Kinetics of Metabolic Cofactors in NAFLD (NAFLDCOFCAL)

• ClinicalTrials.gov Identifier: NCT03838822
• Recruitment Status: Completed
• First Posted: February 12, 2019
• Last Update Posted: February 15, 2019
• Sponsor: Sahlgrenska University Hospital, Sweden
• Collaborators: Karolinska Institutet; Chalmers University of Technology
• Information provided by (Responsible Party): Hanns-Ulrich Marschall, Sahlgrenska University Hospital, Sweden

Study Description

Brief Summary:

There is a strong correlation between major adverse health consequences of obesity and development of non-alcoholic fatty liver disease (NAFLD). NAFLD is characterized by abnormal hepatic accumulation of triglycerides and other lipids. It has become a worldwide health problem that accelerates cirrhosis, type 2 diabetes mellitus (T2DM), and especially premature cardiovascular morbidity and mortality.

The plasma level of glutathione (GSH) is typically depleted in individuals with metabolism related disorders. However, cellular GSH levels cannot be increased by supplementing GSH and it must be synthesized within the liver either de novo or by salvation pathway. The level of GSH is not enough to maintain and regulate the thiol redox status of the liver in subjects with high hepatic steatosis at fasting stage due to the depletion of glycine. Glycine can be synthesized via the interconversion of serine. It has been shown that the serine synthesis is downregulated in patients with NAFLD and supplementation of serine has attenuated alcoholic fatty liver by enhancing homocysteine metabolism in mice and rats. Depleted liver glutathione is also restored by the administration of N-acetylcystein as in acetaminophen poising. L-carnitine and nicotinamide that both stimulate the transfer of fatty acids from cytosol to mitochondria have been identified as two additional cofactors that are depleted in patients with NAFLD.

In this study, the kinetics in blood of pivotal metabolic cofactors, serine, L-carnitine, N-acetylcystein and nicotinamide after single and simultaneous dietary supplementation, are measured.

Condition or disease	Intervention/treatment	Phase
Healthy	Dietary Supplement: Cofactors	Early Phase 1

Detailed Description:

In 10 healthy subjects with BMI <30 kg/m2 the plasma concentrations of 4 natural compounds (nicotinamide riboside, L-carnitine, L-serine and N-acetylcystein) are measured by ultra-performance liquid chromatography-tandem mass spectrometry (UPLCMSMS) after individual and combined administration, on five consecutive days and at every hour during 9 hours after administration. The study will start at 8:00 every morning and at each time point, blood samples will be collected.

The taste and any potential sensing of the co-factors such as vertigo, nausea, bowel movement will be recorded.

Each participant will receive one oral dose of Day 1: 1 g nicotinamide riboside; Day 2: 3 g L-carnitine; Day 3: 5 g N-acetylcystein; Day 4: 20 g L-serine; Day 5: combined 1 g nicotinamide riboside, 3 g L-carnitine, 5 g N-acetylcystein, and 20 g L-serine

In addition, untargeted metabolomics analysis as well as O-link proteomics analysis we be performed to study effect of the administered cofactors.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 10 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Kinetics of Metabolic Cofactors After Oral Supplementation in Healthy Subjects
• Actual Study Start Date: September 1, 2018
• Actual Primary Completion Date: November 1, 2018
• Actual Study Completion Date: December 1, 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: Intervention; Oral administration of cofactors, 1g nicotinamide riboside, 3g L-carnitine, 20g serine and 5g N-acetylcystein, first as single compounds, then combined, on 5 days	Dietary Supplement: Cofactors; Oral administration of 1g nicotinamide riboside, 3g L-carnitine, 20g serine and 5g N-acetylcystein, first as single compounds, then combined, on 5 days

Outcome Measures

Primary Outcome Measures :

1. Changes of plasma levels of nicotinamide riboside measured by mass spectrometry [ Time Frame: Twenty-four hours after administration ]
   Plasma levels of nicotinamide riboside by UPLCMSMS at 8 time points during 24h after administration
2. Changes of plasma levels of L-carnitine measured by mass spectrometry [ Time Frame: Twenty-four hours after administration ]
   Plasma levels of L-carnitine (nM) measured by UPLCMSMS at 8 time points during 24h after administration
3. Changes of plasma levels of L-serine measured by mass spectrometry [ Time Frame: Twenty-four hours after administration ]
   Plasma levels of L-serine (nM) measured by UPLCMSMS at 8 times points during 24h after administration
4. Changes of plasma levels of N-acetylcystein measured by mass spectrometry [ Time Frame: Twenty-four hours after administration ]
   Plasma levels of N-acetylcystein (nM) measured by UPLCMSMS at 8 times points during 24h after administration

Secondary Outcome Measures :

1. Changes in the plasma level of metabolites associated with the supplementation of metabolic co-factors. [ Time Frame: Twenty-four hours after administration of combined cofactors ]
   Untargeted metabolomic analysis using mass spectrometry. (Untargeted = not pre-specified in terms of outcome)
2. Changes in the plasma level of inflammation-related proteins associated with the supplementation of metabolic co-factors. [ Time Frame: Twenty-four hours after administration of combined cofactors ]
   Changes in the plasma level of inflammation related proteins associated with the supplementation of metabolic co-factors.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 40 Years (Adult)
• Sexes Eligible for Study: Male
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

Healthy without any medication, no smokers, no obesity

Exclusion Criteria:

Any known disease, obesity

Contacts and Locations

Locations

Sweden

Hanns-Ulrich Marschall

Göteborg, Sweden, 411 31

Sahlgrenska Academy

Göteborg, Sweden

Sponsors and Collaborators

Sahlgrenska University Hospital, Sweden

Karolinska Institutet

Chalmers University of Technology

Investigators

• Principal Investigator: Hanns-Ulrich Marschall, Prof; Sahlgrenska University Hospital, Sweden

More Information

• Responsible Party: Hanns-Ulrich Marschall, Professor, University Hospital Consultant, Sahlgrenska University Hospital, Sweden
• ClinicalTrials.gov Identifier: NCT03838822
• Other Study ID Numbers: Cofactor Calibration 1.0
• First Posted: February 12, 2019
• Last Update Posted: February 15, 2019
• Last Verified: February 2019

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Hanns-Ulrich Marschall, Sahlgrenska University Hospital, Sweden:

nicotinamid riboside; L-carnitine; L-serine; N-acetylcystein