The Canadian Multicentre CSF Monitoring and Biomarker Study (CAMPER)
The purpose of this study is to:
- Measure the pressure in the spinal fluid surrounding the spinal cord to find out how well the spinal cord is being supplied with blood.
- Determine how drugs called "vasopressors", which are used to control blood pressure following SCI (spinal cord injury), influence spinal fluid pressure.
- Characterize the severity of an SCI using the levels of specific proteins found within the spinal fluid.
- Predict how much neurologic recovery may be regained using the levels of specific proteins within your spinal fluid.
- Identify proteins within the spinal fluid that will help us learn more about what is happening after SCI and assist us in developing new treatments for SCI.
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
|Official Title:||The Canadian Multicentre CSF Monitoring and Biomarker Study|
- Spinal cord perfusion pressure [ Time Frame: 5 days ] [ Designated as safety issue: No ]SCPP will be calculated as the difference between the MAP and ITP. The ITP and MAP will be recorded over 5 days(5-7 days post-injury) while the lumbar intrathecal catheter is in place.
- Levels of specific biochemical markers in the CSF [ Time Frame: 5 days ] [ Designated as safety issue: No ]CSF samples will be obtained from the intrathecal catheter at 8-hour intervals, three times daily for 5 days. These samples will be evaluated will the goal of prospectively validating a series of biochemical markers that correlate with injury severity and predict neurologic outcome.
- International Standards for Neurological Classification of Spinal Cord Injury (aka ASIA Examination) [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]For the purposes of ensuring that neurologic deterioration is not occurring while the lumbar intrathecal catheter is in place, an ASIA assessment will be performed daily while the intrathecal catheter is inserted. For the purpose of documenting neurologic recovery over time, the ASIA examination will also be performed at 3, 6, and 12 months post-injury.
- DN4 and other pain questionnaires [ Time Frame: 1 year ] [ Designated as safety issue: No ]It is currently believed that the development of neuropathic pain is closely related to neuroinflammation after SCI. In an effort to determine if we could establish etiologic cytokines, we will administer the DN4 and other pain questionnaires to characterize and quantify neuropathic pain. These questionnaires will be administered at screening, days 1-5 post-insertion of the lumbar intrathecal catheter, 3 months, 6 months and 1 year post-injury.
|Study Start Date:||January 2011|
|Estimated Study Completion Date:||March 2018|
|Estimated Primary Completion Date:||January 2018 (Final data collection date for primary outcome measure)|
Other: Crossover of vasopressors
To evaluate the effect of different vasopressor agents on SCPP, a "crossover" intervention will be conducted on patients requiring either NORepinephrine or DOPamine post-operatively, once daily for 5 days while the catheter is in place. A subject on NORepinephrine will be switched over to DOPamine for 1 hr, and then switched back to NORepinephrine. Likewise, a subject on DOPamine will be switched over to NORepinephrine for 1 hr, and then switched back to DOPamine. Subjects on both vasopressors will have DOPamine stopped for 1 hr and NORepinephrine titrated up to maintain the same MAP for 1 hr, and then brought back to the original levels of both vasopressors. On the following day, the reverse will be carried out, with a stoppage of the NORepinephrine and maintenance solely on DOPamine.
This research project consists of two complementary yet distinct initiatives:
- First, we will prospectively evaluate spinal cord perfusion pressure(SCPP)in patients with acute spinal cord injuries, to provide scientifically-based guidelines on the management of blood pressure during the acute injury phase.
- Second, we will evaluate cerebrospinal fluid(CSF) samples from these patients with the goal of prospectively validating a series of biochemical markers that correlate with injury severity and predict neurologic outcome. Ultimately, our goals are to enhance the neurologic outcome of individuals with spinal cord injuries by improving upon their acute clinical care, and to establish biological surrogates of injury severity that may be used to facilitate clinical trials of novel therapeutic interventions for acute spinal cord injury.
This multicenter study will enroll patients with acute traumatic cervical and thoracic SCI within 48 hours of their injury. A lumbar intrathecal catheter will be inserted pre-operatively for the measurement of intrathecal pressure (ITP) and the collection of CSF samples. Spinal cord perfusion pressure will be calculated as the difference between mean arterial pressure (MAP) and the ITP. The objectives of this aspect of the study will be to:
- Document the changes in SCPP over the first 5-7 days post-injury (with an intrathecal catheter that is in place for 5 days).
- Determine the effect of different vasopressor agents on SCPP.
Additionally, CSF samples will be obtained from the intrathecal catheter at 8-hour intervals to analyse the expression of the following biochemical markers: including interleukin (IL)-6, IL-8, monocyte chemo-attractant protein (MCP)-1, glial fibrillary acidic protein (GFAP), S100beta, and tau. The objectives of this aspect of the study will be to:
- Evaluate the accuracy of these inflammatory and neuronal markers at classifying the initial severity of paralysis and at predicting the extent of neurologic recovery.
- Characterize the temporal pattern of expression of these proteins to provide a more complete description of the human pathophysiology of SCI.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01279811
|Contact: Daniel Rogersfirstname.lastname@example.org|
|Canada, British Columbia|
|Vancouver General Hospital||Recruiting|
|Vancouver, British Columbia, Canada, V5Z 1M9|
|Principal Investigator: Brian K. Kwon, MD,PhD,FRCSC|
|Canada, Nova Scotia|
|QEII Health Sciences Centre||Recruiting|
|Halifax, Nova Scotia, Canada|
|Hamilton Health Sciences Centre||Recruiting|
|Hamilton, Ontario, Canada|
|London Health Science Centre- Victoria Campus||Recruiting|
|London, Ontario, Canada|
|Hôpital du Sacré-Coeur||Recruiting|
|Montreal, Quebec, Canada|
|Principal Investigator:||Brian K. Kwon, MD,PhD,FRCSC||University of British Columbia and Vancouver General Hospital|