Clinical trial NCT01520454
Conditions: Obesity Leptin Resistance
Keywords: Leptin resistance Free fatty acids Lipotoxicity
Sponsor: Beth Israel Deaconess Medical Center
Start date: 2011-11-01; Completion date: 2016-12-01
Enrollment: 26 participants; Allocation: RANDOMIZED; Intervention model: PARALLEL

Brief summary:
Obese people have elevated levels of the hormone leptin. Despite this, they seem to be resistant to the effects of this hormone, which usually regulates appetite and energy expenditure. This is similar to what happens with insulin levels in the obese. Furthermore, the way lipid ingestion versus lipid infusion may impact novel molecules secreted by tissues commonly affected in insulin resistant states such as liver and muscle have not yet been studied.

The aim of the present study is to investigate the effect of oral vs. different doses of IV lipid administration on molecular parameters related to glucose and energy homeostasis using a randomized, placebo-controlled design.

Additionally, we will examine how increased free fatty acids (FFAs) my impact intracellular leptin signaling such as the STAT3 pathway.

Detailed description:
We propose to test our hypotheses by conducting a non-blinded, interventional study evaluating the effects of acute leptin administration on intracellular leptin signaling pathways after a 6 hour infusion period comparing an oral high fat meal, high fat lipid infusion, low fat lipid infusion, or placebo infusion (saline)iv lipid infusion, placebo (saline) and oral high fat meal. After a screening visit, study participation involves 1 meal pick-up visit, 1 overnight visit, and one 1 follow-up visit. Subjects will be randomized to one of 4 groups: an oral high fat meal, fat emulsion 20% infusion , fat emulsion 10% infusion, and a placebo (saline) infusion infusion and an oral high fat meal.

We plan to screen 100 male and postmenopausal female subjects, with BMI greater than 18 kg/m2, to consent 60 in order to have 32-48 evaluable subjects, 8-12 subjects per group, completing all parts of the study.

The primary study outcome to be evaluated will be the changes in serum concentrations of glucose, hormones influencing metabolism such as insulin, fat-cell-secreted proteins such as leptin, molecules involved in metabolism such as free fatty acids (FFAs), and markers of inflammation such as interleukin (IL)-2 and interferon (IFN)-gamma.

The secondary outcome will be to examine the impacts of increased FFAs on intracellular leptin signaling by phosphorylation of STAT3.

Arms: arm 1: IV saline with heparin, oral water arm 2: Intralipid at high dose, with heparin and PO water arm 3: Low dose IV Intralipid with heparin and PO water arm 4: Oral fat load with IV saline
Interventions: intervention 1: Saline intervention 2: Intralipid intervention 3: Water intervention 4: oral fat intervention 5: Heparin
Intervention descriptions: intervention 1: IV saline at 0.83 mL/kg/hr for six hours intervention 2: Intralipid in either low-dose or high dose (10% vs. 20%) at 0.83 mL/kr/hr for six hours intervention 3: Water by mouth intervention 4: Soybean oil by mouth at 1.25 g/kg x 2 doses intervention 5: Heparin bolus of 1000 units followed by 800 u/hr, adjust per partial thromboplastin time (PTT), for 5.5 hours

Protocol documents: