Cerebral Cavernous Malformations
Conditions
Brief summary
This is a single center, randomized, trial that will enroll twenty (n=20) patients with a diagnosis of symptomatic cavernous malformations who are planned candidates for surgical resection by one of the investigators, and who meet all of the inclusion and exclusion criteria. Patients will be randomized into two groups: A Treatment group of ten (n=10) patients that will receive oral propranolol at a dose of 60mg per day (one 60mg ER capsule per day) for 7- to 10-days prior to surgery plus their usual medications, and a Control group of 10 (n=10) patients will receive only their routine medications. Currently, the only active treatment alternative for symptomatic cerebral cavernous malformations is surgery. A control group is required to allow for a semi-quantitative comparison with mRNA and miRNA levels in the treatment group.
Detailed description
This is a single center, randomized, trial that will enroll twenty (n=20) patients with a diagnosis of symptomatic cavernous malformations who are planned candidates for surgical resection by one of the investigators, and who meet all of the inclusion and exclusion criteria. Patients will be randomized into two groups: A Treatment group of ten (n=10) patients that will receive oral propranolol at a dose of 60mg per day (one 60mg ER capsule per day) for 7- to 10-days prior to surgery plus their usual medications, and a Control group of 10 (n=10) patients will receive only their routine medications. Currently, the only active treatment alternative for symptomatic cerebral cavernous malformations is surgery. A control group is required to allow for a semi-quantitative comparison with mRNA and miRNA levels in the treatment group.
Interventions
DRUGPropranolol
The medication will be administered so that patient receives a minimum of 7- days and maximum of 10-days of treatment with propranolol prior to planned surgical resection of CCM (routine care)
GENETICDNA and RNA Analysis
During the operative procedure, a small sample of the patient's blood will be obtained and small (1 to 2cc) tissue sample from the resected cavernous malformation will be collected. The blood and tissue samples will be labeled and stored for subsequent DNA and RNA analysis
Sponsors
St. Joseph's Hospital and Medical Center, Phoenix
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
Two groups, intervention and control
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject is at least 18-years of age. 2. Clinical and imaging diagnosis of a symptomatic Isolated cavernous malformation or Familial cavernous malformation 3. MRI Imaging Grade Type I or Type II (see Table 1) 4. Patient is considered a candidate for surgical resection of their cavernous malformation 5. Written and informed consent obtained prior to the study enrollment. 6. Negative pregnancy test at time of enrollment for women of child-bearing potential. 7. Heart rate greater than 50 beats per minute 8. Systolic blood pressure \> 90 mmHg
Exclusion criteria
1. Subject is less than 18-years of age. 2. History of allergy to propranolol or other beta blockers. 3. Patient is already taking another beta blocker for cardiac indications. 4. History of asthma presently requiring any active treatment (oral medications or inhalers). 5. History of cardiac dysfunction (as defined by the New York Heart Association Functional Classification grade II, III or IV). 6. Heart rate \< 50 beats per minute 7. Systolic blood pressure \< 90 mmHg 8. History of diabetes and currently on any anti-hyperglycemic medication. 9. Pregnant and lactating women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To measure effects of low-dose oral propranolol on global messenger RNA (mRNA) and microRNA (miRNA) expression in the blood and tissue of patients with CCM | -7 to -10 days until surgery | compare changes noted in mRNA and miRNA in blood and CCM tissue samples of patients who do and do not receive propranolol preoperatively for CCM |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| To correlate treatment response to propranolol with the underlying established mutations in cerebral cavernous malformation (CCM) genes. | -7 to -10 days until surgery | correlate and compare genetic mutations seen in CCM genes in tissue of patients who receive propranolol preoperatively |
| Record adverse event (tolerance to) related to low-dose oral propranolol (60mg ER once daily) | -7 to -10 days until surgery | Number of reported adverse events in patients taking propranolol |
Countries
United States
Outcome results
None listed