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The investigators would like to find out if sitagliptin (dipeptidyl peptidase-4 or DPP4 inhibition), a drug to treat diabetes, affects blood vessel relaxation in healthy people receiving enalapril (angiotensin converting enzyme or ACE inhibition), a blood pressure medicine. Understanding how these drugs interact in healthy people will help us learn their potential effects in people who have diabetes.
To test the hypothesis that DPPIV inhibition with sitagliptin potentiates the vasodilator response to substance P in the presence of ACE inhibition with enalaprilat and to BNP and GLP-1 even in the presence of ACE inhibition. The aim promises to provide important new data regarding the mechanism of action of DPPIV inhibitors and interactive effects of these two drug classes used in a growing population of diabetic patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Placebo then sitagliptin (DPP4 inhibition) group 1 | Placebo Comparator | The effect of vehicle and enalaprilat on the forearm blood flow and t-PA responses to bradykinin and substance P are studied after administration of placebo or sitagliptin (DPP4 inhibition). |
|
| Sitagliptin (DPP4 inhibition) then placebo group 1 | Placebo Comparator | The effect of vehicle and enalaprilat (ACE inhibition) on the forearm blood flow and t-PA responses to substance P and bradykinin are studied after administration of sitagliptin (DPP4 inhibition) or placebo |
|
| Placebo then sitagliptin group 2 | Placebo Comparator | The effect of vehicle and enalaprilat (ACE inhibition) on the forearm blood flow and t-PA responses to glucagon-like peptide-1 and brain natriuretic pepdie are studied after administration of placebo or sitagliptin (DPP4 inhibition). |
|
| Sitagliptin (DPP4 inhibition) then comparator group 2 | Placebo Comparator | The effect of vehicle and enalaprilat on the forearm blood flow and t-PA responses to glucagon-like peptide and brain natriuretic peptide are studied after administration of placebo or sitagliptin (DPP4 inhibition). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sitagliptin (DPP4 inhibitor) | Drug | Sitagliptin 200 mg (DPP4 inhibitor) or matching placebo will be given one hour prior to intra-arterial infusions |
|
| Measure | Description | Time Frame |
|---|---|---|
| The Effect of Enalaprilat (ACE Inhibition), Sitagliptin (DPP4 Inhibition), or the Combination on the Vasodilator Response (Forearm Blood Flow) to Substance P (SP) and Bradykinin (Group 1) or Glucagon Like Peptide-1 and Brain Naturetic Peptide (Group 2). | Forearm blood flow (FBF) was measured by strain gauge plethysmography at the completion of each dose of intra-arterial peptide. A dose response curve was therefore constructed for each vasoactive peptide substrate. The effect of sitagliptin (DPP4 inhibition) vs. placebo and enalaprilat (ACE inhibition) vs. vehicle on the forearm blood flow response to each peptide could then be determined. | 60 minutes post-placebo or sitagliptin (DPP4 inhibition) and over last 2 minutes of each 5 min infusion per peptide dose (30 min washout between peptides); sequence repeated with enalaprilat (ACE inhibition) or vehicle |
| Measure | Description | Time Frame |
|---|---|---|
| Assess Tissue Type Plasminogen Activator (tPA) Release | Following measurement of FBF, samples will be obtained to determine the effect of ACE inhibition and/or DPP4 inhibition on tPA release in response to bradykinin and substance P (SP) (group 1) | Blood for analysis of tPA release was obtained 60 minutes after sitagliptin (DPP4 inhibition) vs. placebo and after each assessment of FBF (see primary outcome measure) |
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Inclusion Criteria:
For female subjects:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nancy J Brown, MD | Vanderbilt University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Vanderbilt University- General Clinic Research Center | Nashville | Tennessee | 37232 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25158865 | Derived | Devin JK, Pretorius M, Nian H, Yu C, Billings FT 4th, Brown NJ. Dipeptidyl-peptidase 4 inhibition and the vascular effects of glucagon-like peptide-1 and brain natriuretic peptide in the human forearm. J Am Heart Assoc. 2014 Aug 26;3(4):e001075. doi: 10.1161/JAHA.114.001075. | |
| 24516103 | Derived | Devin JK, Pretorius M, Nian H, Yu C, Billings FT 4th, Brown NJ. Substance P increases sympathetic activity during combined angiotensin-converting enzyme and dipeptidyl peptidase-4 inhibition. Hypertension. 2014 May;63(5):951-7. doi: 10.1161/HYPERTENSIONAHA.113.02767. Epub 2014 Feb 10. |
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44 participants were enrolled in this study (23 in Group 1 and 21 in Group 2) and completed screening procedures. Twelve of 23 participants met inclusion and exclusion criteria and completed all study-related procedures in Group 1. Seventeen of 21 participants met inclusion/exclusion criteria and completed all study-related procedures in Group 2.
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| ID | Title | Description |
|---|---|---|
| FG000 | Placebo Then Sitagliptin (DPP4 Inhibibition)=Group 1 | Participants first received Placebo then Sitagliptin 200 mg by mouth one time on each of two study days. Two weeks separated each study day. Each study day examined the effect of vehicle and enalaprilat on the forearm blood flow and tPA responses to bradykinin and substance P. |
| FG001 | Sitagliptin (DPP4 Inhibition) Then Placebo=Group 1 | Participants first received Sitagliptin 200 mg then Placebo by mouth one time on each of two study days. Two weeks separated each study day. Each study day examined the effect of vehicle and enalaprilat on the forearm blood flow and tPA responses to bradykinin and substance P. |
| FG002 | Placebo Then Sitagliptin (DPP4 Inhibition)=Group 2 | Participants first received Placebo then Sitagliptin 200 mg by mouth one time on each of two study days. Two weeks separated each study day. Each study day examined the forearm blood flow and tPA responses to brain natriuretic peptide (BNP) and glucagon-like receptor 1 (GLP-1). |
| FG003 | Sitagliptin (DPP4 Inhibition) Then Placebo = Group 2 | Participants first received Sitagliptin 200 mg then Placebo by mouth one time on each of two study days. Two weeks separated each study day. Each study day examined the forearm blood flow and tPA responses to brain natriuretic peptide (BNP) and glucagon-like receptor 1 (GLP-1). |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
This population represents the 29 participants (12 in Group 1; 17 in Group 2) who passed screening and completed at least one study arm. 1 subject did not complete the 2nd arm in Group 1. 4 subjects did not complete the second arm in Group 2. Results and baseline characteristics are presented inclusive of these patients.
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| ID | Title | Description |
|---|---|---|
| BG000 | Group 1 | Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effects of vehicle and enalaprilat on forearm blood flow and tPA responses to bradykinin and substance P were studied. |
| BG001 | Group 2 |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | The Effect of Enalaprilat (ACE Inhibition), Sitagliptin (DPP4 Inhibition), or the Combination on the Vasodilator Response (Forearm Blood Flow) to Substance P (SP) and Bradykinin (Group 1) or Glucagon Like Peptide-1 and Brain Naturetic Peptide (Group 2). | Forearm blood flow (FBF) was measured by strain gauge plethysmography at the completion of each dose of intra-arterial peptide. A dose response curve was therefore constructed for each vasoactive peptide substrate. The effect of sitagliptin (DPP4 inhibition) vs. placebo and enalaprilat (ACE inhibition) vs. vehicle on the forearm blood flow response to each peptide could then be determined. | In Group 1: Peptide 1=Max dose Bradykinin; Peptide 2=Substance P (SP) In Group 2: Peptide 1=GLP-1; Peptide 2=BNP (FBF expressed as percent change for both peptides) ACE inhibition=enalaprilat DPP4 inhibition=sitagliptin | Posted | Mean | 95% Confidence Interval | estimate of difference(ml/min/100ml FBF) | 60 minutes post-placebo or sitagliptin (DPP4 inhibition) and over last 2 minutes of each 5 min infusion per peptide dose (30 min washout between peptides); sequence repeated with enalaprilat (ACE inhibition) or vehicle |
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1 Subject (Group 1) did not complete sitagliptin arm due to inability to establish arterial access.
1 Subject (Group 2) did not complete placebo arm because the Investigator withdrew them after Serious Adverse Event.
3 Subjects (Group 2) did not complete the sitagliptin arm due to inability to establish arterial access during the sitagliptin arm.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1 (Placebo Arm) | Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effects of vehicle and enalaprilat on forearm blood flow and tPA responses to bradykinin and substance P were studied. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Orthostasis with Syncopal Event | Blood and lymphatic system disorders | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Swelling of instrumented arm | Blood and lymphatic system disorders | Non-systematic Assessment | One woman experienced angioedema of the instrumented forearm after infusion of bradykinin and substance P on the sitagliptin treatment day. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Nancy J. Brown | Department of Medicine Vanderbilt University Medical Center | 615-343-8701 | nancy.j.brown@vanderbilt.edu |
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| ID | Term |
|---|---|
| D006973 | Hypertension |
| D003924 | Diabetes Mellitus, Type 2 |
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
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| ID | Term |
|---|---|
| D000068900 | Sitagliptin Phosphate |
| D054873 | Dipeptidyl-Peptidase IV Inhibitors |
| D013373 | Substance P |
| D001920 | Bradykinin |
| D015773 | Enalaprilat |
| D000806 | Angiotensin-Converting Enzyme Inhibitors |
| D052216 | Glucagon-Like Peptide 1 |
| D020097 | Natriuretic Peptide, Brain |
| ID | Term |
|---|---|
| D014230 | Triazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
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|
|
| Substance P, | Drug | Substance P intra-brachial artery (2,4,8 pmol/min) |
|
| bradykinin | Drug | bradykinin intra-brachial artery (23.6, 47.2, and 94.3 pmol/min) |
|
| enalaprilat (ACE inhibitor) | Drug | intra-brachial artery(0.33 µg/min per 100 mL forearm volume) |
|
|
| Glucagon-like peptide 1 | Drug | intra-brachial artery (0.45-3.60 pmol/min) |
|
|
| brain natriuretic peptide | Drug | Intra-brachial artery (0.90, 1.80 and 3.6 pmol/min) |
|
|
| Assess Effect of ACE and/or DPP4 Inhibition on Heart Rate Response to Substance P (SP) | Heart rate was measured every 5 minutes throughout the study day (and thus during each dose of peptide infusion) |
| Effect of Treatment (ACE or DPP4 Inhibition, or Combined) on Norepinephrine (NE) Release (Arterial Venous Gradient) in Response to Substance P (SP) | Blood for analysis of norepinephrine (NE) release was obtained 60 minutes after sitagliptin (DPP4 inhibition) vs. placebo and after each assessment of FBF (see primary outcome measure) |
| Effect of Treatment (DPP4 Inhibition vs. Placebo) on Venous GLP-1 Levels in Response to Arterial GLP-1 Infusion | Blood for analysis of GLP-1 levels was obtained one hour after sitagliptin (DPP4 inhibition) vs. placebo administration and after each dose of GLP-1 |
| Adverse Event |
|
Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effect of brain natriuretic peptide and glucagon like receptor-1 (GLP-1) on forearm blood flow and tPA release was studied. |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| ID |
|---|
| Title |
|---|
| Description |
|---|
| OG000 | Group 1 | Participants were randomized to sitagliptin 200 mg (DPP4 inhibitor) vs. placebo on each of two study days. On each study day, the effects of vehicle and enalaprilat (ACE inhibitor) on forearm blood flow and tPA responses to bradykinin (peptide 1) and substance P (SP) (peptide 2) were studied. |
| OG001 | Group 2 | Participants were randomized to sitagliptin 200 mg (DPP4 inhibitor) vs. placebo on each of two study days. On each study day, the effect of study drug on FBF response to glucagon like peptide-1 (peptide 1) and brain natriuretic peptide (peptide 2) was studied. |
|
|
|
| Secondary | Assess Tissue Type Plasminogen Activator (tPA) Release | Following measurement of FBF, samples will be obtained to determine the effect of ACE inhibition and/or DPP4 inhibition on tPA release in response to bradykinin and substance P (SP) (group 1) | Posted | Number | 95% Confidence Interval | estimate of difference (ng/min/100mL) | Blood for analysis of tPA release was obtained 60 minutes after sitagliptin (DPP4 inhibition) vs. placebo and after each assessment of FBF (see primary outcome measure) |
|
|
|
|
| Secondary | Assess Effect of ACE and/or DPP4 Inhibition on Heart Rate Response to Substance P (SP) | Posted | Mean | Standard Error | beats per minute | Heart rate was measured every 5 minutes throughout the study day (and thus during each dose of peptide infusion) |
|
|
|
|
| Secondary | Effect of Treatment (ACE or DPP4 Inhibition, or Combined) on Norepinephrine (NE) Release (Arterial Venous Gradient) in Response to Substance P (SP) | Posted | Mean | Standard Error | pg/mL | Blood for analysis of norepinephrine (NE) release was obtained 60 minutes after sitagliptin (DPP4 inhibition) vs. placebo and after each assessment of FBF (see primary outcome measure) |
|
|
|
|
| Secondary | Effect of Treatment (DPP4 Inhibition vs. Placebo) on Venous GLP-1 Levels in Response to Arterial GLP-1 Infusion | Posted | Mean | Standard Error | pmol/L | Blood for analysis of GLP-1 levels was obtained one hour after sitagliptin (DPP4 inhibition) vs. placebo administration and after each dose of GLP-1 |
|
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|
|
| 0 |
| 12 |
| 3 |
| 12 |
| EG001 | Group 1 (Sitagliptin Arm) | Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effects of vehicle and enalaprilat on forearm blood flow and tPA responses to bradykinin and substance P were studied. | 0 | 11 | 2 | 11 |
| EG002 | Group 2 (Placebo Arm) | Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effect of brain natriuretic peptide and glucagon like receptor-1 (GLP-1) on forearm blood flow and tPA release was studied. | 0 | 16 | 3 | 16 |
| EG003 | Group 2 (Sitagliptin Arm) | Participants were randomized to sitagliptin 200 mg vs. placebo on each of two study days. On each study day, the effect of brain natriuretic peptide and glucagon like receptor-1 (GLP-1) on forearm blood flow and tPA release was studied. | 1 | 14 | 1 | 14 |
|
| Transient Lightheadedness | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Nephrolithiasis | Renal and urinary disorders | Non-systematic Assessment | Within 2 weeks of completion of first study day. |
|
| Neuropraxia in the instrumented arm | Nervous system disorders | Non-systematic Assessment | Resolved over 2 weeks without therapy. |
|
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| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D011719 |
| Pyrazines |
| D011480 | Protease Inhibitors |
| D004791 | Enzyme Inhibitors |
| D045504 | Molecular Mechanisms of Pharmacological Action |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
| D007004 | Hypoglycemic Agents |
| D045505 | Physiological Effects of Drugs |
| D015320 | Tachykinins |
| D007705 | Kinins |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D009479 | Neuropeptides |
| D009842 | Oligopeptides |
| D011506 | Proteins |
| D009419 | Nerve Tissue Proteins |
| D012898 | Autacoids |
| D018836 | Inflammation Mediators |
| D001685 | Biological Factors |
| D004656 | Enalapril |
| D004151 | Dipeptides |
| D004763 | Glucagon-Like Peptides |
| D052336 | Proglucagon |
| D005768 | Gastrointestinal Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
| D045265 | Natriuretic Peptides |
| D036361 | Peptide Hormones |
| Effect of ACE/DPP4 inhibitio on bradykinin tPA |
|
| effect ace/dpp4 vs. aceinhibi on bradykinin tpa |
|
| effect ace/dpp4 vs. dpp4inhib on bradykinin tpa |
|
| Effect of ACE inhibition on SP tPA release |
|
| Effect of DPP4 inhibition on SP tPA |
|
| Effect of ACE+DPP4 inhibition on SP tPA |
|
| effect ace/dpp4 vs. aceinhibi on SP tpa |
|
| effect ace/dpp4 vs. dpp4inhibi on SP tpa |
|
|
| Pulse change after SP w/ACE+DPP4inhibition |
|
|
| Change NE AV with SP after ACE+DPPinhibition |
|
| 0.007 |
Effect of combined DPP4 and ACE inhibition on the change in the norepinephrine AV gradient during substance P as compared to treatment with ACE inhibition alone (p=0.007). |
| 2-Sided |
| No |
| Superiority or Other |
|
| Venous GLP-1 levels Max Dose GLP-1 (DPP4inhibiton) |
|
| 0.01 |
Effect of intra-arterial GLP-1 on venous GLP-1 concentrations during sitagliptin (p=0.01). |
| 2-Sided |
| No |
| Superiority or Other |
| Wilcoxon signed rank | 0.04 | Effect of DPP4 inhibition on venous GLP-1 levels at high dose of intra-arterial GLP-1 (p=0.04 vs. placebo). | 2-Sided | No | Superiority or Other |