Development of a glucagon sensitivity test in humans: Pilot data and the GLUSENTIC study protocol

• Published in: Peptides (New York, N.Y. : 1980) Vol. 161; p. 170938
• Main Authors: Kjeldsen, Sasha A.S., Richter, Michael M., Jensen, Nicole J., Nilsson, Malin S.D., Heinz, Niklas, Nybing, Janus D., Linden, Frederik H., Høgh-Schmidt, Erik, Boesen, Mikael P., Madsbad, Sten, Vilstrup, Hendrik, Schiødt, Frank Vinholt, Møller, Andreas, Nørgaard, Kirsten, Schmidt, Signe, Rashu, Elias B., Gluud, Lise L., Haugaard, Steen B., Holst, Jens J., Rungby, Jørgen, Wewer Albrechtsen, Nicolai J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2023
• Subjects: Amino Acids; Cross-Sectional Studies; Glucagon; Glucagon - metabolism; Humans; Liver - metabolism; Metabolism; NAFLD; Non-alcoholic Fatty Liver Disease - metabolism; Study protocol; The liver-alpha cell axis; Type 1 diabetes; NAFLD; Study protocol; Glucagon; Type 1 diabetes; The liver-alpha cell axis; Amino acids; Metabolism
• ISSN: 0196-9781; 1873-5169
• DOI: 10.1016/j.peptides.2022.170938

A physiological feedback system exists between hepatocytes and the alpha cells, termed the liver-alpha cell axis and refers to the relationship between amino acid-stimulated glucagon secretion and glucagon-stimulated amino acid catabolism. Several reports indicate that non-alcoholic fatty liver disease (NAFLD) disrupts the liver-alpha cell axis, because of impaired glucagon receptor signaling (glucagon resistance). However, no experimental test exists to assess glucagon resistance in humans. The objective was to develop an experimental test to determine glucagon sensitivity with respect to amino acid and glucose metabolism in humans. The proposed glucagon sensitivity test (comprising two elements: 1) i.v. injection of 0.2 mg glucagon and 2) infusion of mixed amino acids 331 mg/hour/kg) is based on nine pilot studies which are presented. Calculation of a proposed glucagon sensitivity index with respect to amino acid catabolism is also described. Secondly, we describe a complete study protocol (GLUSENTIC) according to which the glucagon sensitivity test will be applied in a cross-sectional study currently taking place. 65 participants including 20 individuals with a BMI 18.6–25 kg/m2, 30 individuals with a BMI ≥ 25–40 kg/m2, and 15 individuals with type 1 diabetes with a BMI between 18.6 and 40 kg/m2 will be included. Participants will be grouped according to their degree of hepatic steatosis measured by whole-liver magnetic resonance imaging (MRI). The primary outcome measure will be differences in the glucagon sensitivity index between individuals with and without hepatic steatosis. Developing a glucagon sensitivity test and index may provide insight into the physiological and pathophysiological mechanism of glucagon action and glucagon-based therapies.
•A glucagon sensitivity test towards hepatic amino acid catabolism was developed.•Pilot studies leading to the final glucagon test are presented.•A novel glucagon sensitivity index is presented.•The test may be an important tool to investigate glucagon resistance.