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Thyroid Hormones Homeostasis and Energy Metabolism Changes During Stimulation of Endogenously Secreted Bile Acids (BAs)

Thyroid Hormones Homeostasis and Energy Metabolism Changes During Stimulation of Endogenously Secreted Bile Acids (BAs)

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00706381
Enrollment
31
Registered
2008-06-27
Start date
2008-06-23
Completion date
2012-08-21
Last updated
2020-07-22

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Healthy Volunteers

Keywords

Deiodinase, Bile Acids, Cholecystokinin, Thyroid Hormones, Energy Expenditure, Healthy Volunteer

Brief summary

Postprandial thermogenesis, or thermic effect of food are terms that describe the increase in utilization of energy by the human body following a meal. The mechanisms involved in this process are believed to differ according to the type of food consumed, whether fat, protein or carbohydrate. The bile acids (BAs), unique substances secreted by the gall bladder into the gut after a meal, play an important role in the absorption of fat and the management of cholesterol stores in the body. Recent studies suggest that BAs may also serve as regulators of energy expenditure (consumption) in the cells of our body by increasing the production of T3, an active form of thyroid hormone. T3 in turn is believed to increase the efficiency with which our bodies burn calories thereby generating heat. Although this process has been shown to be effective in rodents who demonstrated weight loss after treatment, the role of BAs in humans is poorly understood. Thus we do not know whether endogenous (produced by the body) or exogenous (taken as medication) BAs play a significant role in the maintenance of body weight. We hypothesize that, similarly to rodents, humans will respond to BAs by increasing energy expenditure via the production of the active form of thyroid hormone. This randomized, cross-over study will look at changes in thyroid hormones and energy consumption in response to stimuli of endogenous BA secretion including dietary content, and to the intake of pharmacological doses of bile acids. Following a two-day period of equilibration diet, 30 healthy volunteers will be randomly assigned to receive either a high-fat or high-carbohydrate isocaloric meal followed by a 6-hour metabolic chamber stay; the next day they will be crossed-over to the alternate intervention. During the following three days, the study subjects will again be randomized to receive either an intravenous injection of sincalide (the C-terminal octapeptide fragment of cholecystokinin) 0.04 mcg/kg or placebo and P.O. placebo, or I.V. placebo and 15 mg/kg of BA (ursodiol) with similar metabolic chamber stays and cross-over design. The data gathered from this study will provide greater insight into the physiological and molecular mechanism(s) regulating the relation between endogenous bile acid secretion and energy metabolism in response to meals, as well as the role of BAs per se on energy metabolism.

Detailed description

Postprandial thermogenesis, or thermic effect of food are terms that describe the increase in utilization of energy by the human body following a meal. The mechanisms involved in this process are believed to differ according to the type of food consumed, whether fat, protein or carbohydrate. The bile acids (BAs), unique substances secreted by the gall bladder into the gut after a meal, play an important role in the absorption of fat and the management of cholesterol stores in the body. Recent studies suggest that BAs may also serve as regulators of energy expenditure (consumption) in the cells of our body by increasing the production of T3, an active form of thyroid hormone. T3 in turn is believed to increase the efficiency with which our bodies burn calories thereby generating heat. Although this process has been shown to be effective in rodents who demonstrated weight loss after treatment, the role of BAs in humans is poorly understood. Thus we do not know whether endogenous (produced by the body) or exogenous (taken as medication) BAs play a significant role in the maintenance of body weight. We hypothesize that, similarly to rodents, humans will respond to BAs by increasing energy expenditure via the production of the active form of thyroid hormone. This randomized, cross-over study will look at changes in thyroid hormones and energy consumption in response to stimuli of endogenous BA secretion including dietary content, and to the intake of pharmacological doses of bile acids. Following a two-day period of equilibration diet, 30 healthy volunteers will be randomly assigned to receive either a high-fat or high-carbohydrate isocaloric meal followed by a 6-hour metabolic chamber stay; the next day they will be crossed-over to the alternate intervention. During the following three days, the study subjects will again be randomized to receive either an intravenous injection of sincalide (the C-terminal octapeptide fragment of cholecystokinin) 0.04 mcg/kg or placebo and P.O. placebo, or I.V. placebo and 15 mg/kg of BA (ursodiol) with similar metabolic chamber stays and cross-over design. The following parameters will be recorded and compared to placebo: Energy expenditure Substrate utilization Spontaneous movements Skin and core temperature Serial changes in circulating thyroid hormones Serial changes in bile acid serum concentrations The data gathered from this study will provide greater insight into the physiological and molecular mechanism(s) regulating the relation between endogenous bile acid secretion and energy metabolism in response to meals, as well as the role of BAs per se on energy metabolism.

Interventions

PROCEDUREFat Meal

600 calorie meal containing 72% fat, 8% protein, and 20% carbohydrate

PROCEDURECarb meal

600 calorie meal containing 100% carbohydrate

DRUGPlacebo

IV and/or oral placebo

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Lead SponsorNIH

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
TRIPLE (Subject, Caregiver, Investigator)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* INCLUSION CRITERIA: Age greater than or equal to18 years, male or female Written informed consent

Exclusion criteria

Hypo- or hyperthyroidism (history or serum thyroid-stimulating hormone (TSH) greater than 5.0 or less than 0.4 miU/L) Blood pressure greater than 140/90 mmHg (26) or receiving antihypertensive therapy History of cardiovascular disease BMI less than or equal to 20 or greater than or equal to 27 Kg/m(2) Diabetes mellitus (fasting serum glucose greater than or equal to 126 mg/dL) Hyperlipidemia (serum total cholesterol greater than or equal to 240 mg/dL, triglycerides greater than or equal to 220 mg/dL, and/or use of antilipemic therapy) Liver disease or ALT serum concentrations greater than 1.5 times the upper laboratory reference limit Hyperbilirubinemia (serum total bilirubin greater than 1.5 mg/dL) Renal insufficiency or estimated creatinine clearance less than or equal to 50 mL/min (MDRD equation) Anemia (Hemoglobin concentration less than or equal to 11.1 g/dL females, and 12.7 g/dL males) History of cholecystectomy or cholelithiasis (by ultrasound at screening). History of malabsorption, or food allergies/intolerances that would preclude participant from consuming foods required for study Claustrophobia History of illicit drug or alcohol abuse within the last 5 years; current use of illicit drugs (by history) or alcohol (CAGE greater than 3) Psychiatric conditions or behavior that would be incompatible with safe and successful participation in this study Current use of medications/dietary supplements/alternative therapies known to alter thyroid function, energy expenditure or bile acid secretion History of weight loss or weight gain of greater than 3 percent body weight over the past 2 months (self-reported) Pregnancy/breastfeeding/hormonal contraceptive use and childbirth within the last 6 months Perimenopausal (as self-described within two years from onset of amenorrhea or current complaints of hot flashes) Current smoker

Design outcomes

Primary

MeasureTime frameDescription
Energy Expenditure6 hoursEnergy expenditure is measured over 6 hours in a respiratory chamber for each intervention and placebo.
Bile Acid6 hoursBile acid is measured at 0, 60, 90 and 360 minutes during a 6 hour stay in in a respiratory chamber for each intervention and placebo. The mean of these 4 values is then calculated.

Countries

United States

Participant flow

Participants by arm

ArmCount
1: Carb Meal, Fat Meal, Sincalide, Placebo, Urso
Participants randomized to consume a 100% carbohydrate meal day 1, then a high fat (72% fat, 8% protein, 20% carbohydrate) day 2, IV sincalide 0.04mcg/kg + PO placebo day 3, IV placebo + PO placebo day 4, and IV placebo + PO Ursodiol 15mg/kg day 5
10
2: Fat Meal, Carb Meal, Sincalide, Placebo, Urso
Participants randomized to consume a high fat (72% fat, 8% protein, 20% carbohydrate) meal day 1, then a 100% carbohydrate meal day 2, IV sincalide 0.04mcg/kg + PO placebo day 3, IV placebo + PO placebo day 4, then IV placebo + PO Ursodiol 15mg/kg day 5
6
3: Carb Meal, Fat Meal, Placebo, Sincalide, Urso
Participants randomized to consume a 100% carbohydrate meal day 1, then a high fat (72% fat, 8% protein, 20% carbohydrate) meal day 2, IV placebo + PO placebo day 3, IV sincalide 0.04mcg/kg + PO placebo day 4, then IV placebo + PO Ursodiol 15mg/kg day 5
6
4: Fat Meal, Carb Meal, Placebo, Sincalide, Urso
Participants randomized to consume a high fat (72% fat, 8% protein, 20% carbohydrate) meal day 1, then a 100% carbohydrate meal day 2, IV placebo + PO placebo day 3, IV sincalide 0.04mcg/kg + PO placebo day 4, the IV placebo + PO Ursodiol 15mg/kg day 5
9
Total31

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Overall StudyLost to Follow-up0110

Baseline characteristics

Characteristic1: Carb Meal, Fat Meal, Sincalide, Placebo, Urso2: Fat Meal, Carb Meal, Sincalide, Placebo, Urso3: Carb Meal, Fat Meal, Placebo, Sincalide, Urso4: Fat Meal, Carb Meal, Placebo, Sincalide, UrsoTotal
Age, Continuous30.8 years32.3 years33.4 years30.4 years31.6 years
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants0 Participants0 Participants1 Participants2 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
8 Participants6 Participants6 Participants7 Participants27 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants0 Participants0 Participants1 Participants2 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants0 Participants0 Participants0 Participants1 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants2 Participants2 Participants
Race (NIH/OMB)
Black or African American
2 Participants2 Participants2 Participants0 Participants6 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
2 Participants0 Participants0 Participants0 Participants2 Participants
Race (NIH/OMB)
White
5 Participants4 Participants4 Participants7 Participants20 Participants
Sex: Female, Male
Female
6 Participants2 Participants3 Participants4 Participants15 Participants
Sex: Female, Male
Male
4 Participants4 Participants3 Participants5 Participants16 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
0 / 310 / 310 / 310 / 290 / 30
other
Total, other adverse events
0 / 310 / 310 / 310 / 290 / 30
serious
Total, serious adverse events
0 / 310 / 310 / 310 / 290 / 30

Outcome results

Primary

Bile Acid

Bile acid is measured at 0, 60, 90 and 360 minutes during a 6 hour stay in in a respiratory chamber for each intervention and placebo. The mean of these 4 values is then calculated.

Time frame: 6 hours

Population: All participants were to participate in all interventions via cross-over design. One patient did not complete the placebo portion and so was eliminated from analysis in all groups. One other participant did not complete the ursodiol portion.

ArmMeasureValue (MEAN)Dispersion
Carb MealBile Acid2.89 mg/dLStandard Deviation 0.85
Fat MealBile Acid7.26 mg/dLStandard Deviation 4.6
SincalideBile Acid2.42 mg/dLStandard Deviation 0.64
UrsodiolBile Acid5.17 mg/dLStandard Deviation 1.2
PlaceboBile Acid2.69 mg/dLStandard Deviation 0.73
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: 0.096t-test, 2 sided
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: <0.0001t-test, 2 sided
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: 0.83t-test, 2 sided
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: <0.0001t-test, 2 sided
Primary

Energy Expenditure

Energy expenditure is measured over 6 hours in a respiratory chamber for each intervention and placebo.

Time frame: 6 hours

Population: All participants were to participate in all interventions via cross-over design. One patient did not complete the placebo portion and so was eliminated from analysis in all groups. One other participant did not complete the ursodiol portion.

ArmMeasureValue (MEAN)Dispersion
Carb MealEnergy Expenditure1.37 kcal/minStandard Deviation 0.11
Fat MealEnergy Expenditure1.40 kcal/minStandard Deviation 0.09
SincalideEnergy Expenditure1.28 kcal/minStandard Deviation 0.06
UrsodiolEnergy Expenditure1.27 kcal/minStandard Deviation 0.05
PlaceboEnergy Expenditure1.28 kcal/minStandard Deviation 0.05
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: 0.0001t-test, 2 sided
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: <0.0001t-test, 2 sided
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: 0.89Percent change from placebo
Comparison: The percent change from placebo was calculated for each participant and then a t-test was used to test the null hypothesis that this difference was equal to 0.p-value: 0.41t-test, 2 sided

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026