Non-alcoholic fatty liver disease (NAFLD) is a common human liver pathology, closely associated with the obesity pandemic and insulin resistance. In the insulin resistant state the liver remains sensitive to pro-lipogenic signals of insulin, which further promote lipid accumulation. Secretion of very-low-density-lipoproteins (VLDL), the main carriers of triglycerides (TG) in the plasma, is the principal pathway for the liver to mobilize and dispose of lipids. Thus, hepatic TG export must not be too low in order to prevent steatosis. Our preliminary data from animal experiments suggest that enhanced brain insulin signaling promotes hepatic VLDL secretion, and reduces lipid accumulation in the liver. It remains to be tested whether other insulin sensitive tissues, such as the myocardium or the skeletal muscle, are also affected. In humans, neuropeptides, including insulin, can be delivered to the brain via an intranasal (IN) route of administration, without causing relevant systemic side effects. Therefore, we hypothesize that by enhancing brain insulin signaling using chronic IN insulin administration hepatic TG export increases and prohibits lipid accumulation in the liver and other insulin sensitive tissues, such as the myocardium and the skeletal muscle.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
QUADRUPLE
Enrollment
20
intranasal insulin (40 IE) Actrapid (100IE/mL); two 0.1 ml puffs per nostril) or placebo (insulin dilution buffer Novo Nordisk; two 0.1 ml puffs per nostril) four times a day (in total 160 IE Actrapid per day) before each main meal and before going to bed. 40 IE IN insulin enhances insulin concentration in the CSF without any changes in systemic insulin and glucose concentration, and no risk for hypoglycemia
intranasal insulin (40 IE) Actrapid (100IE/mL); two 0.1 ml puffs per nostril) or placebo (insulin dilution buffer Novo Nordisk; two 0.1 ml puffs per nostril) four times a day (in total 160 IE Actrapid per day) before each main meal and before going to bed. 40 IE IN insulin enhances insulin concentration in the CSF without any changes in systemic insulin and glucose concentration, and no risk for hypoglycemia
1H MR spectroscopy and imaging will be performed on the on on the 3.0-T Tim Trio System (Siemens Erlangen Germany). MR Spectroscopy and imaging measurements will last no more than 90 minutes all together.
Medical University Of Vienna, Department of Internal Medicine III
Vienna, State of Vienna, Austria
Changes in total lipid content in the liver
1H magnetic resonance spectroscopy
Time frame: one week before & at baseline & 1,2,3 and 4 weeks after intranasal insulin administration
Changes of hepatic Lipid composition
1H magnetic resonance spectroscopy
Time frame: one week before & baseline & 1,2,3 and 4 weeks after intranasal insulin administration
Changes of myocardial lipid content
1H magnetic resonance spectroscopy
Time frame: baseline, 2 and 4 weeks after intranasal insulin administration
Changes of myocardial lipid composition
1H magnetic resonance spectroscopy
Time frame: baseline, 2 and 4 weeks after intranasal insulin administration
Changes of skeletal muscle lipid content
1H magnetic resonance spectroscopy
Time frame: baseline, 2 and 4 weeks after intranasal insulin administration
Changes of lipid composition in skeletal muscle
1H magnetic resonance spectroscopy
Time frame: baseline, 2 and 4 weeks after intranasal insulin administration
changes in heart function
magnetic resonance imaging
Time frame: baseline, 2 and 4 weeks after intranasal insulin administration
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.