Liver Fibroses, Metabolic Syndrome, Toll-like Receptors, Trimethylamine N-oxyde, Vascular Stiffness
Conditions
Keywords
Metabolic syndrome, Vascular Aging, Non-alcoholic Fatty Liver Disease, Non-drug methods, Interval Hypoxic-hyperoxic training, Trimethylamine N-oxyde (TMAO), Toll-like Receptors (TLR)
Brief summary
The aim of this study is to assess the effect of interval hypoxy-hyperoxic training (IHHT) on the arterial stiffness and elasticity of the liver tissue in patients with metabolic syndrome and on other components of the metabolic syndrome, and the possibility of their reversible recovery after training.
Detailed description
The study will included 60 patients with metabolic syndrome (alimentary obesity (large waist, that measures at least 89 centimeters for women, and 102 centimeters for men), high blood pressure (130/85 mm Hg or higher), dislipidemia (triglyceride level 150 mg/dL (1.7 mmol/L) or higher of this type of fat found in blood; reduced high-density lipoprotein (HDL) cholesterol less than 40 mg/dL (1.04 mmol/L) in men, or less than 50 mg/dL (1.3 mmol/L) in women of HDL cholesterol), elevated fasting blood sugar (100 mg/dL (5,6 mmol/L) or higher). All patients were random separated into two groups: trial (30 pers., who will undergo 15 procedures of the IHHT, 5 days a week for 3 weeks), and control (30 pers., who will undergo 15 placebo procedures simulating IHHT, 5 days a week for 3 weeks). Before and after procedures of IHHT all patients will undergo laboratory and instrumental examinations, wich include arterial stiffness measurement, making by Fukuda Denshi VS-100 VaSera, measurement of liver tissue elasticity and fibrosis, making by elastography on FibroScan (Echosense, XL-sensor), and laboratory analysis (lipid profile, fasting blood sugar, trimethylamin N-oxyde (TMAO), Toll-like receptors 4,7,9). After 6 month of IHHT all patients will undergo the same laboratory and instrumental examinations to assess the duration of the effect.
Interventions
PROCEDUREInterval hypoxic-hyperoxic training (IHHT) using respiratory therapy unit ReOxy.
Every patient from control group undergo 15 procedures of IHHT, 5 procedures per week for 3 weeks, 1 procedure lasts 40 minutes. IHHT is a protocol which employs passive (the patient is at rest), short (several minutes) mild normobaric hypoxic exposures alternated with similar duration intervals of breathing hyperoxia, and repeated for 40 minutes. During the initial pretreatment test, the patient inhales air with low oxygen content at atmospheric pressure in a continuous mode through a mask. In the interval therapeutic mode that follows, periods of hypoxia (10-14% O2) are interrupted by periods of reoxygenation by hyperoxia (up to 35% O2). Automatic switching of gas flows (SRT technology). Built-in intelligent software automatically identifies and suggests key treatment parameters for the individual treatment program, by adjusting the starting parameters based upon the results of the pretreatment hypoxic test.
PROCEDURESimulating Interval hypoxic-hyperoxic training (IHHT) using respiratory therapy unit ReOxy.
Every patient from group control undergo simulating procedures of interval hypoxic-hyperoxic training, 15 procedures, 5 procedures per week for 3 weeks. 1 procedure lasts 40 minutes, in normoxia. Before the start of the course, each patient undergoes a test procedure for 10 minute (in normoxia) for simulate procedures IHHT.
Sponsors
I.M. Sechenov First Moscow State Medical University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient's written informed consent. * The presence of metabolic syndrome: as having three or more of the following traits, including traits you're taking medication to control: * Large waist - A waistline that measures at least 35 inches (89 centimeters) for women and 40 inches (102 centimeters) for men; * High triglyceride level - 150 milligrams per deciliter (mg/dL), or 1.7 millimoles per liter (mmol/L), or higher of this type of fat found in blood; * Reduced good or HDL cholesterol - Less than 40 mg/dL (1.04 mmol/L) in men or less than 50 mg/dL (1.3 mmol/L) in women of high-density lipoprotein (HDL) cholesterol; * Increased blood pressure - 130/85 millimeters of mercury (mm Hg) or higher; * Elevated fasting blood sugar - 100 mg/dL (5.6 mmol/L) or higher. * Must be able to come to the hospital 5 days per week, for 3 weeks.
Exclusion criteria
* Refusal from further participation in the study. * Individual intolerance to hypoxia. * Cirrhosis of the liver with liver failure class C according to the classification of Child-Pugh. * Alcohol use 140 g / week or more for men, and 70 g / week or more for women. * Patients with positive serological reactions to hepatitis B and C. * Chronic kidney disease (GFR less than 30 ml / min / 1.73 m 2). * Pregnancy, lactation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assess the effect of interval hypoxy-hyperoxic training (IHHT) on the arterial stiffness. | Assessment will be measured next day after 15th procedure of the IHHT procedure. | Assessment of arterial stiffness will be measured by pulse wave velocity using VASERA VS-1500 Fukuda Denshi on next day after course of 15 procedures of IHHT. |
| Assess the effect of interval hypoxy-hyperoxic training (IHHT) on the liver fibrosis. | Assessment will be measured next day after 15th procedure of the IHHT procedure. | Assessment of the liver fibrosis and elasticity of liver tissue will be measurement by elastography on FibroScan (Echosense, XL-sensor) by measured liver tissue stiffness (in KPa). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assess the effect of interval hypoxy-hyperoxic training (IHHT) on the lipid profile ( total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides in mmol/l). | Assessment will be measured next day after 15th procedure of the IHHT procedure. | Taken in blood. |
| Assess the effect of interval hypoxy-hyperoxic training (IHHT) on the trimethylamine n-oxide in mg/dl. | Assessment will be measured next day after 15th procedure of the IHHT procedure. | Taken in blood. |
Countries
Russia
Outcome results
None listed