Mesenteric Fat Cryolipolysis to Reverse Insulin Resistance

抽象的。胰岛素抵抗、II型糖尿病、肥胖和代谢共病的患病率 综合症正在上升。超过1.2亿美国成年人患有糖尿病或患有糖尿病前期疾病。这携带着一个巨大的 财政负担，2019年估计为4040亿美元。内脏脂肪(但不是皮下脂肪) 肠系膜脂肪，被证明在胰岛素抵抗和糖尿病的病理生理学中起着重要作用。 与其他类型的细胞相比，脂肪细胞对低温更敏感。脂肪在较高的温度下凝固 温度高于水的冰点温度，形成促进细胞死亡的针状结构。 在100摄氏度的温度下，已经检测到低温(冷冻裂解)诱导脂肪细胞死亡。这 相对较高的温度使冷冻融合术成为一种诱人的方法来诱导肠系膜脂肪质量损失，因为 降低内脏肥胖症患者胰岛素抵抗和糖尿病的新治疗方法。 我们的目标是测试一种新的方法和装置的可行性和安全性，以减少 使用低温肠系膜脂肪作为逆转胰岛素抵抗和发病率的新治疗选择 糖尿病的症状。 假设：肠系膜脂肪过多是胰岛素抵抗、糖尿病、 以及代谢综合征。进入肠系膜脂肪的低温会促进脂肪细胞的损失 不损伤周围组织，无明显副作用。肠系膜脂肪的减少将 对胰岛素抵抗、糖尿病进展和代谢综合征有有益的影响。测试我们的 假设，我们提出了以下具体目标： 1A.利用基于有限元分析(FEA)的计算传热学方法模拟脂肪 不同的设备温度、形状、材料和处理时间的热循环。1B.要验证急性 用于体内慢性安全性和可行性研究的安全性和热循环(目标2)。 2.在Ossabaw猪胰岛素抵抗模型上，评价肠系膜脂肪的安全性和可行性。 冷冻溶解对胰岛素抵抗进展的影响。 里程碑：成功模拟内脏脂肪的热循环将被视为第一个里程碑。 建造冷冻裂解原型设备和在体内验证在1a计算的组织温度将是 第二个里程碑。术后7天无并发症生存将被视为第三个 这是一个里程碑。成功和安全地减少肠系膜脂肪块和逆转胰岛素进展 阻力(目标2)将是第四个里程碑。这些研究的成功完成将表明 肠系膜脂肪冻融术是治疗胰岛素抵抗的一种安全有效的方法。开发的设备，以及 所获得的结果将为优化装置设计和安全性和有效性研究利用铺平道路 设想的方案最终将在人体试验中得到翻译。

Abstract. The prevalence of insulin resistance, type II diabetes, obesity and co-morbidities of the metabolic syndrome is rising. More than 120M US adults are living with diabetes or are pre-diabetics. This carries a huge financial burden, which was estimated at ~$404B in 2019. Visceral fat (but not subcutaneous) and specifically the mesenteric fat, was shown to have a major role in the pathophysiology of insulin resistance and diabetes. Fat cells are more sensitive to low temperatures compared to any other cell type. Fat solidifies at a higher temperature than the freezing temperature of water, forming needle like structures that promote cell death. Induction of fat cell death by low temperatures (cryolipolysis) is already detected at a temperature of +100C. This relatively high temperature is making cryolipolysis an attractive approach to induce mesenteric fat mass loss as a new treatment modality to reduce Insulin resistance and diabetes in patients with visceral obesity. Our objective is to test the feasibility and safety of a novel approach and device to reduce the mass of the mesenteric fat using cold temperatures, as a new treatment option to reverse insulin resistance and the incidence of diabetes. Hypothesis: excessive mesenteric fat is a major contributor to the progression of insulin resistance, diabetes, and the metabolic syndrome. Cold temperatures delivered into the mesenteric fat will promote fat cells loss without injuring surrounding tissues and without any significant side effects. The decrease in mesenteric fat will have beneficial effects on insulin resistance, diabetes progression, and the metabolic syndrome. To test our hypothesis, we propose the following Specific Aims: 1A. To utilize computational heat transfer methods based on Finite Element Analysis (FEA) to model fat thermal cycle for different device temperatures, shapes, materials, and treatment duration. 1B. To validate acute safety and thermal cycle to be used in in-vivo chronic safety and feasibility studies (Aim 2). 2. In the Ossabaw pig model of insulin resistance, to evaluate the safety and feasibility of mesenteric fat cryolipolysis on insulin resistance progression. Milestones: Successfully modeling the thermal cycle in visceral fat will be considered as a first milestone. Building a cryolipolysis prototype device and in vivo validation of tissue temperatures calculated in 1A will be the second milestone. Seven days post-procedure survival without complications will be considered as the third milestone. Successfully and safely reducing the mesenteric fat mass and reversing the progression of insulin resistance (Aim 2) will be the fourth milestone. The successful completion of these studies will show that cryolipolysis of mesenteric fat is a safe and effective way to treat insulin resistance. The device developed, and the results obtained, will pave the way for optimal device design and safety and efficacy studies utilizing envisioned protocols to be eventually translated in human trials.