## Protocol Section
### Identification Module
**NCT ID:** NCT04259879

**Brief Title:** Molecular Pathways Related to Short-term Fasting Response

**Official Title:** Evaluation of p21 Induction and Molecular Pathways Related to Short-term Fasting Response

#### Organization Study ID Info
**ID:** IMD PI0025
#### Organization
**Class:** OTHER
**Full Name:** IMDEA Food
### Status Module
#### Completion Date
**Date:** 2016-06-15

**Type:** ACTUAL

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2020-02-17

**Type:** ACTUAL

**Last Update Submit Date:** 2020-02-12

**Overall Status:** COMPLETED

#### Primary Completion Date
**Date:** 2016-05-18

**Type:** ACTUAL

#### Start Date
**Date:** 2016-04-07

**Type:** ACTUAL

**Status Verified Date:** 2020-01

#### Study First Post Date
**Date:** 2020-02-07
**Type:** ACTUAL
**Study First Submit Date:** 2020-02-05
**Study First Submit QC Date:** 2020-02-05
### Sponsor Collaborators Module

#### Collaborators

**Class:** OTHER

**Name:** Centro Nacional de Investigaciones Oncologicas CARLOS III

#### Lead Sponsor

**Class:** OTHER

**Name:** IMDEA Food

#### Responsible Party

**Type:** SPONSOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** False

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** This study will evaluate the effect of short-term fasting (36 hours) in gene expression in blood cells in healthy volunteers.

**Detailed Description:** Fasting is a nutritional intervention consisting on the restriction of nutrient intake during a relatively long period of time. It elicits a profound metabolic reprogramming aimed at shifting nutrient supply from external food intake to internal stored nutrients. Periodic activation of this complex response, termed periodic or intermittent fasting (IF), elicits numerous protective effects against aging, metabolic alterations, neurological disorders and cardiovascular health. Short-term fasting is protective in different stress scenarios, including ischemia reperfusion, bouts of inflammation and chemotherapy-induced toxicity, and improves the anti-tumor efficacy of chemotherapy. Although the basic physiology of fasting is well known, the molecular mechanisms underlying its beneficial effects are not yet completely understood.

In mammals, the response to short-term fasting (from 12 to 48 hours) in terms of nutrient mobilization through the bloodstream has been extensively studied. Fasting follows sequential phases, during which nutrients are released from different storing depots. First, glucose is released from glycogen stores in the liver and muscle. Upon depletion of glycogen, two fasting mechanisms are activated: fatty acids are exported from the adipose tissue into the bloodstream in the form of free fatty acids (FFAs), reaching the liver where they are used to produce ketone bodies, a process termed ketogenesis. Also, gluconeogenesis is activated in the liver, generating glucose mainly from glycerol (released during lipolysis) and amino acids, that originate mainly from muscle breakdown. All these physiological responses are tightly regulated by hormonal and molecular mechanisms.

At the hormonal level, fasting induces a decrease in blood insulin, leptin and ghrelin, and an increase in glucagon levels, while blood adiponectin remains unchanged. Also, several signal transduction pathways are affected by fasting. PPARalpha, a nuclear receptor of fatty acids, becomes activated by the fasting-mediated increase in blood Free fatty Acids (FFAs) and triggers the expression of many target genes in several tissues, including blood cells. It has been shown that the Cyclin Dependent Kinase (CDK) inhibitor p21 is highly upregulated during short-term fasting in many mouse tissues. Moreover, it is known that p21-null mice are unable to endure normal periods of fasting and that p21 is required for the full activation of PPARa target genes both in vivo and in isolated hepatocytes.

In the current study, the investigators wanted to study for the first time molecular mechanisms of fasting that still remained unexplored, specially the expression induction of p21 and PPARalpha signalling pathway. For this, the investigators analyzed blood samples from healthy volunteers subjected to 36 hours of fasting, to explore gene expression in Peripheral Blood Mononuclear Cells (PBMCs).

### Conditions Module

**Conditions:**

- Fasting

**Keywords:**

- Short-term Fasting

- molecular mechanisms

- p21

- Peripheral blood mononuclear cells (PBMCs)

- PPARalpha

### Design Module

#### Design Info

**Allocation:** NA

**Intervention Model:** SINGLE_GROUP

**Intervention Model Description:** This study was an Interventional study. There were three evaluations: the basal one was an initial evaluation after overnight fasting, the second evaluation 24 hours later (36 hours fasting) and the third one 24 hours post-refeeding.

##### Masking Info

**Masking:** NONE

**Primary Purpose:** BASIC_SCIENCE

#### Enrollment Info

**Count:** 20

**Type:** ACTUAL

**Phases:**

- NA

**Study Type:** INTERVENTIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** The participants will follow a short-term fasting period for 36 hours

**Intervention Names:**

- Other: Fasting

**Label:** Fasting

**Type:** EXPERIMENTAL

### Interventions

#### Intervention 1

**Arm Group Labels:**

- Fasting

**Description:** Food intake restriction

**Name:** Fasting

**Type:** OTHER

### Outcomes Module

#### Primary Outcomes

**Description:** Expression analysis of p21, Pyruvate Dehydrogenase Kinase 4 (PDK4), Carnitine palmitoyltransferase 1 (CPT1), Adipophilin (ADFP) and Solute carrier family 25, member 50 (SLC25A50) were performed in a HT-7900 Fast Real time polymerase chain reaction (PCR). Quantifications were made applying the ΔCt method (ΔCt = \[Ct of gene of interest - Ct of housekeeping\]). The housekeeping genes used for input normalization were β-actin (ACTB) and ribosomal protein lateral stalk subunit P0 (RPLP0).

**Measure:** Changes in gene expression in PBMCs after fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

#### Secondary Outcomes

**Description:** Insulin levels (International Units per milliliter) were measured with a kit from Abbott Laboratories, by luminescent immunoassay using the Architect instrument from Abbott Laboratories.

**Measure:** Changes in Insulin levels in response to fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

**Description:** Free fatty acids levels (moles per milliliter) were evaluated with a kit from Abbott Laboratories, by enzymatic spectrophotometric assays using an Architect instrument from Abbott Laboratories.

**Measure:** Changes in Free Fatty Acids levels in response to fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

**Description:** Ketone bodies concentration (moles per milliliter) will be measured with a kit from Sigma-Aldrich, by an enzymatic spectrophotometric assay using an microplate reader from Thermo Fisher.

**Measure:** Changes ketone bodies in response to fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

**Description:** Leptin levels (nanograms per milliliter) were measured with a kit from Mercodia by a non-competitive automatic ELISA immunoanalysis

**Measure:** Changes in leptin levels in response to fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

**Description:** To evaluate lipid improvements the following measurements were considered: Triacylglycerol, Total Cholesterol, low Density Lipoprotein and High-Density Lipoprotein measured by routine laboratory (CQS, Madrid, Spain) methods.

**Measure:** Changes in lipid profile in response to fasting

**Time Frame:** Baseline, 24 hours and 48 hours later

**Description:** To evaluate the tolerance to fasting, participants will fill in a fasting tolerance test based on the symptoms they feel, this will result in a final score of tolerance to fasting.

**Measure:** Subjective evaluation of tolerance to fasting

**Time Frame:** 36 hours of fasting

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

* Men and women between 18 - 50 years old.
* BMI \>20\<30
* Adequate education level and comprehension of the clinical study
* Willingness to participate in the study as a volunteer and to provide written consent

Exclusion Criteria:

* BMI \<20 (thinness)
* BMI \>30 (obesity)
* Abnormal low glucose levels after fasting
* Having donated blood less than 8 weeks before starting the study
* Subjects who report special discomfort after previous periods of short fasting
* Diagnosis of type 2 Diabetes mellitus (insulin-dependent)
* Dyslipidemia under pharmacological treatment
* High blood pressure under pharmacological treatment
* Dementia, neurological disease or reduction of cognitive function
* Severe illness (hepatic disease, renal disease, etc
* Taking medications that could affect the lipid and glycemic profiles (statins, fibrate, diuretics, corticoids, anti-inflammatory, hypoglycemic or insulin) 30 days before the beginning of the study.
* Taking medications or substances for weight loss management (15 days before the beginning of the study)
* Pregnancy or lactation

**Healthy Volunteers:** True

**Maximum Age:** 50 Years

**Minimum Age:** 18 Years

**Sex:** ALL

**Standard Ages:**

- ADULT

### Contacts Locations Module

#### Locations

**Location 1:**

**City:** Madrid

**Country:** Spain

**Facility:** IMDEA Food

**Zip:** 28049

#### Overall Officials

**Official 1:**

**Affiliation:** IMDEA Food

**Name:** Pablo J Fernandez-Marcos, PhD

**Role:** PRINCIPAL_INVESTIGATOR

**Official 2:**

**Affiliation:** Spanish National Cancer Research Center

**Name:** Manuel Serrano Marugán, PhD

**Role:** PRINCIPAL_INVESTIGATOR

### References Module

#### References

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**PMID:** 28091348

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**PMID:** 21088487

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**PMID:** 22323820

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## Derived Section

### Misc Info Module

- Version Holder: 2024-05-24
