Clinical trial NCT04259879: Molecular Pathways Related to Short-term Fasting Response
Official title: Evaluation of p21 Induction and Molecular Pathways Related to Short-term Fasting Response
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Fasting
Keywords: Short-term Fasting
molecular mechanisms
p21
Peripheral blood mononuclear cells (PBMCs)
PPARalpha
Lead sponsor: IMDEA Food
Sponsor class: OTHER
Collaborators: name: Centro Nacional de Investigaciones Oncologicas CARLOS III
First posted: 2020-02-07
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 50
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: This study was an Interventional study. There were three evaluations: the basal one was an initial evaluation after overnight fasting, the second evaluation 24 hours later (36 hours fasting) and the third one 24 hours post-refeeding.
Primary purpose: BASIC_SCIENCE

Brief summary: This study will evaluate the effect of short-term fasting (36 hours) in gene expression in blood cells in healthy volunteers.

Detailed description: Fasting is a nutritional intervention consisting on the restriction of nutrient intake during a relatively long period of time. It elicits a profound metabolic reprogramming aimed at shifting nutrient supply from external food intake to internal stored nutrients. Periodic activation of this complex response, termed periodic or intermittent fasting (IF), elicits numerous protective effects against aging, metabolic alterations, neurological disorders and cardiovascular health. Short-term fasting is protective in different stress scenarios, including ischemia reperfusion, bouts of inflammation and chemotherapy-induced toxicity, and improves the anti-tumor efficacy of chemotherapy. Although the basic physiology of fasting is well known, the molecular mechanisms underlying its beneficial effects are not yet completely understood.

In mammals, the response to short-term fasting (from 12 to 48 hours) in terms of nutrient mobilization through the bloodstream has been extensively studied. Fasting follows sequential phases, during which nutrients are released from different storing depots. First, glucose is released from glycogen stores in the liver and muscle. Upon depletion of glycogen, two fasting mechanisms are activated: fatty acids are exported from the adipose tissue into the bloodstream in the form of free fatty acids (FFAs), reaching the liver where they are used to produce ketone bodies, a process termed ketogenesis. Also, gluconeogenesis is activated in the liver, generating glucose mainly from glycerol (released during lipolysis) and amino acids, that originate mainly from muscle breakdown. All these physiological responses are tightly regulated by hormonal and molecular mechanisms.

At the hormonal level, fasting induces a decrease in blood insulin, leptin and ghrelin, and an increase in glucagon levels, while blood adiponectin remains unchanged. Also, several signal transduction pathways are affected by fasting. PPARalpha, a nuclear receptor of fatty acids, becomes activated by the fasting-mediated increase in blood Free fatty Acids (FFAs) and triggers the expression of many target genes in several tissues, including blood cells. It has been shown that the Cyclin Dependent Kinase (CDK) inhibitor p21 is highly upregulated during short-term fasting in many mouse tissues. Moreover, it is known that p21-null mice are unable to endure normal periods of fasting and that p21 is required for the full activation of PPARa target genes both in vivo and in isolated hepatocytes.

In the current study, the investigators wanted to study for the first time molecular mechanisms of fasting that still remained unexplored, specially the expression induction of p21 and PPARalpha signalling pathway. For this, the investigators analyzed blood samples from healthy volunteers subjected to 36 hours of fasting, to explore gene expression in Peripheral Blood Mononuclear Cells (PBMCs).

Eligibility criteria: Inclusion Criteria:

* Men and women between 18 - 50 years old.
* BMI \>20\<30
* Adequate education level and comprehension of the clinical study
* Willingness to participate in the study as a volunteer and to provide written consent

Exclusion Criteria:

* BMI \<20 (thinness)
* BMI \>30 (obesity)
* Abnormal low glucose levels after fasting
* Having donated blood less than 8 weeks before starting the study
* Subjects who report special discomfort after previous periods of short fasting
* Diagnosis of type 2 Diabetes mellitus (insulin-dependent)
* Dyslipidemia under pharmacological treatment
* High blood pressure under pharmacological treatment
* Dementia, neurological disease or reduction of cognitive function
* Severe illness (hepatic disease, renal disease, etc
* Taking medications that could affect the lipid and glycemic profiles (statins, fibrate, diuretics, corticoids, anti-inflammatory, hypoglycemic or insulin) 30 days before the beginning of the study.
* Taking medications or substances for weight loss management (15 days before the beginning of the study)
* Pregnancy or lactation

Primary outcomes:
measure: Changes in gene expression in PBMCs after fasting
timeFrame: Baseline, 24 hours and 48 hours later
Secondary outcomes:
measure: Changes in Insulin levels in response to fasting
timeFrame: Baseline, 24 hours and 48 hours later
measure: Changes in Free Fatty Acids levels in response to fasting
timeFrame: Baseline, 24 hours and 48 hours later
measure: Changes ketone bodies in response to fasting
timeFrame: Baseline, 24 hours and 48 hours later
measure: Changes in leptin levels in response to fasting
timeFrame: Baseline, 24 hours and 48 hours later
measure: Changes in lipid profile in response to fasting
timeFrame: Baseline, 24 hours and 48 hours later
measure: Subjective evaluation of tolerance to fasting
timeFrame: 36 hours of fasting
Other outcomes:
Locations:
city: Madrid
country: Spain
facility: IMDEA Food
Study officials:
affiliation: IMDEA Food
name: Pablo J Fernandez-Marcos, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: Spanish National Cancer Research Center
name: Manuel Serrano Marugán, PhD
role: PRINCIPAL_INVESTIGATOR
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