IL-1-receptor Antagonist During Cephalic Phase of Insulin Secretion in Health and Type 2 Diabetes

Phase 2TerminatedNCT04227769

University Hospital, Basel, Switzerland18 enrolled

Overview

A prospective, randomized, mixed double- and single-blinded, placebo-controlled, cross-over clinical trial to test whether acute treatment with an IL-1 receptor antagonist impacts insulin secretion over time during the cephalic phase, defined as the first 10 minutes after the first sensorial contact to food, in healthy individuals in healthy humans (Group 1) and in obese patients with type 2 diabetes (Group 2).

The role of the immune system in metabolism has been extensively investigated in pancreatic islets and insulin sensitive tissues. However little attention has been given to a potential role of the innate immune system in the cephalic phase of insulin secretion. In humans, the cephalic phase of insulin secretion appear reduced in obesity and in patients with type 2 diabetes. In this prospective, randomized, mixed double- and single-blinded, placebo-controlled, cross-over clinical trial we aim to test whether acute treatment with an IL-1 receptor antagonist impacts insulin secretion over time during the cephalic phase, defined as the first 10 minutes after the first sensorial contact to food, in healthy individuals in healthy humans (Group 1) and in obese patients with type 2 diabetes (Group 2). Group 1: After screening, subjects will be randomized to two crossover visits with a washout period of at least 4 days in-between visits and at most two weeks: A) subcutaneous saline injection 3h before an oral standardized meal, B) subcutaneous injection of 100 mg of the IL-1 receptor antagonist anakinra 3h before an oral standardized meal. Treatments will be placebo controlled, crossover, double blinded. The study will be performed in a population of healthy individuals. Group 2: Same as for Group 1 with the following addition: after the second study day, participant in group 2 will be trained to self-inject the medication for 6 days. On the 7th day, an oral standardized meal test will be performed. Healthy subjects from group 1 will be matched for sex and age to the diabetic cohort from group 2.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

BASIC_SCIENCE

Masking

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion criteria: Main inclusion criteria: * Age ≥ 18 years and ≤ 70 years at screening * Male or female of non-child-bearing potential (meaning for women: not currently pregnant, post-menopausal female or using condoms and either intrauterine devices or 3-monthly contraceptive injection or birth-control pill.) Healthy subjects: * No apparent disease requiring medication * BMI \< 25 kg/ m2 * C-reactive protein ≤ 2 mg/L Obese diabetic type 2 subjects: * Type 2 diabetes * HbA1c 7.0 -10.0% * BMI ≥ 30.0 kg/m2 * C-reactive protein ≥ 2 mg/L Exclusion criteria: Subjects will be excluded from the study if they meet any of the following criteria: * Mental incapacity, unwillingness or language barriers precluding adequate understanding or cooperation * Aversion or allergy to paracetamol or any component of the meal. * Known history of allergy or hypersensitivity to any component of the investigational product formulations * Concomitant treatment with GLP-1 agonists, DPP-4 inhibitors, insulin or insulin derivative * Change in diabetes medication within the last 30 days * Any biologic drugs targeting the immune system * Fever, or other signs of infection requiring antibiotics within 3 weeks prior to screening, history of recurrent infection, immunodeficiency, known HIV or tuberculosis infection, active foot ulcer * Participation in another study with investigational drug within 30 days prior to Screening and during the present study * eGFR \< 30 mL/min/1.73m2 per MDRD formula or kidney transplant (regardless of renal function) * Known active or recurrent hepatic disorder (including cirrhosis, hepatitis B and hepatitis C, or confirmed ALAT/ASAT levels \> 3 times ULN or total bilirubin \> 2 times ULN), * Haemoglobin \<10.0 g/dL, white blood cell \<3.0 x 103/mm3, platelet count \<125 x 103/mm3 * Atrial fibrillation and/or a pacemaker

Outcomes

Primary Outcomes

Change in insulin concentration in blood during the cephalic phase of insulin secretion in healthy individuals

Insulin concentration in blood at 0, 3,6 and 10 minutes after ingestion of a standardized meal in healthy individuals.

Time frame: 10 minutes

Change in insulin concentration in blood during the cephalic phase of insulin secretion in obese patients with type 2 diabetes

Insulin concentration in blood at 0, 3, 6 and 10 minutes after ingestion of a standardized meal in healthy individuals in obese patients with type 2 diabetes.

Time frame: 10 minutes

Secondary Outcomes

Change of C-peptide

Plasma level of c-peptide before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of insulin

Plasma level of insulin before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of glucose

Plasma level of glucose before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of glucagon

Plasma level of glucagon before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of GLP-1

Plasma level of GLP-1 before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of pancreatic polypeptide

Plasma level of pancreatic polypeptide before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of IL-1β

Plasma level of IL-1β before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of IL-6

Plasma level of IL-6 before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change of IL-1Ra

Plasma level of IL-1Ra before and after a meal through nasogastric tube or with anakinra or placebo after a standardized meal.

Time frame: 6 hours

Change of TNFa

Plasma level of TNFa before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

change in hunger

Visual analogue scale (VAS) for hunger (from minimum value = not hungry at all to maximum value = extremely hungry) before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

Change in autonomic function

Change in heart-rate variability during a continuous ECG as indirect measure of measure of the autonomic function before and after a standardized meal after acute treatment or repeated treatment with anakinra or placebo. Repeated Treatment applies only to anakinra and to Group 2.

Time frame: 6 hours

IL-1-receptor Antagonist During Cephalic Phase of Insulin Secretion in Health and Type 2 Diabetes

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes