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The investigators propose a pilot randomized trial to gather preliminary data to test the hypothesis that Fisetin will reduce abundance of senescent cells in blood, skeletal muscle, and both subcutaneous and inter muscular adipose tissue and improve 6-minute walk distance in 34 people with peripheral artery disease (PAD). the investigators will determine whether greater declines in abundance of cells with senescent markers are associated with greater improvement in 6-minute walk distance in people with peripheral artery disease. In exploratory analyses, the investigators will assess whether Fisetin reduces interleukin-6 (IL-6) and novel senescent markers in adipose tissue, muscle, and/or blood.
Fisetin is a flavanol, present in strawberries, apples, and persimmons, that destroys senescent cells (i.e. a senolytic therapy). Of three senolytic therapies being tested in clinical trials, Fisetin has the best safety profile. Hence, the investigators propose a pilot randomized trial to gather preliminary data to test the hypothesis that Fisetin will reduce abundance of senescent cells in blood, skeletal muscle, and both subcutaneous and inter muscular adipose tissue and improve 6-minute walk distance in 34 people with PAD. The investigators will determine whether greater declines in abundance of cells with senescent markers are associated with greater improvement in 6-minute walk distance in people with PAD. In exploratory analyses, the investigators will assess whether Fisetin reduces IL-6 and novel senescent markers in adipose tissue, muscle, and/or blood.
To achieve the trial's specific aims, investigators will randomize 34 participants age 50 and older with PAD to one of two groups: Fisetin vs placebo. Participants will be followed for four months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Fisetin | Experimental | Sharp Clinical Services will provide fisetin (100 mg capsules). Randomized participants will receive fisetin 20 mgs/kg once daily for two days, followed by 12 days without therapy. Fisetin will be dosed in 100 mg tablets. Dosing will be rounded to the nearest 100 mg. For example, a 73 kg participant with a dose of 1,460 mg (i.e.73 kg x 20 mg) receives 1,500 mgs daily (i.e. 15 x 100 mg capsules) for two days every 14 days. |
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| Placebo | Placebo Comparator | Sharp Clinical Services will provide placebo (100 mg capsules). Randomized participants will receive placebo 20 mgs/kg once daily for two days, followed by 12 days without therapy. Placebo will be dosed in 100 mg tablets. Dosing will be rounded to the nearest 100 mg. For example, a 73 kg participant with a dose of 1,460 mg (i.e.73 kg x 20 mg) receives 1,500 mgs daily (i.e. 15 x 100 mg capsules) for two days every 14 days. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Fisetin | Drug | Fisetin is a flavanol, present in strawberries, apples, and persimmons, that destroys senescent cells (i.e. a senolytic therapy). Of three senolytic therapies being tested in clinical trials, fisetin has the best safety profile. |
| Measure | Description | Time Frame |
|---|---|---|
| Six-minute Walk Distance | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin improves six-minute walk distance at 4-month follow-up | Measured at baseline and 4 month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Hand Grip Strength | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin improves hand grip strength at 4-month follow-up. readouts. | Measured at baseline and 4 months |
| Short physical performance battery (SPPB) |
| Measure | Description | Time Frame |
|---|---|---|
| Abundance of oxylipin dihomo-15d-PGJ2 | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin changes abundance of oxylipin dihomo-15d-PGJ2 in blood at 4-month follow-up. | Measured at baseline and 4 months |
| Abundance of interleukin-6 markers |
Inclusion Criteria:
First, all participants will be age 50 and older. Second, all participants will have PAD. PAD will be defined as:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mary McDermott, MD | Contact | 312-503-6419 | mdm608@northwestern.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Northwestern University Feinberg School of Medicine | Recruiting | Chicago | Illinois | 60611-3008 | United States |
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| ID | Term |
|---|---|
| D058729 | Peripheral Arterial Disease |
| D016491 | Peripheral Vascular Diseases |
| D051346 | Mobility Limitation |
| D007383 | Intermittent Claudication |
| ID | Term |
|---|---|
| D050197 | Atherosclerosis |
| D001161 | Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
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| ID | Term |
|---|---|
| C017875 | fisetin |
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To achieve the trial's specific aims, the investigators will randomize 34 participants age 50 and older with PAD to one of two groups: Fisetin vs placebo. Participants will be followed for four months
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This will be a double blinded study where both the participant and the investigators collecting data will be blinded.
| Placebo | Drug | The placebo will be matched to the Fisetin intervention |
|
Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin improves the short physical performance battery (SPPB) at 4-month follow-up. SPPB range, range 0-12, 12-best |
| Measured at baseline and 4 months |
| Number of cells with senescence markers | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin decreases cells with senescence markers in lower extremity adipose tissue, blood (CD3+ T lymphocytes), and gastrocnemius muscle at 4-month follow-up. | Measured at baseline and 4 months |
| Gastrocnemius perfusion | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin improves gastrocnemius perfusion at 4-month follow-up. The investigators will use arterial spin labeling with magnetic resonance imaging (MRI) and post-cuff occlusion hyperemia to measure changes in calf perfusion at 3 Tesla. MRI perfusion will be measured using cuff occlusion hyperemia while the participant is supine. Gastrocnemius perfusion will be measured in ml/minute per 100g of tissue. | Measured at baseline and 4 months |
Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin changes abundance of interleukin-6 (IL-6) markers in blood at 4-month follow-up. Quantitative reverse transcription-PCR (qRT-PCR) will be performed by Dr. Peterson's lab for RNA encoding IL-6 markers in adipose tissue, including interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), IL-1α, growth differentiation factor 15, and IL-6. Abundance of IL-6 markers will be measured in units of pg/mL. |
| Measured at baseline and 4 months |
| Gastrocnemius muscle fibrosis | Among older people with PAD, the investigators will determine whether reduced senescent cell abundance and whether reduced IL-6 factor abundance in blood, gastrocnemius muscle, and adipose tissue, respectively, are correlated with reduced gastrocnemius muscle fibrosis at 4-month follow up. Antibodies to collagen I and III will quantify extracellular matrix composition. Picrosirius Red histochemistry will quantify total fibrous collagen, with polarized light to assess collagen organization. | Measured at baseline and 4 months |
| Gastrocnemius muscle collagen | Among older people with PAD, the investigators will determine whether reduced senescent cell abundance and whether reduced IL-6 factor abundance in blood, gastrocnemius muscle, and adipose tissue, respectively, are correlated with reduced gastrocnemius muscle collagen at 4-month follow up. Antibodies to collagen I and III will quantify extracellular matrix composition. Picrosirius Red histochemistry will quantify total fibrous collagen, with polarized light to assess collagen organization. | Measured at baseline and 4 months |
| Abundance of cells with increased myofiber size | Among older people with PAD, the investigators will determine whether reduced senescent cell abundance and whether reduced IL-6 factor abundance in blood, gastrocnemius muscle, and adipose tissue, respectively, are correlated with a reduced abundance of cells with increased myofiber size at 4-month follow up. Muscle fiber cross-sectional area will be quantified and 4',6-diamidino-2-phenylindole (DAPI) staining performed for centrally nucleated fibers, a marker of ischemic injury/regeneration. | Measured at baseline and 4 months |
| Abundance of cells with central nuclei | Among older people with PAD, the investigators will determine whether reduced senescent cell abundance and whether reduced IL-6 factor abundance in blood, gastrocnemius muscle, and adipose tissue, respectively, are correlated with a reduced abundance of cells with central nuclei at 4-month follow up. Muscle fiber cross-sectional area will be quantified and DAPI staining performed for centrally nucleated fibers, a marker of ischemic injury/regeneration. | Measured at baseline and 4 months |
| Interleukin-6 mRNA abundance | Among older people with PAD, the investigators will determine whether, compared to placebo, fisetin changes IL-6 mRNA abundance in gastrocnemius muscle and lower extremity adipose tissue at 4-month follow-up. qRT-PCR will quantify IL-6 mRNAs as described for fat tissue | Measured at baseline and 4 months |
| D002318 |
| Cardiovascular Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |