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Vascular Dysfunction in Black Individuals: Roles of Nitric Oxide and Endothelin-1

Vascular Dysfunction in Black Individuals: Roles of Nitric Oxide and Endothelin-1

Status
Terminated
Phases
Early Phase 1
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04770155
Acronym
UMMC_Pilot
Enrollment
8
Registered
2021-02-25
Start date
2021-05-27
Completion date
2021-09-20
Last updated
2023-10-31

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

Conditions

Vascular Function, Racial Disparity

Keywords

Black, African American, White, Caucasian American, Hyperemia, Blood Flow, Conductance

Brief summary

The research aims of this proposal are: * Specific Aim 1: To test whether an increase in nitric oxide signaling can increase vasodilator responses in young Black individuals. * Specific Aim 2: To test whether a decrease in endothelin-1 signaling can increase vasodilator responses in young Black individuals.

Detailed description

Studies will be conducted in the Clinical Research and Trials Unit at the University of Mississippi Medical Center. All study visits will follow the same procedures, except for the drug or supplement being administered. For Aim 1, double-blind, randomized, placebo-controlled crossover designs will examine the effects of increasing nitric oxide and cyclic guanosine monophosphate bioavailability on vascular function of young Black and White individuals. Three sets of two visits will be performed: * Aim 1a: At the beginning of each visit, participants will ingest either a nitrate-rich beetroot juice or a nitrate-depleted beetroot juice (serving as placebo) in their liquid commercial form, which has a distinct color and flavor. The nitrates will be absorbed and reduced in the plasma to nitrite and nitric oxide, increasing endothelium-independent nitric oxide bioavailability. * Aim 1b: Participants will receive a 7-day supplement of L-citrulline or placebo before each study visit, with a washout period of 7 days between visits. The activity of the endothelial nitric oxide synthase converts L-arginine into nitric oxide and L-citrulline, which is normally recycled back into L-arginine. Unlike L-arginine, oral ingestion of L-citrulline is not catabolized in the gut, nor is it extracted from systemic circulation through hepatic first-pass metabolism. Thus, ingested L-citrulline becomes available in large quantities in the plasma for enzymatic conversion into L-arginine, increasing endothelium-dependent nitric oxide bioavailability. * Aim 1c: At the beginning of each visit, participants will ingest a liquid mixture prepared by Investigational Drug Services at the University of Mississippi Medical Center containing Sildenafil or placebo. Sildenafil inhibits phosphodiesterase 5, an enzyme that degrades cyclic guanosine monophosphate in the vascular smooth muscle cells inactivating the nitric oxide-mediated signal; thus, Sildenafil will prolong the availability of cyclic guanosine monophosphate, enhancing the nitric oxide-mediated intracellular cascade. For Aim 2, a double-blind, randomized, placebo-controlled crossover design will examine the role of endothelin-1 on the vascular function of young Black and White individuals. Two visits will be performed, with a minimum of 7 days between them. • Aim 2: At the beginning of each visit, participants will ingest a liquid mixture prepared by Investigational Drug Services at the University of Mississippi Medical Center containing Bosentan or placebo. Bosentan blocks ETA and ETB receptors, leading to a reduction in vasoconstrictor tone and a greater magnitude of vasodilator responses.

Interventions

DIETARY_SUPPLEMENTDietary Nitrates 400 mg

The nitrates in the beetroot juice will be absorbed and reduced in the plasma to nitrite and nitric oxide, increasing endothelium-independent nitric oxide bioavailability.

DIETARY_SUPPLEMENTL-citrulline 3 g

Ingested L-citrulline becomes available in large quantities in the plasma for enzymatic conversion into L-arginine. The activity of the endothelial nitric oxide synthase converts L-arginine into nitric oxide, increasing endothelium-dependent nitric oxide bioavailability.

Sildenafil inhibits phosphodiesterase 5, an enzyme that degrades cyclic guanosine monophosphate in the vascular smooth muscle cells inactivating the nitric oxide-mediated signal; thus, Sildenafil will prolong the availability of cyclic guanosine monophosphate, enhancing the nitric oxide-mediated intracellular cascade.

Bosentan blocks endothelin-1 receptors ETA and ETB, leading to a reduction in vasoconstrictor tone and a greater magnitude of vasodilator responses.

Sponsors

University of Mississippi Medical Center
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
ALL
Age
18 Years to 40 Years
Healthy volunteers
Yes

Inclusion criteria

* Self-identification of their race and the race of their biological parents as being only Black (i.e., African American) or only White (i.e., Caucasian American) * Born and raised in the United States

Exclusion criteria

* Mixed races * Any chronic or ongoing disease * Prescribed pharmacological treatment * Smoking or tobacco use * Obesity (body mass index \> 30 kg / m2)

Design outcomes

Primary

MeasureTime frameDescription
Flow-mediated DilationWithin 4 hours of drug/supplement administration.The percent change in arterial diameter normalized to arterial shear rate during reperfusion after 5 minutes of circulatory occlusion.
Reactive Hyperemia (Cuff Release)Within 4 hours of drug/supplement administration.Blood velocity area-under-the-curve from the beginning of reperfusion to return to resting values.
Muscle Hyperemia (Passive Leg Movement)Within 4 hours of drug/supplement administration.Peak and the area-under-the-curve of the change in femoral artery blood flow during 1 minute of passive leg movement.
Muscle Hyperemia (Rhythmic Handgrip Exercise)Baseline measurements with no drug/supplement administration before or after.Changes in brachial artery blood flow and conductance during single handgrip contractions at 3 intensities.
Muscle Hyperemia (Rhythmic Knee Extension Exercise)Within 4 hours of drug/supplement administration.Changes in femoral artery blood flow and conductance during 3 minutes of rhythmic knee extension exercise.

Countries

United States

Participant flow

Participants by arm

ArmCount
Experimental: Beetroot Juice, Then Placebo (Aim 1a)
Upon arriving at the laboratory, participants will ingest 140 ml of beetroot juice containing a high (\ 12.8 mmol) concentration of nitrates (James White Drinks, Suffolk, UK), or 140 ml of beetroot juice containing a low concentration (\ 0.0055 mmol) of nitrates (James White Drinks, Suffolk, UK). Dietary Nitrates 400 mg: The nitrates in the beetroot juice will be absorbed and reduced in the plasma to nitrite and nitric oxide, increasing endothelium-independent nitric oxide bioavailability.
1
Experimental: Placebo, Then Beetroot Juice (Aim 1a)
Upon arriving at the laboratory, participants will ingest 140 ml of beetroot juice containing a low concentration (\ 0.0055 mmol) of nitrates (James White Drinks, Suffolk, UK), or 140 ml of beetroot juice containing a high (\ 12.8 mmol) concentration of nitrates (James White Drinks, Suffolk, UK). Dietary Nitrates 400 mg: The nitrates in the beetroot juice will be absorbed and reduced in the plasma to nitrite and nitric oxide, increasing endothelium-independent nitric oxide bioavailability.
1
Experimental: L-citrulline, Then Placebo (Aim 1b)
Participants will receive pills containing 3 g of L-citrulline (Superior Labs, Park City, UT) to take twice daily for 7 days before the study visit, or pills containing a placebo to take twice daily for 7 days before the study visit. L-citrulline 3 g: Ingested L-citrulline becomes available in large quantities in the plasma for enzymatic conversion into L-arginine. The activity of the endothelial nitric oxide synthase converts L-arginine into nitric oxide, increasing endothelium-dependent nitric oxide bioavailability.
1
Experimental: Placebo, Then L-citrulline (Aim 1b)
Participants will receive pills containing a placebo to take twice daily for 7 days before the study visit, or pills containing 3 g of L-citrulline (Superior Labs, Park City, UT) to take twice daily for 7 days before the study visit. L-citrulline 3 g: Ingested L-citrulline becomes available in large quantities in the plasma for enzymatic conversion into L-arginine. The activity of the endothelial nitric oxide synthase converts L-arginine into nitric oxide, increasing endothelium-dependent nitric oxide bioavailability.
1
Experimental: Sildenafil, Then Placebo (Aim 1c)
Upon arriving at the laboratory, participants will ingest a liquid mixture containing Sildenafil (100 mg), an inhibitor of phosphodiesterase 5, or a liquid mixture containing a placebo. Sildenafil 100 mg: Sildenafil inhibits phosphodiesterase 5, an enzyme that degrades cyclic guanosine monophosphate in the vascular smooth muscle cells inactivating the nitric oxide-mediated signal; thus, Sildenafil will prolong the availability of cyclic guanosine monophosphate, enhancing the nitric oxide-mediated intracellular cascade.
1
Experimental: Placebo, Then Sildenafil (Aim 1c)
Upon arriving at the laboratory, participants will ingest a liquid mixture containing a placebo, or a liquid mixture containing Sildenafil (100 mg), an inhibitor of phosphodiesterase 5. Sildenafil 100 mg: Sildenafil inhibits phosphodiesterase 5, an enzyme that degrades cyclic guanosine monophosphate in the vascular smooth muscle cells inactivating the nitric oxide-mediated signal; thus, Sildenafil will prolong the availability of cyclic guanosine monophosphate, enhancing the nitric oxide-mediated intracellular cascade.
1
Experimental: Bosentan, Then Placebo (Aim 2)
Upon arriving at the laboratory, participants will ingest a liquid mixture containing Bosentan (125 mg), a non-selective blocker of endothelin-1 receptors ETA and ETB, or a liquid mixture containing a placebo. Bosentan 125 mg: Bosentan blocks endothelin-1 receptors ETA and ETB, leading to a reduction in vasoconstrictor tone and a greater magnitude of vasodilator responses.
1
Experimental: Placebo, Then Bosentan (Aim 2)
Upon arriving at the laboratory, participants will ingest a liquid mixture containing a placebo, or a liquid mixture containing Bosentan (125 mg), a non-selective blocker of endothelin-1 receptors ETA and ETB. Bosentan 125 mg: Bosentan blocks endothelin-1 receptors ETA and ETB, leading to a reduction in vasoconstrictor tone and a greater magnitude of vasodilator responses.
1
Total8

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004FG005FG006FG007
Overall StudyBaseline measurements only. Investigator did not obtain treatments for the planned interventions.11111111

Baseline characteristics

CharacteristicTotalExperimental: Placebo, Then Beetroot Juice (Aim 1a)Experimental: Beetroot Juice, Then Placebo (Aim 1a)Experimental: L-citrulline, Then Placebo (Aim 1b)Experimental: Placebo, Then L-citrulline (Aim 1b)Experimental: Sildenafil, Then Placebo (Aim 1c)Experimental: Placebo, Then Sildenafil (Aim 1c)Experimental: Bosentan, Then Placebo (Aim 2)Experimental: Placebo, Then Bosentan (Aim 2)
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Age, Categorical
Between 18 and 65 years
8 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants1 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
7 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants1 Participants0 Participants
Region of Enrollment
United States
8 participants1 participants1 participants1 participants1 participants1 participants1 participants1 participants1 participants
Sex: Female, Male
Female
3 Participants1 Participants1 Participants1 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Sex: Female, Male
Male
5 Participants0 Participants0 Participants0 Participants1 Participants1 Participants1 Participants1 Participants1 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
EG006
affected / at risk
EG007
affected / at risk
deaths
Total, all-cause mortality
0 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0
other
Total, other adverse events
0 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0
serious
Total, serious adverse events
0 / 00 / 00 / 00 / 00 / 00 / 00 / 00 / 0

Outcome results

Primary

Flow-mediated Dilation

The percent change in arterial diameter normalized to arterial shear rate during reperfusion after 5 minutes of circulatory occlusion.

Time frame: Within 4 hours of drug/supplement administration.

Population: Flow-mediated dilation was not collected in any participant.

Primary

Muscle Hyperemia (Passive Leg Movement)

Peak and the area-under-the-curve of the change in femoral artery blood flow during 1 minute of passive leg movement.

Time frame: Within 4 hours of drug/supplement administration.

Population: Muscle hyperemia with passive leg movement was not collected in any participant.

Primary

Muscle Hyperemia (Rhythmic Handgrip Exercise)

Changes in brachial artery blood flow and conductance during single handgrip contractions at 3 intensities.

Time frame: Baseline measurements with no drug/supplement administration before or after.

Population: The only data collected were baseline measurements and no participants were ever given either intervention; the investigator was never able to obtain the treatments to use for the planned intervention arm of the study, resulting in its termination. Upon resigning his Instructor position at UMMC, the investigator backed up the baseline data files on an external hard drive. Unfortunately, some issues with the external hard drive corrupted the files, making them no longer accessible.

Primary

Muscle Hyperemia (Rhythmic Knee Extension Exercise)

Changes in femoral artery blood flow and conductance during 3 minutes of rhythmic knee extension exercise.

Time frame: Within 4 hours of drug/supplement administration.

Population: Muscle hyperemia with rhythmic knee extension exercise was not collected in any participant.

Primary

Reactive Hyperemia (Cuff Release)

Blood velocity area-under-the-curve from the beginning of reperfusion to return to resting values.

Time frame: Within 4 hours of drug/supplement administration.

Population: Reactive hyperemia with cuff release was not collected in any participant.

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