Effect of DPP4 Inhibition on Growth Hormone Secretion

Growth hormone secretion is low in patients with obesity, insulin resistance, and
hyperlipidemia. GH therapy in these populations and others has been limited by side effects
which include hyperglycemia. Another strategy to increase GH secretion is to enhance
pulsatile GH secretion by growth hormone releasing hormone. Growth hormone releasing hormone
(GHRH) has a half life of 5 minutes due to its rapid inactivation by DPP4. An alternative
strategy to increase endogenous GH secretion is by inhibiting degradation of GHRH by DPP4.
DPP4 inhibitors are currently approved therapies for the treatment of hyperglycemia in
patients with type 2 diabetes mellitus. They additionally cause blood vessel relaxation. We
therefore propose to test the hypothesis that DPP4 inhibition simultaneously enhances GH
secretion while improving blood glucoses and vascular function in patient populations with
low GH and increased cardiovascular risk. These preliminary aims serve primarily as a novel
"proof of concept" study to define the effect of acute pharmacologic DPPIV inhibition on
stimulated GH secretion.

Inclusion Criteria:

- Age 18 to 40 years inclusive

- BMI ≤ 25 kg/m2

- For female subjects:

Status-post surgical sterilization, or If of child-bearing potential, utilization of a
barrier method of birth control following negative serum pregnancy test at screening visit
and on every study day

Exclusion Criteria:

- Smoking

- Type 1 or Type 2 Diabetes Mellitus, as defined by a fasting glucose of 126 mg/dL or
greater at the time of screening visit or the use of anti-diabetic medication

- Hypertension, as defined by an untreated seated systolic blood pressure (SBP) greater
than 140 mmHg and/or an untreated diastolic blood pressure (DBP) greater than 90 mmHg
at the time of screening visit or the use of anti-hypertensive medication

- History of reported or recorded hypoglycemia (plasma glucose < 70 mg/dL)

- Pregnancy and/or Breast-Feeding

- Use of any medication other than multivitamin, including use of transdermal as well as
oral hormone replacement therapy or use of oral contraceptive therapy

- Anemia defined as hematocrit <35% at screening visit

- Cardiovascular or cerebrovascular disease, including history of myocardial infarction,
history of congestive heart failure, history of stroke

- Pulmonary Hypertension

- Abnormal thyroid hormone levels (TSH) at the time of screening visit

- Abnormal serum insulin like growth factor-1 (IGF-1) at the time of screening visit

- Impaired renal function, defined as estimated glomerular filtration rate (eGFR) <60
mL/min/1.73 m^2

- Impaired hepatic function (alanine or aspartate transaminase > 2 X upper limit of
normal range)

- Treatment with an investigational drug in the 1 month preceding the study