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Autologous Peripheral Nerve Grafts Into the Substantia Nigra of Subjects With PD Undergoing Deep Brain Stimulation

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01833364
Recruitment Status : Completed
First Posted : April 16, 2013
Last Update Posted : March 9, 2016
Sponsor:
Collaborator:
University of Kentucky
Information provided by (Responsible Party):
Craig van Horne, MD, PhD, University of Kentucky

Study Description
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Brief Summary:

By doing this study, the investigators hope to learn provide safety data that can be used to generate a larger phase III clinical trial. If successful, it would promote the development of a new treatment for PD in which patients are able to provide their own tissue as a source of a supportive environment for the injured and dying cells and thereby possibly stopping the progression of the illness or even improve the symptoms of PD.

The purpose of this research is to gather information on the safety and feasibility of nerve graft implantation is. The results of this study will be shared with the University of Kentucky, Center for Clinical and Translational Science (group providing financial support for the study) and other federal agencies, if required.

The overall goal of this research is to develop a novel, regenerative treatment strategy for idiopathic Parkinson's disease (PD) that is safe, cost effective and widely available to patients.


Condition or disease Intervention/treatment Phase
Parkinson's Disease Procedure: Implantation of the Peripheral Nerve Graft Not Applicable

Detailed Description:

This pilot study is designed to test the safety and feasibility of the implantation of the subject's own peripheral nerve tissue into an area of the brain called the substantia nigra. Only subjects who have elected to undergo DBS surgery will be asked to participate in this research study.

The implantation of the nerve graft will take place in the operating room at the end of the second stage surgery for DBS. Subjects will be asked to donate a piece of their own peripheral nerve tissue that will be used to create the graft for their implantation. The peripheral nerve tissue is obtained from a small incision (approximately 2 inches) above and on the outer-side of one ankle. The initial incision is created during stage I of the DBS procedure and will take place under general anesthesia. The incision will be closed with internal sutures, and a dressing will cover the incision after the procedure.

The nerve will be harvested during stage II of the DBS procedure. This involves opening the same incision using local anesthesia injected around the incision site. Once a small piece (about an inch) of the nerve is removed, the incision will be sutured closed with internal stitches. These stitches will dissolve on their own and will not need to be removed in the office.

Follow-up. Subjects will be followed in our clinic for for DBS follow-up visits and treatment, none of those visits are part of this study.

Prior to coming in for study visits subjects will need to stop taking their PD medications 12 hours before each visit. Subjects will be allowed to restart their normal PD medication during the examination.

Subjects will undergo formal Unified Parkinson's Disease Rating Scale (UPDRS) evaluations at screening and months 1, 3, 6, 9 and 12. In order to visually document potential changes in their Parkinson's Disease symptoms following their DBS surgery, we will be videotaping study related neurological testing sessions.

Subject will also be videotaped at screening, and visits 1, 3, 6, 9, 12.

A neuropsychological exam will be performed at screening and again at month 12.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 8 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Pilot Study to Evaluate the Safety and Feasibility of Implanting Autologous Peripheral Nerve Grafts Into the Substantia Nigra of Subjects With Parkinson's Disease Undergoing Deep Brain Stimulation Surgery and Treatment
Study Start Date : April 2013
Actual Primary Completion Date : July 2015
Actual Study Completion Date : September 2015

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Implantation of Perpherial Nerve Graft
Subjects own peripheral nerve tissue that will be used to create the graft for implantation. The autologous peripheral nerve graft will then be implanted unilaterally into the substantia nigra of the subject after the placement of DBS electrodes.
 Procedure: Implantation of the Peripheral Nerve Graft

The preparatory surgery for harvesting the peripheral nerve graft will take place in the operating room at the time of the Stage I surgery for the DBS procedure. The nerve exposure and preparation will take approximately 15 minutes of operating time in addition to the DBS procedure which typically takes 75-90 minutes.

The implantation of the nerve graft will take place in the operating room at the end of the second stage surgery for DBS. The graft harvesting and implantation will take approximately 15 minutes in addition to the 4 hours that is needed for the DBS surgery. The subject's peripheral nerve graft will be implanted into the substantia nigra unilaterally. This is a single arm trial to assess safety and feasibility.

Other Name: Peripheral Nerve Graft


Outcome Measures
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Primary Outcome Measures :
  1. Safety and Tolerability of Nerve Graft Implantation [ Time Frame: One year ]
    All Adverse events will be collected from the time subject signs the consent to the time they complete study visit 12 in order to measure the safety and tolerability of the grafting procedure. Adverse events will be documented and compared to the known and reported adverse events of DBS of STN. In addition, MRI imaging of the graft site within the substantia nigra will be compared to the contralateral, non-grafted site.


Secondary Outcome Measures :
  1. Peripheral Nerve Graft Efficacy -- clinical improvement [ Time Frame: 1 year ]

    Post operative data will be collected at study visit 1, 3, 6, 9 and 12 from the time of the second stage surgery.

    • Subjects will undergo UPDRS evaluation at each visit. This will include evaluations with the patients off medication and off stimulation as well as on medication and on stimulation. Comparisons will be evaluated for changes relating to time from implantation as well as between the implanted side vs the non-implanted side.

  2. Peripheral Nerve Graft Efficacy -- Therapy Reduction [ Time Frame: 1 year ]

    This is a composite evaluation targeting changes in medication requirements and DBS stimulation requirements.

    - Changes in medication dosages and stimulation parameters will be recorded at each visit (1,3,6,9,and 12 months post-implantation). Stimulation parameter changes will be evaluated from time of implantation and also compared between the grafted and non-grafted side.


  3. Peripheral Nerve Graft Efficacy -- Quality of Life [ Time Frame: 1 year ]
    Subjects will also have a formal neuropsychological and PDQ-8 examination pre-operatively and at 12 months post implantation. These tests will be used to evaluate psychological profiles and for possible changes in quality of life.


Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   40 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Elected to have DBS Surgery
  • Parkinson's Disease for 5 years or more
  • Ages 40-75

Exclusion Criteria:

  • Have previously undergone PD surgery or any intracranial surgery
  • Unwilling to delay taking PD medications during the study
  • Unable to follow the directions of the study team
  • Unable to attend all study visits
  • Have participated in previous clinical studies and received an investigational product within 30 days of screening
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01833364


Locations
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United States, Kentucky
University of Kentucky Medical Center
Lexington, Kentucky, United States, 40475
University of Kentucky Medical Center
Lexington, Kentucky, United States, 40536
Sponsors and Collaborators
Craig van Horne, MD, PhD
University of Kentucky
Investigators
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Principal Investigator: Craig van Horne, MD University of Kentucky, Department of Neurosurgery
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Craig van Horne, MD, PhD, Principal Investigator, University of Kentucky
ClinicalTrials.gov Identifier: NCT01833364    
Other Study ID Numbers: 12-1021-F6A
12-1021 ( Other Identifier: UK CCTS )
First Posted: April 16, 2013    Key Record Dates
Last Update Posted: March 9, 2016
Last Verified: March 2016
Keywords provided by Craig van Horne, MD, PhD, University of Kentucky:
Parkinson's Disease
Deep Brain Stimulation
Peripheral Nerve Graft
Additional relevant MeSH terms:
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Parkinson Disease
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
 Nervous System Diseases
Movement Disorders
Synucleinopathies
Neurodegenerative Diseases