Clinical trial NCT00401791: ACTIV- Exercise Intervention in Healthy Young Men
Official title: "ACTIV"Validation of a Paradigm for the Evaluation of Compounds That Activate Mitochondrial Biogenesis in Skeletal Muscle
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Insulin Resistance
Lead sponsor: Pennington Biomedical Research Center
Sponsor class: OTHER
First posted: 2006-11-22
Enrollment: 40
Sex: MALE
Minimum age (years): 25
Maximum age (years): 35
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: The study is designed to compare muscle energy capacity in men with obesity or diabetes as compared to athletes. This study will also enable researchers to determine whether MRS can replace muscle biopsy for this type of assessment.

Detailed description: Skeletal muscle mitochondrial defects are a sine qua non of insulin resistance in patients with type 2 diabetes mellitus (T2DM), obese and subjects with family history of T2DM (FH+). Exercise increases mitochondrial capacity whereas lipid infusion or high fat diet decreases genes involved in mitochondrial biogenesis. In this study 2 cohorts will be involved: Cohort I (athletes, T2DM and obese) and Cohort II (healthy with "FH+" or without "FH-" family history of T2DM). This randomized, parallel arm clinical trial will consist of 4 periods: screening, stabilization (3 days), baseline (for Cohort I and II) and exercise period (14 days, only for Cohort II). The overall objective of the study is to validate a paradigm for the evaluation of compounds and drugs that activate mitochondrial biogenesis in skeletal muscle. In Specific Aim 1 we will compare and contrast biopsy and MRS power to detect differences in mitochondrial capacity in 78 subjects: athletes (N=10), FH- (N=24), FH+ (N=24), obese (N=10) and T2DM (N=10). In Specific Aim 2 we will compare mitochondrial changes in response to exercise in subjects FH - vs. FH + subjects. In Specific Aim 3 we will determine if HFD impairs mitochondrial changes in response to exercise in FH+ subjects. In Specific Aim 4 we will determine the role of mitochondrial capacity in metabolic flexibility and insulin sensitivity in T2DM, obese, FH+, FH- and athlete subjects.

Eligibility criteria: Inclusion Criteria:

T2DM group:

* Men aged 25-35
* BMI \> 30 kg/m2
* Sedentary lifestyle determined by activity index questionnaire (not involved in regular exercise program) and accelerometer data.
* Are willing to eat only foods provided by Pennington for the study period
* Diagnosed with T2DM defined by one or more of the following:

  * fasting plasma glucose \> 126 mg/dL at entry
  * a two-hour OGTT glucose \> 200mg/dL
  * current medication for T2DM

Obese group:

* Men aged 25-35
* BMI \> 30 kg/m2
* Sedentary lifestyle activity index questionnaire (not involved in regular exercise program) and accelerometer data.
* Are willing to eat only foods provided by Pennington for the study period

FH+ group:

* Men aged 25-35
* One parent diagnosed with T2DM
* fasting insulin \> 10mIU/ml (\> 50th %tile)
* BMI between 22 and 30 kg/m2
* Sedentary lifestyle activity index questionnaire (not involved in regular exercise program) and accelerometer data.
* Are willing to exercise every day for the study period
* Are willing to eat only foods provided by Pennington for the study period

FH- group:

* Men aged 25-35
* Parents and grandparents were not diagnosed with T2DM
* Fasting insulin \< 10mIU/ml (\< 50th %tile)
* BMI between 22 and 30 kg/m2
* Sedentary lifestyle activity index questionnaire (not involved in regular exercise program) and accelerometer data.
* Are willing to exercise for the study period
* Are willing to eat only foods provided by Pennington for the study period

Athlete group:

* Men aged 25-35
* Maximal oxygen uptake \> 60 ml/kg.min
* Are engaged in minimum of 1.5 h of aerobic exercise 3 times/ week
* Are willing to eat only foods provided by Pennington for the study period

Exclusion Criteria:

* Abnormal resting or exercise ECG
* Significant renal, cardiac, liver, lung, or neurological disease (controlled hypertension is acceptable if baseline bp \< 140/90 on medications)
* Use of drugs known to affect energy metabolism or body weight: including, but not limited to: orlistat, sibutramine, ephedrine, phenylpropanolamine, corticosterone, etc
* Alcohol or other drug abuse
* Smoking
* Gait problems
* Unwilling or unable to abstain from caffeine (48h) prior to metabolic rate measurements
* Unwilling or unable to eat all study foods
* Increased liver function tests at baseline (AST/ALT/GGT/or alkaline phosphatase greater than 2.5 times the upper limit of normal)
* Metal objects that would interfere with the measurement of body composition /MRS such as implanted rods, surgical clips, etc
* NYHA class III/IV CHF is an exclusionary cardiac condition
* history of deep vein thrombosis (DVT) or pulmonary embolism (PE)
* varicose veins
* major surgery on the abdomen, pelvis, or lower extremities within previous 3 months
* cancer (active malignancy with or without concurrent chemotherapy)
* rheumatoid disease
* bypass graft in limb
* known genetic factor (Factor V Leiden, etc) or hypercoagulable state
* diagnosed peripheral arterial or vascular disease, or intermittent claudication
* family history of primary DVT or PE (pulmonary embolism)
* peripheral neuropathy

Primary outcomes:
measure: To compare/ contrast the power of skeletal muscle biopsy vs. MRS to detect differences in mitochondrial capacity
timeFrame: baseline and after intervention
Secondary outcomes:
measure: To compare mitochondrial changes in response to exercise in subjects FH - vs. FH + subjects by skeletal muscle biopsy and MRS
timeFrame: baseline and after intervention
measure: To determine if HFD impairs mitochondrial changes in response to exercise in the FH + group by muscle biopsy and MRS.
timeFrame: baseline and after intervention
measure: To determine the role of mitochondrial capacity in metabolic flexibility and insulin sensitivity
timeFrame: baseline and after intervention
Other outcomes:
Locations:
city: Baton Rouge
country: United States
facility: Pennington Biomedical Research Center
state: Louisiana
Study officials:
affiliation: Pennington Biomedical Research Center
name: Steven R Smith, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Covington JD, Noland RC, Hebert RC, Masinter BS, Smith SR, Rustan AC, Ravussin E, Bajpeyi S. Perilipin 3 Differentially Regulates Skeletal Muscle Lipid Oxidation in Active, Sedentary, and Type 2 Diabetic Males. J Clin Endocrinol Metab. 2015 Oct;100(10):3683-92. doi: 10.1210/JC.2014-4125. Epub 2015 Jul 14.
citation: Bajpeyi S, Myrland CK, Covington JD, Obanda D, Cefalu WT, Smith SR, Rustan AC, Ravussin E. Lipid in skeletal muscle myotubes is associated to the donors' insulin sensitivity and physical activity phenotypes. Obesity (Silver Spring). 2014 Feb;22(2):426-34. doi: 10.1002/oby.20556. Epub 2013 Sep 10.
citation: Gan Z, Rumsey J, Hazen BC, Lai L, Leone TC, Vega RB, Xie H, Conley KE, Auwerx J, Smith SR, Olson EN, Kralli A, Kelly DP. Nuclear receptor/microRNA circuitry links muscle fiber type to energy metabolism. J Clin Invest. 2013 Jun;123(6):2564-75. doi: 10.1172/JCI67652. Epub 2013 May 8.
citation: Bajpeyi S, Pasarica M, Moro C, Conley K, Jubrias S, Sereda O, Burk DH, Zhang Z, Gupta A, Kjems L, Smith SR. Skeletal muscle mitochondrial capacity and insulin resistance in type 2 diabetes. J Clin Endocrinol Metab. 2011 Apr;96(4):1160-8. doi: 10.1210/jc.2010-1621. Epub 2011 Feb 9.
citation: Costford SR, Bajpeyi S, Pasarica M, Albarado DC, Thomas SC, Xie H, Church TS, Jubrias SA, Conley KE, Smith SR. Skeletal muscle NAMPT is induced by exercise in humans. Am J Physiol Endocrinol Metab. 2010 Jan;298(1):E117-26. doi: 10.1152/ajpendo.00318.2009. Epub 2009 Nov 3.