Effects of a Surgery-induced Peripheral Inflammatory Response on the Blood Brain Barrier

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Richard Hall, Capital District Health Authority, Canada
ClinicalTrials.gov Identifier:
NCT00878371
First received: April 7, 2009
Last updated: March 12, 2014
Last verified: March 2014
  Purpose

The purpose for this study is to determine if surgery (repair of descending thoracic aneurysm) causes a temporary decrease in the Blood Brain Barrier's ability to remove drugs from the brain back into the blood. The Blood Brain Barrier surrounds the brain and the spinal cord. This Blood Brain Barrier acts as a filter and allows some things to cross into the brain and allows other matter to be removed. Studies have shown the Blood Brain Barrier is affected by inflammation.

Functions of the Blood Brain Barrier in animals have been studied. Human studies with multiple causes of inflammation (e.g. Alzheimer's, Epilepsy, trauma and severe infections in critically

Hypothesis: Surgically-induced inflammation will temporarily reduce blood-brain barrier drug efflux transporter function in proportion to the degree of inflammation. The investigators anticipate that inflammation-mediated reductions in drug transporter function will be reflected by an increased cerebral spinal fluid (CSF) concentration of morphine (a PGP substrate) and M3G and M6G (MRP1 substrates). The corresponding in vitro studies will allow us to elucidate the mechanism(s) by which inflammation alters blood brain barrier efflux transport of morphine, M3G and M6G.


Condition Intervention Phase
Dissecting Aneurysm of the Thoracic Aorta
Procedure: Repair of descending thoracic aneurysm and morphine
Procedure: all patients went repair of thier TAA
Phase 4

Study Type: Interventional
Study Design: Endpoint Classification: Pharmacokinetics/Dynamics Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Identification and Quantification of the Effects of a Surgery-induced Peripheral Inflammatory Response on Changes in Drug Efflux Transporter Function in the Brain

Resource links provided by NLM:


Further study details as provided by Capital District Health Authority, Canada:

Primary Outcome Measures:
  • The primary outcome variables are the correlation between the ratio of CSF/plasma morphine , morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) levels and the plasma concentration of IL-6 over time. [ Time Frame: CSF and Blood samples will be taken in the OR, post operatively ( every 6 hrs until POD 5 if CSF drain still in place) ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Correlation between CSF/Plasma ratios of morphine, M3G, M6G and plasma concentration of TNFα and ET-1 over time. [ Time Frame: CSF and Blood samples will be taken in the OR, post operatively ( every 6 hrs until POD 5 if CSF drain still in place) ] [ Designated as safety issue: No ]
  • Correlation between CSF/plasma ratios for morphine, M3G, M6G and CSF/Plasma ratios for albumin and S-100β over time. [ Time Frame: CSF and Blood samples will be taken in the OR, post operatively ( every 6 hrs until POD 5 if CSF drain still in place) ] [ Designated as safety issue: No ]

Enrollment: 35
Study Start Date: May 2009
Study Completion Date: February 2013
Primary Completion Date: February 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
No Intervention: morphine
All patients treated with Morphine during induction after the lumbar drain inserted. Morphine was prescribed as Standard of care post operatively
Procedure: Repair of descending thoracic aneurysm and morphine
Elective surgical patients undergoing repair of a descending thoracic aortic aneurysm, requiring insertion of a cerebral spinal fluid (CSF) drain and receiving Morphine as their primary analgesic agent can be enrolled
Procedure: all patients went repair of thier TAA

patient stratified into three groups

  1. patients undergoing insertion of aortic stent
  2. patients undergoing thoracotomy
  3. patients undergoing thoracotomy and CPB

2. TAA repair endovascular


Detailed Description:

Study Objectives: To determine the role of surgery-induced inflammation on the transport of morphine and its metabolites, M3G and M6G, across the blood-brain barrier.

Study phase: IV Study Design: This is a sequential enrolment study design in which elective surgical patients presenting for repair of an ascending thoracic aneurysm and fitted with a CSF drain as part of their standard of care will be approached for permission to draw blood samples at specified times during their hospital course. Concomitantly, samples of CSF will be collected from the CSF drainage system (CSF is normally wasted).

Morphine will be used as the primary analgesic agent (this is within the standard of care). Samples will be collected at specified time intervals for 5 days or until the CSF drain is removed (whichever comes first). Samples collected will be analysed for morphine, its 3- and 6- glucuronide metabolites, inflammatory cytokines, markers of CNS injury and anatomical integrity of the BBB. Area under the concentration vs. time curve will be calculated and the effect on morphine metabolism and penetration across the BBB will be determined using a repeated measures analysis of variance technique (as used in our previous study).

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Subjects who are to undergo elective surgery for thoracic aortic vascular disease requiring insertion of a lumbar CSF drain
  2. Informed consent will be obtained from the subject or authorized legal representative -

Exclusion Criteria:

  1. Unwilling or unable to provide informed consent
  2. Sensitivity or documented allergy to morphine
  3. Inability to place lumbar CSF drain
  4. Dialysis dependent -
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00878371

Locations
Canada, Nova Scotia
Capital Health- Queen Elizabeth II Health Sciences Centre
Halifax, Nova Scotia, Canada, B3H3A7
Sponsors and Collaborators
Capital District Health Authority, Canada
Investigators
Principal Investigator: Richard I Hall, MD Capital Health- Queen Elizabeth II Health Sciences Center
  More Information

Publications:
Responsible Party: Richard Hall, MD FRCPC FCCP, Capital District Health Authority, Canada
ClinicalTrials.gov Identifier: NCT00878371     History of Changes
Other Study ID Numbers: Hall Morphine TAA-01
Study First Received: April 7, 2009
Last Updated: March 12, 2014
Health Authority: Canada: Ethics Review Committee

Keywords provided by Capital District Health Authority, Canada:
morphine
blood brain barrier
surgery induced peripheral inflammatory response

Additional relevant MeSH terms:
Aneurysm
Aneurysm, Dissecting
Vascular Diseases
Cardiovascular Diseases
Morphine
Analgesics, Opioid
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Central Nervous System Depressants
Narcotics

ClinicalTrials.gov processed this record on April 23, 2014