This study is NOT currently recruiting participants.
To learn how MG and ALA can help the body process food.
People aged 18 to 65 years with a body mass index between 30 and 40 kg/m2.
Participants will be screened. They will have a physical exam. They will have blood and urine tests and a test of their heart function. They will speak with a dietician.
The study has two phases. Each phase begins with a 2-day stay in the clinic; then the participant will take the study drugs at home for about 4 weeks, followed by another 2-day stay in the clinic. They will also have outpatient visits about 2 weeks after each clinic stay.
They will have a plastic tube (catheter) inserted into a vein in each arm. These will be used to draw blood and to infuse glucose (sugar) and insulin.
They will have imaging scans.
They will have a clear hard plastic shield placed over their head to measure oxygen and carbon dioxide as they breathe.
Participants will take the study drugs at home. Both MG and ALA are taken by mouth with water. During one phase, participants will take MG plus a placebo. A placebo looks like the study drug but doesn t contain medicine.
They will log their diet, exercise, and sleep.
INCLUSION CRITERIA To be eligible to participate in this study, an individual must meet all of the following criteria:
1. Adults 18 to 65 years of age
2. BMI greater than or equal to 30 kg/m^2 and less than or equal to 45 kg/m^2
EXCLUSION CRITERIA
An individual who meets any of the following criteria will be excluded from participation in this study:
1. Hypersensitivity and associated allergic reactions to mirabegron or alpha-lipoic acid (or similar drug substances or components).
2. Abnormal bladder function, diagnosis of bladder outlet obstruction, urgency, and urinary frequency or use of antimuscarinic medication to treat overactive bladder (OAB).
3. Type 1 diabetes mellitus; type 2 diabetes mellitus; or any person taking exogenous insulin therapy or any medication that is a hypoglycemic agent. (type 1 or Type 2 Diabetes mellitus, fasting serum glucose >125 mg/dL, and/or an HbA1c test >6.5%).
4. Elevated resting blood pressure >140/90 mmHg.
5. Individuals with eGFR <60 ml/min/1.72 m^2 and a urinary albumin/creatinine ratio UACR>300 mg/g.
6. Hypo- or hyper-thyroid disease (TSH >5.0, or <0.4 MIU/L) that is controlled for less than one year or someone currently taking thyroid hormone replacement.
7. Anemia, defined by hemoglobin <11.5 g/dL (females) or <13.5 g/dL (males); sickle cell anemia or other blood disorders; and/or wound healing problems.
8. Cardiovascular disease, cardiac arrhythmias, orthostasis, unstable vasomotor system, or renal impairment.
9. A clinically significant abnormal ECG and/or QTc interval above normal
10. Moderate hepatic impairment (Child-Pugh Class B) or above
11. Elevated liver enzymes >75 U/L (ALT or AST)
12. Recent history in last 4 weeks of any local or systemic infectious disease with fever or requiring antibiotics
13. Pregnancy, childbirth within the last year, or breastfeeding in the past 12 months.
14. Individuals that have been on a very low-calorie diet (<800 kcal/d), self-reported weight loss >5% in the preceding six months, or those taking weight loss medications.
15. History of seizure disorder.
16. Addiction to alcohol or substances of abuse within the last 5 years.
17. Self-reported current alcohol consumption of more than 2 servings of alcohol per day.
18. Self-reported current use of nicotine and/or tobacco products.
19. Current use of any drugs known to:
a. Have major drug-drug interactions with mirabegron or alpha-lipoic acid
b. Be CYP2D6 substrates
c. Prolong QT interval
d. Alter glucose metabolism or cause insulin resistance (in last six months)
e. Treat diabetes mellitus
f. Treat hypertension
g. Be drugs of abuse
20. Inability to provide informed consent.
21. Unwilling or unable to eat metabolic meals, as determined by dietitian consult.
22. Individuals with significant medical comorbidities or other factors that would render the individual s participation unsafe or affect the outcome of the study as assessed by the investigator.