Vascular Function, Racial Disparity
Conditions
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
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.
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Flow-mediated Dilation | Within 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
| Arm | Count |
|---|---|
| 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 |
| Total | 8 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 | FG006 | FG007 |
|---|---|---|---|---|---|---|---|---|---|
| Overall Study | Baseline measurements only. Investigator did not obtain treatments for the planned interventions. | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Baseline characteristics
| Characteristic | Total | Experimental: 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 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 7 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 0 Participants |
| Region of Enrollment United States | 8 participants | 1 participants | 1 participants | 1 participants | 1 participants | 1 participants | 1 participants | 1 participants | 1 participants |
| Sex: Female, Male Female | 3 Participants | 1 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 5 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 1 Participants |
Adverse events
| Event type | EG000 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 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
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.
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.
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.
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.
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.