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Patients suffering from the metabolic myopathy Glycogen Storage Disease type IIIa (GSDIIIa) have a problem releasing sugar stored in cells that is needed for energy production. This causes several systemic impairments, but only recently have the exercise-related symptoms in the muscles been examined. A previous study showed signs that intravenous infusion of glucose relieves some of these symptoms. The purpose of this study is to investigate in a randomized and placebo-controlled fashion whether oral ingestion of sugar can alleviate muscular symptoms in patients with GSDIIIa.
It has recently been documented how patients with GSDIIIa have a moderate to severely reduced exercise capacity, and that exercise induces muscle pain and cramps. These symptoms are caused by the inability to mobilize skeletal muscle glycogen and are most likely the consequence of a severe energy deficiency within muscles. The study changed the phenotype of GSDIIIa, to include exercise-induced symptoms, which is a typical presentation in other metabolic myopathies. It also documented that exercise capacity was significantly improved while exercise-induced muscular symptoms were relieved by an intravenous glucose infusion. Based on these findings, this study wishes to investigate if oral ingestion of sucrose has the same effects on work capacity on a larger number of patients, in a randomized, placebo-controlled, cross-over setup. Ingestion of sucrose has the potential to be an effective, cheap and easily accessible dietary treatment of muscular symptoms in GSDIIIa.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FAXE Kondi - a sugary soft-drink | Experimental | 100 ml FAXE Kondi (10 grams of carbohydrates per 100 ml) is ingested every ten minutes during exercise plus 400 ml before exercise start. |
|
| FAXE Kondi Free - a sugarfree soft-drink | Placebo Comparator | 100 ml FAXE Kondi Free (0 grams of carbohydrates per 100 ml) is ingested every ten minutes during exercise plus 400 ml before exercise start. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FAXE Kondi | Dietary Supplement | Sucrose and glucose containing softdrink |
|
| Measure | Description | Time Frame |
|---|---|---|
| maximal work capacity | Area Under the Curve (AUC) = resistance times duration of workout | After up to 1 hour of bicycling on the 2nd and 4th day. |
| Measure | Description | Time Frame |
|---|---|---|
| Peak oxygen consumption | (VO2peak) | After up to 1 hour of cycling on the 2nd and 4th day. |
| Peak workload | (Wpeak) | After up to 1 hour of cycling on the 2nd and 4th day. |
| Measure | Description | Time Frame |
|---|---|---|
| Respiratory exchange ratio, RER | VO2/VCO2 | measured continously during the exercise test day 2 and 4. |
| p-glucose | Analysis of blood sample | measured at rest and max on day 1, and before first dose of soft drink, before exercise and every 10 minutes during exercise at day 2 and 4. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Astrid E Buch, BSc Medicine | Copenhagen Neuromuscular Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Copenhagen Neuromuscular Center, department 3342, Rigshospitalet | Copenhagen | Capital Region | 2100 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20631546 | Background | Kishnani PS, Austin SL, Arn P, Bali DS, Boney A, Case LE, Chung WK, Desai DM, El-Gharbawy A, Haller R, Smit GP, Smith AD, Hobson-Webb LD, Wechsler SB, Weinstein DA, Watson MS; ACMG. Glycogen storage disease type III diagnosis and management guidelines. Genet Med. 2010 Jul;12(7):446-63. doi: 10.1097/GIM.0b013e3181e655b6. | |
| 5235982 |
| Label | URL |
|---|---|
| Scientific Committee on Food. Re-evaluation of acesulfame K with reference to the previous SCF opinion of 1991. | View source |
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| ID | Term |
|---|---|
| D006010 | Glycogen Storage Disease Type III |
| ID | Term |
|---|---|
| D006008 | Glycogen Storage Disease |
| D002239 | Carbohydrate Metabolism, Inborn Errors |
| D008661 | Metabolism, Inborn Errors |
| D030342 | Genetic Diseases, Inborn |
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| Faxe Kondi Free | Dietary Supplement | Diet softdrink with artificial sweeteners aspartame and acesulfame potassium. Both sweeteners are approved for use as food additives in the European Union and by the FDA. Aspartame metabolism is well understood and normal doses does not affect plasma concentrations of lipids, amino acids, glucose levels, key regulatory hormones or skeletal muscle metabolism. Acesulfame Potassium is not metabolized in humans and is excreted as the parent compound in urine. Since the two artificial sweeteners does not affect skeletal muscle metabolism or blood glucose levels, and both compounds have a well documented safety profiles, FAXE Kondi Free is considered to be an ideal placebo soft drink in this study. |
|
| Peak respiratory exchange ratio | (RER) | After up to 1 hour of cycling on the 2nd and 4th day. |
| p-lactate | Analysis of blood sample | measured at rest and max on day 1, and before first dose of soft drink, before exercise and every 10 minutes during exercise at day 2 and 4. |
| Heart rate | pulsemonitoring | Continously during the cycle test (max. 1 hour) on the 2nd and 4th day |
| Borg score | Rate of percieved exertion | Measured periodically during the cycle test (max. 1 hour) on the 2nd and 4th day |
| Pain | Pain assessed on a visual analog scale (VAS) with a scale of 0 to 10 cm | Assessed on days 3 and 5 of the trial |
| Fatigue | Fatigue Severity Score (FSS) | Assessed on days 3 and 5 of the trial |
| p-Creatine kinase | To asses muscle damage | measured on day 1, 3 and 5. |
| p-myoglobin | To asses muscle damage | measured on day 1, 3 and 5. |
| p-ammonia | Analysis of blood sample | measured at rest and max on day 1, and before exercise, at 10 minutes, 20 min of exercise and at max on day 2 and 4. |
| p-insulin | analysis of blood sample | measured at rest and max on day 1 and before exercise and every 10 minutes during exercise at day 2 and 4. |
| p-glucagon | analysis of blood sample | measured at rest and max on day 1, and before exercise, at 10 minutes, 20 min of exercise and at max on day 2 and 4. |
| p-catecholamines | analysis of blood sample | measured at rest and max on day 1, and before exercise, at 10 minutes, 20 min of exercise and at max on day 2 and 4. |
| Hypoglycemic episodes | Clinical observation as well as blood glucose levels monitored during exercise tests | 2 hour observation after each of the two exercise test. |
| Van Hoof F, Hers HG. The subgroups of type 3 glycogenosis. Eur J Biochem. 1967 Oct;2(3):265-70. doi: 10.1111/j.1432-1033.1967.tb00134.x. No abstract available. |
| 1580445 | Background | Coleman RA, Winter HS, Wolf B, Gilchrist JM, Chen YT. Glycogen storage disease type III (glycogen debranching enzyme deficiency): correlation of biochemical defects with myopathy and cardiomyopathy. Ann Intern Med. 1992 Jun 1;116(11):896-900. doi: 10.7326/0003-4819-116-11-896. |
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| 23891579 | Background | Marinovich M, Galli CL, Bosetti C, Gallus S, La Vecchia C. Aspartame, low-calorie sweeteners and disease: regulatory safety and epidemiological issues. Food Chem Toxicol. 2013 Oct;60:109-15. doi: 10.1016/j.fct.2013.07.040. Epub 2013 Jul 23. |
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| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |