Immunometabolism in Pediatric Obesity

Study Overview
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Brief Summary
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This is a study to learn about obesity and how insulin resistance and Type 2 Diabetes develops in children.

Detailed Description
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The main purpose of this proposed study is to determine whether the immunometabolic phenotypes of CD4+T cells from obese children is skewed towards Teff with mTOR-driven glycolysis and away from Tregs with AMPK-driven OXPHOS and whether metformin can reverse the immunometabolic phenotypes. This study consists of: An observational cross sectional immune and metabolic analysis of several groups of children including lean, overweight/obese, and T2D. A prospective immune and metabolic analysis of newly diagnosed children with T2D or insulin resistance who will be or were recently prescribed metformin as part of their clinical care. Children with T2D or insulin resistance who will be or were recently prescribed metformin, will be asked to complete two study visits. If completed, the second visit will occur 6 months (+/- 2 weeks) after beginning metformin as part of their clinical care. All other children, will be asked to complete only the first visit.

Official Title
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Immunometabolism in Pediatric Obesity

Conditions
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Obesity, Type 2 Diabetes Mellitus, Insulin Resistance

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 5-17 years, inclusive Either healthy lean (BMI≥ 5th percentile and <85th percentile for age/sex) or overweight (BMI ≥ 85th percentile and <95th) or obese (BMI ≥ 95th percentile for age/sex) For those with BMI≥ 85th percentile for age/sex, parental verbal confirmation that the child had a history of BMI≥ 85th percentile for age/sex for at least six months prior to study enrollment OR Age 5 years - 17 years 5 months, inclusive Either overweight or obese (BMI≥ 85th percentile for age/sex) Parental verbal confirmation that the child had a history of BMI≥ 85th percentile for age/sex for at least six months prior to study enrollment Diagnosed with type 2 diabetes mellitus or insulin resistance Prescribed metformin (either not yet taking or began taking within 3 weeks of enrollment) Exclusion Criteria: Having an infection (viral, respiratory, gastrointestinal) in the previous 4 weeks Genetic or physical conditions impacting mobility over past year as determined by the PI Having known chronic illnesses/disorders that may independently affect study outcome measures: type 1 diabetes mellitus, neurologic (e.g. epilepsy), developmental (developmental delay, autism spectrum disorder), endocrine (thyroid, Cushing's), hepatic, autoimmune, cardiac and renal disorders. Also, chronic lung disorders except well controlled asthma that does not require permanent use of inhaled/oral steroids Taking any of the following medications that can affect study outcome: antipsychotics, thyroid hormone replacement therapy, inhaled/oral steroids, insulin, anabolic drugs (growth hormone replacement therapy and oxandrolone) and stimulants Taking metformin prescribed as part of their clinical care for longer than 3 weeks at the time of enrollment (may begin metformin therapy prescribed as part of their clinical care while enrolled in the study) BMI<5th percentile for age/sex (classified as underweight based on CDC growth charts) Subjects determined ineligible by the PI or delegated staff.

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy Lean<br>Healthy lean individuals (n=20) defined with a Body Mass Index (BMI) ≥ 5th percentile and <85th percentile for age/sex will be recruited. Participants in this cohort will be asked to complete a one-time study visit. | |
| Overweight/Obese<br>Overweight/Obese individuals (n=20) defined with a Body Mass Index (BMI) ≥ 85th percentile for age/sex will be recruited. Participants in this cohort will be asked to complete a one-time study visit. | |
| Type 2 Diabetes or Insulin Resistant<br>Obese individuals with Type 2 Diabetes or insulin resistance who have been recently prescribed Metformin and have a Body Mass Index (BMI) ≥ 85th percentile for age/sex (n=20) will be recruited. Participants in this cohort will be asked to complete a two study visits approximately 6 months apart. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| circulating CD4+T cells in Overweight/Obese vs Lean | We will measure and report the percent of ATP derived from glycolysis and oxidative phosphorylation in circulating CD4+ T cells as well as the % CD4+CD25+CD127lowFoxP3+ cells (Tregs) in overweight/obese vs lean children. | After completion of all study visits, approximately 2 years. | 
| circulating CD4+T cells in Type 2 Diabetic pre/post Metformin | We will measure and report the percent of ATP derived from glycolysis and oxidative phosphorylation in circulating CD4+ T cells as well as the % CD4+CD25+CD127lowFoxP3+ cells (Tregs) in Type 2 Diabetic children pre and post-Metformin treatment. | After completion of all study visits, approximately 2 years. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Obesity, Type2 Diabetes Mellitus, Type2 Diabetes, Insulin Resistance, Metformin, Pediatric Health