Cerebral Arterio-venous Malformation
Conditions
Keywords
Arterio-venous malformation, DMSO, Immune response, Cytokines
Brief summary
In our ICU, it could notice that patients with cerebral arterio-venous malformation (AVM) treated with embolization develop more severe Ventilator Associated Pneumoniae (VAP) compare to other patients hospitalized for neurological diseases. The Dimethylsulfoxyde (DMSO), the solvent of the embolization implant, is known to have immune effect on vitro analysis. The investigator want to prove that exposition to embolization implant for a cerebral AMV modify the cytokines production involved the system immune's regulation.
Detailed description
Cerebral AVM are defined by abnormal connections between arteries and veins. For treatment of this vascular malformation, embolization is the gold standard. Embolization agent is made with vinylic alcohol ethylene (EVOH) copolymer which (the embolization implant) and the DMSO which is the solvent. During the injection of the product, DMSO dissipates in the bloodstream, and the EVOH precipitates and forms the embolus. It knows that DMSO had in-vitro immune effect (inhibits signalizations ways of innate and acquired immune response, decrease of pro-inflammatory cytokines production and decrease INF-γ and TNF-α production). DMSO could decrease activation and recruitment of leukocytes, which could expose patients to an increased risk of infection. The investigator will dose cytokines in 3 blood samples (preoperative, H+6 and H+24) in planned patient's hospitalized for cerebral AVM embolization. The cytokine content of the plasmas will be analyzed with multiplex ELISA technic
Interventions
OTHERBlood sample
Based on supplementary blood sampled before embolization procedure and 6 hours and 24 hours after we will be analyzed cytokines concentration (Elisa test) and cortisol
Sponsors
University Hospital, Limoges
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult hospitalized for a planned cerebral embolization
Exclusion criteria
* Immunosuppressed patient or immunosuppressive treatment (corticosteroid included) * Patient with auto-immune disease * Hospitalization in ICU or for a planned or emergency surgery in the past three months * Hospitalization for an active infection in the past three months * Pregnancy * Patients requiring steroid therapy to prevent postoperative nausea and/or vomiting
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in blood concentrations of cytokines of the innate immune response | Hour 0 and Hour 6 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g) of the innate immune response between patients who underwent a cerebral AVM embolization procedure with patients who underwent a cerebral aneurysm embolization procedure between the expected peak at H6 and H0 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| blood concentrations of cytokines of adaptive and innate immune response | Hour 0 and Hour 24 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g) of adaptive and innate immune response between patients with cerebral AVM embolization procedures and brain aneurysms embolization |
| blood concentrations of cytokines | Hour 6 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g)according to the duration of the embolization procedure at H6 |
| blood concentrations of cytokines of adaptive immune response | Hour 0 and Hour 6 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g)of adaptive immune response between patients with cerebral AVM embolization procedures and brain aneurysms embolization between the expected peak at H6 and H0 |
| blood concentrations of cytokines according to the volume of embolizing agent | Hour 0 and Hour 6 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g)according to the volume of embolizing agent |
| blood concentrations of cytokines according to the embolizing agent | Hour 0 and Hour 6 | Compare blood concentrations of cytokines (IL-1N, IL-10, IL-12p70, IL-6, IL-2, IL-4, IL-17A; TNF-a, TGF-b1, IFN-g)according to the embolizing agent used during the procedure |
| Cortisol production | Hour 0 and Hour 6 | Comparison of cortisol levels before and after AMV embolization procedure |
| lymphocyte subpopulations differences | Hour 24 and Hour 0 | Measurement of differences in lymphocyte subpopulations in patients with cAVM embolization procedure and cerebral aneurysm between the expected peak H24 and H0 in 10 patients in each arm |
Countries
France
Outcome results
None listed