Ignite Creation Date:
2025-12-25 @ 1:40 AM
Ignite Modification Date:
2026-03-03 @ 8:10 AM
Study NCT ID:
NCT04083794
Status:
COMPLETED
Last Update Posted:
2024-06-17
First Post:
2019-09-04
Is NOT Gene Therapy:
True
Has Adverse Events:
True
Brief Title:
Exploration of Blood Flow Regulation to Bone in Humans
Sponsor:
Organization:
Raw JSON
{'hasResults': True, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D013119', 'term': 'Spinal Cord Injuries'}], 'ancestors': [{'id': 'D013118', 'term': 'Spinal Cord Diseases'}, {'id': 'D002493', 'term': 'Central Nervous System Diseases'}, {'id': 'D009422', 'term': 'Nervous System Diseases'}, {'id': 'D020196', 'term': 'Trauma, Nervous System'}, {'id': 'D014947', 'term': 'Wounds and Injuries'}]}, 'interventionBrowseModule': {'meshes': [{'id': 'D018475', 'term': 'Head-Down Tilt'}], 'ancestors': [{'id': 'D011187', 'term': 'Posture'}, {'id': 'D009142', 'term': 'Musculoskeletal Physiological Phenomena'}, {'id': 'D055687', 'term': 'Musculoskeletal and Neural Physiological Phenomena'}]}}, 'resultsSection': {'moreInfoModule': {'pointOfContact': {'email': 'adraghici@mgh.harvard.edu', 'phone': '617-758-5508', 'title': 'Dr. Adina E. Draghici', 'organization': 'Spaulding Rehabilitation Hospital Cambridge'}, 'certainAgreement': {'piSponsorEmployee': True}, 'limitationsAndCaveats': {'description': 'This represented an exploratory study of physiological mechanisms underlying bone blood flow regulation in humans. Given the exploratory nature of this work, several technical challenges resulted in unreliable or uninterpretable data which was not included in the final results reported. Technical difficulties included motion artifacts for total hemoglobin measurements, spasticity in adults with spinal cord injury, and inability to perform certain physiological stimuli.'}}, 'adverseEventsModule': {'timeFrame': 'Adverse Events Time Frame - 1 week following study completion.', 'eventGroups': [{'id': 'EG000', 'title': 'Laboratory Based Assessments', 'description': 'The current study has no arms; it is a cross-sectional assessment where all participants will undergo the same procedures.\n\nLaboratory based assessments: physical maneuvers to assess physiological responses in bone blood flow', 'otherNumAtRisk': 81, 'deathsNumAtRisk': 81, 'otherNumAffected': 0, 'seriousNumAtRisk': 81, 'deathsNumAffected': 0, 'seriousNumAffected': 0}], 'frequencyThreshold': '0'}, 'outcomeMeasuresModule': {'outcomeMeasures': [{'type': 'PRIMARY', 'title': 'Tibial Blood Perfusion', 'denoms': [{'units': 'Participants', 'counts': [{'value': '81', 'groupId': 'OG000'}]}], 'groups': [{'id': 'OG000', 'title': 'Laboratory Based Assessments', 'description': 'The current study has no arms; it is a cross-sectional assessment where all participants will undergo the same procedures.\n\nLaboratory based assessments: physical maneuvers to assess physiological responses in bone blood flow'}], 'classes': [{'title': 'Spinal Cord Injury: Isometric handgrip exercise - maximum tibial total hemoglobin (N=14 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '0.54', 'spread': '1.66', 'groupId': 'OG000'}]}]}, {'title': 'Uninjured controls: Isometric handgrip exercise - maximum tibial total hemoglobin (N=13 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '13', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '-1.47', 'spread': '3.86', 'groupId': 'OG000'}]}]}, {'title': 'Uninjured controls: Cold pressor test - maximum tibial total hemoglobin (N=13 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '13', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '0.43', 'spread': '2.18', 'groupId': 'OG000'}]}]}, {'title': 'Uninjured controls: Nitroglycerin response - maximum tibial total hemoglobin(N=16 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '16', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '2.08', 'spread': '0.88', 'groupId': 'OG000'}]}]}, {'title': 'Uninjured controls: Reactive hyperemia - maximum tibial total hemoglobin (N=11 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '11', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '3.42', 'spread': '2.06', 'groupId': 'OG000'}]}]}, {'title': 'Uninjured controls: Leg dependency - tibial total hemoglobin (N=14 analyzed)', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'OG000'}]}], 'categories': [{'measurements': [{'value': '1.55', 'spread': '8.55', 'groupId': 'OG000'}]}]}], 'paramType': 'MEAN', 'timeFrame': '1 day', 'description': 'Concentration of hemoglobin content assessed in response to several physical maneuvers (isometric handgrip exercise, cold pressor test, nitroglycerin, reactive hyperemia, leg dependency). Results are reported in tibial total hemoglobin content (μM). To date there are no absolute established values of tibial bone hemoglobin content and thus an absolute range (minimum and maximum) cannot be provided.', 'unitOfMeasure': 'μM (concentration)', 'dispersionType': 'Standard Deviation', 'reportingStatus': 'POSTED', 'populationDescription': '81 participants include 67 controls and 14 SCI across 2 protocols. Thus, most individuals completed only a subset of the total physiological maneuvers.\n\nAfter quality control, unusable data was discarded and outcome measures are reported only in the subgroup of individuals (# of participants analyzed for each group included for each test below) analyzed with appropriate data. Reasons for unusable data: spasticity (SCI), unable to complete certain physiological stimuli, motion artifacts.'}]}, 'participantFlowModule': {'groups': [{'id': 'FG000', 'title': 'Laboratory Based Assessments', 'description': 'The current study has no arms; it is a cross-sectional assessment where all participants will undergo the same procedures.\n\nLaboratory based assessments: physical maneuvers to assess physiological responses in bone blood flow'}], 'periods': [{'title': 'Overall Study', 'milestones': [{'type': 'STARTED', 'achievements': [{'comment': 'Note that the current study as initially approved by the local MGB IRB was not a clinical trial. Once the study was funded, the funding agency NIH/NIAMS requested that the study be designed and registered as a clinical trial. Thus, the initial start date (5/31/2018) was considered the start date of the first enrollment under the approved IRB and not just for the participants enrolled under the NIAMS funding. The date was changed in the protocol section to reflect first enrollment (5/31/2018).', 'groupId': 'FG000', 'numSubjects': '90'}]}, {'type': 'COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '81'}]}, {'type': 'NOT COMPLETED', 'achievements': [{'groupId': 'FG000', 'numSubjects': '9'}]}], 'dropWithdraws': [{'type': 'Lost to Follow-up', 'reasons': [{'groupId': 'FG000', 'numSubjects': '9'}]}]}], 'preAssignmentDetails': 'The current study does not assign participants to arms; it is a cross-sectional assessment where all participants will undergo the same procedures. Upon enrollment, all participants underwent laboratory based assessments.'}, 'baselineCharacteristicsModule': {'denoms': [{'units': 'Participants', 'counts': [{'value': '81', 'groupId': 'BG000'}]}], 'groups': [{'id': 'BG000', 'title': 'Laboratory Based Assessments', 'description': 'The current study has no arms; it is a cross-sectional assessment where all participants will undergo the same procedures.\n\nLaboratory based assessments: this is a cross-sectional study including physical maneuvers to assess physiological responses in bone blood flow in young healthy adults and adults with spinal cord injury.'}], 'measures': [{'title': 'Age, Categorical', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '67', 'groupId': 'BG000'}]}], 'categories': [{'title': '<=18 years', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}, {'title': 'Between 18 and 65 years', 'measurements': [{'value': '67', 'groupId': 'BG000'}]}, {'title': '>=65 years', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injury individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'BG000'}]}], 'categories': [{'title': '<=18 years', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}, {'title': 'Between 18 and 65 years', 'measurements': [{'value': '14', 'groupId': 'BG000'}]}, {'title': '>=65 years', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants', 'populationDescription': 'Overall number (81) includes both uninjured controls (67) and spinal cord injured individuals (14)'}, {'title': 'Sex: Female, Male', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '67', 'groupId': 'BG000'}]}], 'categories': [{'title': 'Female', 'measurements': [{'value': '30', 'groupId': 'BG000'}]}, {'title': 'Male', 'measurements': [{'value': '37', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injury individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'BG000'}]}], 'categories': [{'title': 'Female', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'Male', 'measurements': [{'value': '13', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants', 'populationDescription': 'The overall number (81) includes both uninjured controls (67) and spinal cord injured individuals (14).'}, {'title': 'Ethnicity (NIH/OMB)', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '67', 'groupId': 'BG000'}]}], 'categories': [{'title': 'Hispanic or Latino', 'measurements': [{'value': '5', 'groupId': 'BG000'}]}, {'title': 'Not Hispanic or Latino', 'measurements': [{'value': '60', 'groupId': 'BG000'}]}, {'title': 'Unknown or Not Reported', 'measurements': [{'value': '2', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injured individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'BG000'}]}], 'categories': [{'title': 'Hispanic or Latino', 'measurements': [{'value': '2', 'groupId': 'BG000'}]}, {'title': 'Not Hispanic or Latino', 'measurements': [{'value': '11', 'groupId': 'BG000'}]}, {'title': 'Unknown or Not Reported', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants', 'populationDescription': 'The overall number (81) includes uninjured controls (67) and spinal cord injured individuals (14).'}, {'title': 'Race (NIH/OMB)', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '67', 'groupId': 'BG000'}]}], 'categories': [{'title': 'American Indian or Alaska Native', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'Asian', 'measurements': [{'value': '7', 'groupId': 'BG000'}]}, {'title': 'Native Hawaiian or Other Pacific Islander', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}, {'title': 'Black or African American', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'White', 'measurements': [{'value': '50', 'groupId': 'BG000'}]}, {'title': 'More than one race', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'Unknown or Not Reported', 'measurements': [{'value': '7', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injured individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'BG000'}]}], 'categories': [{'title': 'American Indian or Alaska Native', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}, {'title': 'Asian', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'Native Hawaiian or Other Pacific Islander', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}, {'title': 'Black or African American', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'White', 'measurements': [{'value': '11', 'groupId': 'BG000'}]}, {'title': 'More than one race', 'measurements': [{'value': '1', 'groupId': 'BG000'}]}, {'title': 'Unknown or Not Reported', 'measurements': [{'value': '0', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants', 'populationDescription': 'The overall number (81) includes uninjured controls (67) and spinal cord injured individuals (14).'}, {'title': 'Region of Enrollment', 'classes': [{'title': 'United States', 'denoms': [{'units': 'Participants', 'counts': [{'value': '81', 'groupId': 'BG000'}]}], 'categories': [{'title': 'Uninjured controls', 'measurements': [{'value': '67', 'groupId': 'BG000'}]}, {'title': 'Spinal cord injury individuals', 'measurements': [{'value': '14', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants'}, {'title': 'Population', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '81', 'groupId': 'BG000'}]}], 'categories': [{'measurements': [{'value': '67', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injury individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '81', 'groupId': 'BG000'}]}], 'categories': [{'measurements': [{'value': '14', 'groupId': 'BG000'}]}]}], 'paramType': 'COUNT_OF_PARTICIPANTS', 'unitOfMeasure': 'Participants'}, {'title': 'Body Mass Index', 'classes': [{'title': 'Uninjured controls', 'denoms': [{'units': 'Participants', 'counts': [{'value': '67', 'groupId': 'BG000'}]}], 'categories': [{'measurements': [{'value': '23.1', 'spread': '2.9', 'groupId': 'BG000'}]}]}, {'title': 'Spinal cord injury individuals', 'denoms': [{'units': 'Participants', 'counts': [{'value': '14', 'groupId': 'BG000'}]}], 'categories': [{'measurements': [{'value': '23.6', 'spread': '2.5', 'groupId': 'BG000'}]}]}], 'paramType': 'MEAN', 'unitOfMeasure': 'kg/m^2', 'dispersionType': 'STANDARD_DEVIATION', 'populationDescription': 'The overall number (81) includes uninjured controls (67) and spinal cord injured individuals (14).'}]}}, 'documentSection': {'largeDocumentModule': {'largeDocs': [{'date': '2022-05-24', 'size': 442332, 'label': 'Study Protocol and Statistical Analysis Plan', 'hasIcf': False, 'hasSap': True, 'filename': 'Prot_SAP_000.pdf', 'typeAbbrev': 'Prot_SAP', 'uploadDate': '2024-03-20T15:53', 'hasProtocol': True}, {'date': '2024-01-04', 'size': 6407390, 'label': 'Informed Consent Form', 'hasIcf': True, 'hasSap': False, 'filename': 'ICF_001.pdf', 'typeAbbrev': 'ICF', 'uploadDate': '2024-03-20T16:43', 'hasProtocol': False}]}}, 'protocolSection': {'designModule': {'phases': ['NA'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'NA', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'BASIC_SCIENCE', 'interventionModel': 'SINGLE_GROUP', 'interventionModelDescription': 'This is a Basic Experimental study with Humans with able-bodied individuals and individuals with spinal cord injury (SCI). This study is a cross sectional assessment and will have 1 or 2 visits consisting of 2 protocols where individuals will undergo several physical maneuvers during which bone perfusion response will be assessed. Protocol #1 will investigate tibial perfusion response to tibial loading. Protocol #2 will investigate tibial perfusion response to isometric handgrip exercise and tilt. Volunteers can choose to do one or both protocols during 1 or 2 laboratory visits.\n\nStudy completion update: In able bodied adults, we have investigated tibial perfusion in response to isometric handgrip exercise, cold pressor test, leg dependency, reactive hyperemia, and sublingual nitroglycerin. In adults with spinal cord injury, we have investigated tibial perfusion in response to isometric handgrip exercise.'}, 'enrollmentInfo': {'type': 'ACTUAL', 'count': 90}}, 'statusModule': {'overallStatus': 'COMPLETED', 'startDateStruct': {'date': '2018-05-31', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2024-06', 'completionDateStruct': {'date': '2023-04-13', 'type': 'ACTUAL'}, 'lastUpdateSubmitDate': '2024-06-14', 'studyFirstSubmitDate': '2019-09-04', 'resultsFirstSubmitDate': '2024-03-21', 'studyFirstSubmitQcDate': '2019-09-07', 'lastUpdatePostDateStruct': {'date': '2024-06-17', 'type': 'ACTUAL'}, 'resultsFirstSubmitQcDate': '2024-06-14', 'studyFirstPostDateStruct': {'date': '2019-09-10', 'type': 'ACTUAL'}, 'resultsFirstPostDateStruct': {'date': '2024-06-17', 'type': 'ACTUAL'}, 'primaryCompletionDateStruct': {'date': '2023-04-13', 'type': 'ACTUAL'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'Tibial Blood Perfusion', 'timeFrame': '1 day', 'description': 'Concentration of hemoglobin content assessed in response to several physical maneuvers (isometric handgrip exercise, cold pressor test, nitroglycerin, reactive hyperemia, leg dependency). Results are reported in tibial total hemoglobin content (μM). To date there are no absolute established values of tibial bone hemoglobin content and thus an absolute range (minimum and maximum) cannot be provided.'}]}, 'oversightModule': {'oversightHasDmc': False, 'isFdaRegulatedDrug': False, 'isFdaRegulatedDevice': False}, 'conditionsModule': {'keywords': ['bone perfusion', 'bone blood flow regulation', 'vascular sympathetic activity', 'skeletal loading', 'spinal cord injury'], 'conditions': ['Bone Blood Flow Regulation']}, 'referencesModule': {'references': [{'pmid': '13463047', 'type': 'BACKGROUND', 'citation': 'BROOKES M. Femoral growth after occlusion of the principal nutrient canal in day-old rabbits. J Bone Joint Surg Br. 1957 Aug;39-B(3):563-71. doi: 10.1302/0301-620X.39B3.563. No abstract available.'}, {'pmid': '12673899', 'type': 'BACKGROUND', 'citation': 'Laroche M, Moulinier L, Leger P, Lefebvre D, Mazieres B, Boccalon H. Bone mineral decrease in the leg with unilateral chronic occlusive arterial disease. Clin Exp Rheumatol. 2003 Jan-Feb;21(1):103-6.'}, {'pmid': '22419020', 'type': 'BACKGROUND', 'citation': 'Portal-Nunez S, Lozano D, Esbrit P. Role of angiogenesis on bone formation. Histol Histopathol. 2012 May;27(5):559-66. doi: 10.14670/HH-27.559.'}, {'pmid': '18454418', 'type': 'BACKGROUND', 'citation': 'Kanczler JM, Oreffo RO. Osteogenesis and angiogenesis: the potential for engineering bone. Eur Cell Mater. 2008 May 2;15:100-14. doi: 10.22203/ecm.v015a08.'}, {'pmid': '19016540', 'type': 'BACKGROUND', 'citation': 'Caulkins C, Ebramzadeh E, Winet H. Skeletal muscle contractions uncoupled from gravitational loading directly increase cortical bone blood flow rates in vivo. J Orthop Res. 2009 May;27(5):651-6. doi: 10.1002/jor.20780.'}, {'pmid': '24658222', 'type': 'BACKGROUND', 'citation': 'Stabley JN, Moningka NC, Behnke BJ, Delp MD. Exercise training augments regional bone and marrow blood flow during exercise. Med Sci Sports Exerc. 2014 Nov;46(11):2107-12. doi: 10.1249/MSS.0000000000000342.'}, {'pmid': '24056176', 'type': 'BACKGROUND', 'citation': 'Stabley JN, Prisby RD, Behnke BJ, Delp MD. Chronic skeletal unloading of the rat femur: mechanisms and functional consequences of vascular remodeling. Bone. 2013 Dec;57(2):355-60. doi: 10.1016/j.bone.2013.09.003. Epub 2013 Sep 19.'}, {'pmid': '495729', 'type': 'BACKGROUND', 'citation': 'Gross PM, Heistad DD, Marcus ML. Neurohumoral regulation of blood flow to bones and marrow. Am J Physiol. 1979 Oct;237(4):H440-8. doi: 10.1152/ajpheart.1979.237.4.H440.'}, {'pmid': '8095442', 'type': 'BACKGROUND', 'citation': 'Ye Z, Wood MB, Vanhoutte PM. Alpha-adrenergic receptor responsiveness in vascular smooth muscle of canine bone. Clin Orthop Relat Res. 1993 Feb;(287):286-91.'}, {'pmid': '9671929', 'type': 'BACKGROUND', 'citation': 'Briggs PJ, Moran CG, Wood MB. Actions of endothelin-1, 2, and 3 in the microvasculature of bone. J Orthop Res. 1998 May;16(3):340-7. doi: 10.1002/jor.1100160310.'}, {'pmid': '28561268', 'type': 'BACKGROUND', 'citation': 'Draghici AE, Potart D, Hollmann JL, Pera V, Fang Q, DiMarzio CA, Andrew Taylor J, Niedre MJ, Shefelbine SJ. Near infrared spectroscopy for measuring changes in bone hemoglobin content after exercise in individuals with spinal cord injury. J Orthop Res. 2018 Jan;36(1):183-191. doi: 10.1002/jor.23622. Epub 2017 Jun 28.'}, {'pmid': '38133925', 'type': 'DERIVED', 'citation': 'Draghici AE, Ely MR, Hamner JW, Taylor JA. Nitric oxide-mediated vasodilation in human bone. Microcirculation. 2024 Feb;31(2):e12842. doi: 10.1111/micc.12842. Epub 2023 Dec 22.'}]}, 'descriptionModule': {'briefSummary': 'Without blood flow, bone cannot maintain its integrity. Bone blood flow responds to various local and systemic factors, however, bone perfusion in humans remains relatively unstudied. The investigators will study key mechanisms that regulate bone perfusion in able-bodied and contrast responses to those with spinal cord injury (SCI). SCI is a model of chronic reduced loading with loss of sympathetic regulation. In tibial cortical bone, the investigators will: 1) determine the impact of compressive loading with and without muscle contractions; 2) determine the impact of vascular sympathetic activity and systemic perfusion pressure; 3) compare the response between able-bodied and those with SCI. Acute metabolic needs of bone due to loading increase flow substantially. In addition, the bone vasculature is innervated by a rich network of sympathetic nerves that serve a functional purpose in the control of blood flow. A critical limitation to the study of bone blood flow in humans has been the lack of non-invasive assessments. Previously, the investigators developed a near infrared spectroscopy (NIRS) device to non-invasively assess blood content in bone and assessed tibial perfusion in response to exercise. Here, the investigators will test the hypothesis that bone blood flow increases proportional to loading conditions in both able-bodied individuals and those with SCI. The investigators will also test the hypothesis that there are decreases in blood bone flow that are proportional to increases in leg vascular sympathetic outflow in the able-bodied, but that changes in bone blood flow are proportional to changes in blood pressure in those with SCI. The proposed research will be some of the first to determine the control of bone flow in humans.', 'detailedDescription': "All tissues of the human body require adequate perfusion to provide oxygen and nutrients to meet metabolic demands. It has long been known that the arterial system in bone is of overwhelming importance and that without blood flow, bone cannot maintain its integrity. Indeed, there is an extensive network of arteries, arterioles, and capillaries that supply human bone. Moreover, blood flow to bone is responsive to various local and systemic factors that can determine the overall health of bone. However, bone perfusion in humans remains relatively unstudied and so the underlying mechanisms that regulate bone blood flow are not well understood. The investigators propose to study key mechanisms that regulate bone perfusion in able-bodied individuals and to contrast them with spinal cord injured (SCI) individuals. SCI represents a human 'model' of chronic reduced loading with loss of sympathetic regulation below the level of injury that likely alters control of bone perfusion. Accordingly, our aims are to: 1) Determine the impact of compressive loading with and without associated muscle contractions on tibial perfusion; 2) Determine the impact of vascular sympathetic activity and systemic perfusion pressure on tibial perfusion; 3) Compare the changes in tibial perfusion in response to local and systemic factors between able-bodied and those with SCI.\n\nThe majority of work in bone blood flow has been in animals and/or has focused on the association between adequate or inadequate perfusion and bone health. For example, inadequate flow has been associated with bone loss, impaired growth, and delayed fracture healing. However, the acute metabolic needs of bone due to loading either with or without associated muscle contractions increase flow substantially. Indeed, within two minutes of isolated muscle contractions alone, tibial perfusion has been shown to increase significantly. Furthermore, when there is compressive loading with associated muscle contractions, flow to bone can double. Similarly, skeletal unloading for as short as ten minutes cuts femoral perfusion by half. Although it is unclear what specific local factors (e.g., metabolic by-products) with loading might be responsible for regulation of blood flow, these data strongly suggest that perfusion to bone is highly responsive to skeletal loading. Indeed, it appears that similar regulatory mechanisms may be at play in control of flow to bone and skeletal muscle during exercise. In addition, the bone vasculature is richly innervated by sympathetic nerves. Application of norepinephrine decreases blood flow to both intact bone and isolated bone. Likewise, sympathetic stimulation decreases flow to bone via alpha-adrenergic receptor activation. Moreover, smooth muscle of arterioles in bone respond as expected to vasodilators and vasoconstrictors. Hence, sympathetic innervation of the bone vasculature serves a functional purpose in control of flow. If this were not the case, independent of the link between bone metabolism and bone flow, the arterial network in bone would act as a simple pressure passive system.\n\nA critical limitation to the study of bone flow in humans has been the lack of noninvasive assessments. Thus, it has been difficult to elucidate the mechanisms that control perfusion to bone. The dense nature of bone makes it difficult to investigate perfusion and the techniques used to quantify circulation in other tissues are either difficult or impossible to apply to bone in vivo. the investigators recently demonstrated the efficacy of a near infrared spectroscopy (NIRS) system to non-invasively detect changes in hemoglobin content in the tibia. Although our preliminary work showed the utility of NIRS, it was not designed to provide insight to blood flow regulation and disentangle the various possible contributors to bone perfusion. Here the investigators propose to study different mechanisms that control blood flow to bone in both able-bodied and spinal cord injured (SCI). The SCI population will offer valuable insights to the mechanisms of perfusion as several contributors (i.e. loading and vascular sympathetic control) are either reduced or disrupted.\n\nStudy completion update: Given the exploratory nature of this study, the scope has been adjusted to address the challenges and limitations that have occurred during the duration of this research. Nonetheless the work completed has provided unprecedented findings on key mechanisms of vascular regulation in bone in vivo in humans. We were not able to assess the impact of compressive loading with or without associated muscle contractions on tibial perfusion due to marked impact of motion artefacts on the near infrared spectroscopy technology used to assess tibial perfusion. In young healthy adults, we have assessed the impact of vascular sympathetic activity (in response to two stimuli: isometric handgrip exercise and cold pressor test) and increased perfusion pressure (in response to two stimuli: leg dependency and reactive hyperemia). In those with spinal cord injury, given the inherent limitations of working with this population (i.e., increased spasticity, autonomic dysreflexia), we have assessed the impact of lack of vascular sympathetic activity on tibial blood flow regulation. Furthermore, we have extended the initial work and in young healthy adults we have investigated an additional key regulation mechanism of the tibial vasculature, namely nitric oxide mediated vasodilation.\n\nEven though we have obtained data during compressive loading in both able-bodied and adults with spinal cord injury, the data were not usable due to motion artefacts. In addition, the data obtained in those with SCI during leg dependency and reactive hyperemia were insufficient or unusable (due to increased spasticity and autonomic dysreflexia) to draw any meaningful conclusions."}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT'], 'maximumAge': '40 Years', 'minimumAge': '18 Years', 'healthyVolunteers': True, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* healthy males and females\n* individuals with spinal cord injuries, between 3 and 24 months post injury, with complete injuries according to the American Spinal Injury Association Impairment Scale A and B, with injuries at T6 and below\n\nExclusion Criteria:\n\n* clinical signs or symptoms of heart disease\n* hypertension\n* coronary disease\n* diabetes\n* other neurological disease\n* cancer\n* recent weight change \\>15 pounds\n* abnormal resting ECG\n* pregnant and/or breastfeeding women\n* underweight and obese individuals (body mass index between 18.5 and 29.9)\n* use of amphetamines (Ritalin, Adderall, Concerta) in the past 48 hours\n* tibial fracture or tibial stress fracture in the past year\n* those with SCI will have no extreme spasticity to avoid spontaneous contractions\n* use of baclofen for those with SCI'}, 'identificationModule': {'nctId': 'NCT04083794', 'briefTitle': 'Exploration of Blood Flow Regulation to Bone in Humans', 'organization': {'class': 'OTHER', 'fullName': 'Spaulding Rehabilitation Hospital'}, 'officialTitle': 'Exploration of Blood Flow Regulation to Bone in Humans', 'orgStudyIdInfo': {'id': '2018P000156'}, 'secondaryIdInfos': [{'id': 'R21AR074054-01A1', 'link': 'https://reporter.nih.gov/quickSearch/R21AR074054-01A1', 'type': 'NIH'}]}, 'armsInterventionsModule': {'armGroups': [{'type': 'OTHER', 'label': 'Laboratory based assessments', 'description': 'The current study has no arms; it is a cross-sectional assessment where all participants will undergo the same procedures.', 'interventionNames': ['Other: Laboratory based assessments']}], 'interventions': [{'name': 'Laboratory based assessments', 'type': 'OTHER', 'otherNames': ['handgrip', 'tilt', 'tibial loading'], 'description': 'physical maneuvers to assess physiological responses in bone blood flow', 'armGroupLabels': ['Laboratory based assessments']}]}, 'contactsLocationsModule': {'locations': [{'zip': '02138', 'city': 'Cambridge', 'state': 'Massachusetts', 'country': 'United States', 'facility': 'Spaulding Rehabilitation Cambridge/ Cardiovascular Laboratory', 'geoPoint': {'lat': 42.3751, 'lon': -71.10561}}], 'overallOfficials': [{'name': 'J. A Taylor, PhD', 'role': 'PRINCIPAL_INVESTIGATOR', 'affiliation': 'Harvard Medical School/Spaulding Rehabilitation Hospital'}]}, 'ipdSharingStatementModule': {'ipdSharing': 'NO'}, 'sponsorCollaboratorsModule': {'leadSponsor': {'name': 'Spaulding Rehabilitation Hospital', 'class': 'OTHER'}, 'collaborators': [{'name': 'National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)', 'class': 'NIH'}], 'responsibleParty': {'type': 'PRINCIPAL_INVESTIGATOR', 'investigatorTitle': 'Associate Chair for Research', 'investigatorFullName': 'J. Andrew Taylor', 'investigatorAffiliation': 'Spaulding Rehabilitation Hospital'}}}}