Ketones, SGLT2, HFrEF

Официальное название

Ketones, Muscle Metabolism, and SGLT2 Inhibitors

Обзор

The study team will examine the effects of elevated plasma ketone levels following initiation of SGLT2 inhibitor therapy in high-risk type 2 diabetes mellitus (T2DM) individuals with heart failure (HF) with reduced ejection fraction (HFrEF) providing an energy-rich fuel that is taken up with great avidity by the myocardium, to measure change in Left Ventricle diastolic and systolic function

Подробное описание

The study team will examine the effects of elevated plasma ketones caused by 12-week treatment with an SGLT2i (empagliflozin) treatment in participants with T2DM and HF. The study team will focus on three possible mechanisms of action for these effects and test the following:

(i) Skeletal muscle bioenergetics. Using 31P-MRS, the team will quantify phosphocreatine \[PCr\], ATP, inorganic phosphate, phosphodiester, and intracellular pH. With 1H-MRS, and will measure intramyocellular lipid content at rest and ATPmax production after exercise. The team will examine the relationships between phosphorous metabolite concentrations, intramyocellular lipid content, and ATP generation before and after 12 weeks of SGLT2 inhibition.

(ii) LV systolic and diastolic function using cardiac MRI in type 2 diabetic patients with Class II-III NYHA heart failure and reduced EF.

(iii) To examine the contribution of the SGLT2i-induced increase in plasma ketone concentration on myocardial function and myocardial blood flow by inhibiting the rise in plasma ketone concentration with acipimox while continuing empagliflozin.

(iv) Improvements in Patient-Reported Outcomes (PRO). Kansas City Cardiomyopathy Questionnaire ( KCCQ) scoring will be used to evaluate self-reported physical function and well-being. This tool is a well-developed and validated method to obtain patient self-reported parameters of health in adults.

Вмешательства

• Препарат Empagliflozin 25 MG Oral Tablet
  Empagliflozin 25MG will be administered orally once per day for 3 months
• Препарат Placebo
  The placebo will be administered orally once per day for 3 months
• Препарат Acipimox 250 Mg Oral Capsule
  subjects will be started on acipimox 250mg every 6 hours for 8 days while on continued empagliflozin/placebo therapy. This will be added at the end of 3 months after they finished baseline studies

Первичные конечные точки

• Change in Phosphocreatine [Срок оценки: Baseline to 3 months]
• Change in Adenosine Triphosphate (ATP) [Срок оценки: Baseline to 3 months]
• Change in Inorganic Phosphate [Срок оценки: Baseline to 3 months]
• Change in Phosphodiester [Срок оценки: Baseline to 3 months]
• ATPmax production [Срок оценки: Baseline to 3 months]

Вторичные конечные точки (6)

• Plasma Beta-hydroxybutyrate (β-OH-B) [Срок оценки: baseline to 3 months]
• Acetoacetate concentrations [Срок оценки: baseline to 3 months]
• 6-min walking test [Срок оценки: baseline to 3 months]
• Patient-Reported Outcomes Measure Information System [Срок оценки: baseline to 3 months]
• plasma ketone concentration on myocardial function [Срок оценки: Baseline to 3months + 8 days]
• plasma ketone concentration on myocardial blood flow [Срок оценки: Baseline to 3months + 8 days]

Критерии участия

Критерии включения

• Type 2 Diabetes Mellitus
• Class II-III New York Heart Association (NYHA) heart failure and reduced ejection fraction (EF) <50%
• Age 18-80 years
• BMI 23-44 kg/m2
• Glycated hemoglobin (HbA1c) 6.0-10.0%
• Blood Pressure (BP) ≤ 145/85 mmHg
• Estimated glomerular filtration rate (eGFR) ≥30 ml/min•1.73 m2
• Only Type 2 diabetics treated with diet/exercise, metformin, sulfonylureas, metformin/sulfonylurea, Glucagon-like peptide-1 receptor agonist (GLP-1 RA), or insulin
• Stable body weight (±4 pounds) over the previous 3 months prior to enrollment
• Ability to understand study procedures and to comply with them for the entire length of the study.

Критерии исключения

• Heart failure due to restrictive cardiomyopathy, active myocarditis, constrictive pericarditis, severe valvular heart disease, hypertrophic obstructive cardiomyopathy.
• Significant change in diuretic management during the month prior to screening (defined by doubling of diuretic dose or addition of another heart failure medication)
• Type 2 Diabetics treated with Dipeptidyl Peptidase-4 Inhibitor (DPP4i) or pioglitazone
• Pregnancy, lactation, or plans to become pregnant. A negative pregnancy test will be performed before each MRI study to assess current status. For women of child-bearing age (WOCBA) willingness to use contraception, if applicable.
• Allergy/sensitivity to study drugs or their ingredients.
• Cancer.
• Current drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
• Inability or unwillingness of individual or legal guardian/representative to give written informed consent.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Фундаментальное исследование

Центры проведения

США · 1 центр

• Texas Diabetes Institute - University Health System — San Antonio

Идентификаторы

NCT: NCT06229678 · STUDY00000012 · R01DK107680

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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