receive diazoxide (up to 7 mg/kg) and undergo the pancreatic clamp study. Type 2 diabetic participants will be admitted the evening before the study day to normalize blood sugar levels. They will then receive diazoxide (up to 7 mg/kg) the next morning and undergo the pancreatic clamp study.
Arms:
Clamp: Non-diabetic transplant (Diazoxide), Clamp: T2D transplant (Diazoxide + Nicotinic Acid), Clamp: T2D transplant (Diazoxide), MRI: Non-diabetic transplant (Diazoxide), MRI: T2D transplant (Diazoxide + Nicotinic Acid), MRI: T2D transplant (Diazoxide)
Other names:
Proglycem
Placebo (for diazoxide)
MRI studies: Non-diabetic and T2D participants will receive placebo (for diazoxide) between baseline MRI scan and second MRI scan. Clamp studies: Non-diabetic participants will not require an overnight admission. They will receive a taste-matched placebo (for diazoxide) and undergo the pancreatic clamp study. Type 2 diabetic participants will be admitted the evening before the study day to normalize blood sugar levels. They will then receive a taste-matched placebo (for diazoxide) the next morning and undergo the pancreatic clamp study.
Arms:
Clamp: Non-diabetic transplant (Placebo), Clamp: T2D transplant (Placebo + Nicotinic Acid), Clamp: T2D transplant (Placebo), MRI: Non-diabetic transplant (Placebo), MRI: T2D transplant (Placebo + Nicotinic Acid), MRI: T2D transplant (Placebo)
Other names:
Placebo
Nicotinic acid
Type 2 diabetic participants in this arm will receive a nicotinic acid infusion to lower free fatty acid levels. They will then receive diazoxide (up to 7 mg/kg) the next morning and undergo the MRI or pancreatic clamp study.
Arms:
Clamp: T2D transplant (Diazoxide + Nicotinic Acid), Clamp: T2D transplant (Placebo + Nicotinic Acid), MRI: T2D transplant (Diazoxide + Nicotinic Acid), MRI: T2D transplant (Placebo + Nicotinic Acid)
Other names:
Niacin
Primary endpoint
Endogenous glucose production (EGP)
7-7.5 hours
Eligibility criteria
Inclusion Criteria: * Liver Transplant at least one year ago * Age: 21-70 Exclusion Criteria: * BP \> 150/90 or \<90/60 on more than one occasion, unless there is a documented history of white coat hypertension by treating physician. * Triglycerides \> 400 mg/dl and/or Total Cholesterol \>300 mg/dl * Clinically significant liver dysfunction * Clinically significant kidney dysfunction, GFR: \<60 mg/dL * Anemia: HgB \<12.5 for men and \<11.0 for women * Positive urine drug test. Occasional use of cannabis (once or twice per week) will not be a basis for exclusion. * Urinalysis: Clinically significant abnormalities * Clinically significant electrolyte abnormalities * Smoking \>10 cig/day * Alcohol: Men \>14 drinks/wk or \>4 drinks/day, Women \>7 drinks/wk or \>3 drinks/day * History of active hepatitis infection, HIV/AIDS, chronic kidney disease (stage 3 or greater), active cancer, cardiovascular disease or other heart disease, systemic rheumatologic conditions, seizures, bleeding disorders, muscle disease * Surgeries that involve removal of endocrine glands except for thyroidectomy (if euthyroid on thyroid hormone replacement - if such history T4 and TSH will be checked) * Pregnant women * Subject enrolled in another study less than one month prior to the anticipated start date in the proposed study, besides those done by our group * Family history: family history of premature cardiac death * Allergies to medication administered during study * Uncontrolled psychiatric disorders * Any condition which in the opinion of the PI makes the subject ill-suited for participation in the study
Protocol
{'studyType': 'INTERVENTIONAL', 'phases': ['PHASE2'], 'designInfo': {'allocation': 'NON_RANDOMIZED', 'interventionModel': 'CROSSOVER', 'primaryPurpose': 'BASIC_SCIENCE', 'maskingInfo': {'masking': 'SINGLE', 'maskingDescription': 'The subject will be blinded to which study drug is received first (Drug or Placebo).', 'whoMasked': ['PARTICIPANT']}}, 'enrollmentInfo': {'count': 0, 'type': 'ACTUAL'}}
Updated at
2023-06-05

1 organization

3 products

5 indications

Product
Diazoxide
Indication
Type 2
Indication
Blood sugar
Indication
Hypertension
Product
Placebo