VNS Prospective Neuromodulation of Immune and Gastrointestinal Systems

NCT03953768 | Recruiting FDA Device

• 1 other identifier: 19.0330
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 4

Brief Summary

Vagal nerve stimulation is a neurosurgical procedure consisting of implantation of an impulse generator battery with leads placed into the vagus nerve in the neck. This procedure was FDA approved for epilepsy in the 1990s and is commonly performed as an outpatient surgery. The mechanism of action is not well understood; however it is increasingly recognized that electrical stimulation of the vagus nerve may impact other organ systems in the body including the immune and gastrointestinal systems. Concrete characterization of the peripheral effects of VNS in human gut microbiome and immune systems will: (1) elucidate peripheral mechanism of action of chronic VNS therapy, (2) identify peripheral preoperative biomarker of VNS efficacy, and (3) create a foundation for research investigating new GM and IM-related disease indications for VNS. The primary objective of this study is to characterize the pre- and post-operative oral and gut microbiome of patients implanted with vagal nerve stimulator (VNS) for epilepsy. Secondary objectives of this study include: (1) to characterize the pre-operative and post-operative immune profile of patients undergoing VNS implantation for epilepsy, (2) to elucidate whether oral and/or gut microbiota changes are related to VNS efficacy for epilepsy and (3) identification of a biomarker predicting VNS efficacy.

Conditions

Autoimmune Diseases; Epilepsy; Autonomic Dysfunction; Inflammatory Bowel Diseases

Keywords

epilepsy; vagal; autoimmune; autonomic; inflammatory bowel disease; immune

Outcome Measures

Primary Outcomes (9)

• Metagenomic microbiome profile

  Stool and saliva specimens will be used to generate metagenomic profiles of gut flora populations. Pre- and post-VNS gut profiles will be compared. It is important to note that the genomic profile of all gut flora is the outcome, rather than the presence or absence of any specific type of bacteria.

  1 year

• Bowel movement frequency

  A brief clinical questionnaire regarding the frequency and consistency of bowel movements will be administered. This will be done pre- and post-VNS implantation in each patient. Any medications to manage diarrhea and constipation will be carefully recorded as well as their efficacy.

  1 year

• Bowel habits

  A clinical bowel habits questionnaire will be administered at each study visit to determine changes in bowel habits pre and post operatively. Additionally, the Bristol stool scale will be assessed at each visit.

  1 year

• Immune Profile 1 - Flow cytometric profiling of cell populations

  One milliliter of whole blood from each subject will be aliquoted into separate tube and directly stained with fluorochrome-conjugated antibodies to investigate the cellular composition of the blood. Subtypes of lymphocytes, monocytes and granulocytes will be defined by set phenotypic marker expression

  1 year

• Immune Profile 2 - Ex vivo stimulation of cells in whole blood

  Up to 10 ml of the whole blood will be cultured in 24-well tissue culture plates in the presence and absence of innate immune cell activators, such as TLR ligands, LPS, CpG ODN, poly I:C or flagellin, or adaptive immune activators such as anti-CD3/anti-CD28 beads, PHA or recall antigens. Culture supernatants and cells will be harvested at the needed time points and analyzed via MSD and qPCR, respectively.

  1 year

• Inflammatory Profile 1 - Meso Scale Discovery (or MSD) analysis for pro-inflammatory cytokines/chemokines

  Serum electrochemiluminescence detection analysis of the following cytokines/chemokines: IFNg, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, TNFα. Units in Picograms/ml or Nanograms/ml depending on the specific chemokine/cytokine

  1 year

• Inflammatory Profile 2 - Meso Scale Discovery (or MSD) analysis for metabolic hormones

  Serum electrochemiluminescence detection analysis of the following hormones: GLP-1, insulin, Glucagon, Leptin. All in picograms/mL.

  1 year

• Inflammatory Profile 3 - Metabolomics for Short Chain Fatty acids (SCFAs)

  Short Chain Fatty Acids (SCFAs) in both feces and serum will be derivatized, extracted in organic solvent and analyzed using Gas chromatography-mass spectrometry (GC-MS) to determine the levels of short-chain fatty acids. To the microbial community SCFAs are a necessary waste product, required to balance redox equivalent production in the anaerobic environment of the gut. SCFAs are saturated aliphatic organic acids that consist of one to six carbons of which acetate (C2), propionate (C3), and butyrate (C4) are the most abundant (≥95%). Acetate, propionate, and butyrate are present in an approximate molar ratio of 60:20:20 and will be measured in picomoles/mL.

  1 year

• Inflammatory Profile 4 - Intestinal inflammation and permeability markers

  sCD163 (nanograms/mL), sCD14 (micrograms/mL), CRP (mg/L), and I-FABP (picograms/mL) are markers of intestinal inflammation and permeability and will be measured using an enzyme-linked immunosorbent assay (ELISA) performed on cell-free supernatants such as plasma, serum and urine. The units of measurement

  1 year

Secondary Outcomes (1)

• Epilepsy severity

  1 year

Study Arms (1)

Patients undergoing device implantation

EXPERIMENTAL

Patients undergoing device implantation with vagal nerve stimulator (VNS) for epilepsy

Device: Vagal nerve stimulation (VNS)

Interventions

Vagal nerve stimulation (VNS) DEVICE

Implantation with vagal nerve stimulator for epilepsy

Also known as: Cyberonics VNS

Patients undergoing device implantation

Eligibility Criteria

• Age: 0 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Undergoing VNS implantation for the first time as a treatment for epilepsy and
• Documented follow up with a Louisville-based neurologist in the past 1 year. If at the University of Utah or Baylor University documented ability to travel to their corresponding neurologist.
• Documented ability to travel to Louisville for outpatient medical care. If at the University of Utah or Baylor University documented ability to travel to their facilities.

You may not qualify if:

• Previous treatment with VNS (other than the one implanted for this study)
• Current pregnancy (contraindication to surgery)
• Active infection
• History of cancer or treatment with chemotherapy
• History of autoimmune disease: Patients who received high effect anticholinergic medication within 30 days of enrollment will be excluded, whereas moderate to low effect anticholinergic medication will be discussed with and decided by the PI.
• If any high effect anticholinergic medication is started after enrollment, it will be the PI's decision to drop or postpone the corresponding visit or exclude the patient entirely.
• Patients who received high effect corticosteroids within 30 days of enrollment will be excluded, whereas moderate to low effect corticosteroids will be discussed with and decided by the PI.
• If any high effect corticosteroid is started after enrollment, it will be the PI's decision to drop or postpone the corresponding visit or exclude the patient entirely.
• Treatment with antiarrhythmic or (heart) rate controlling medication,
• Pre-existing cardiac arrhythmia or presence of cardiac pacemaker / defibrillator

Sponsors & Collaborators

• University of Louisville: lead
• LivaNova: collaborator
• Norton Foundation: collaborator

Study Sites (4)

Norton Healthcare

Louisville, Kentucky, 40202, United States

NOT YET RECRUITING

University of Louisville

Louisville, Kentucky, 40202, United States

RECRUITING

Texas Children's Hospital

Houston, Texas, 77030, United States

ACTIVE NOT RECRUITING

Primary Children's Hospital/University of Utah

Salt Lake City, Utah, 84113, United States

RECRUITING

MeSH Terms

Conditions

Autoimmune Diseases; Epilepsy; Primary Dysautonomias; Inflammatory Bowel Diseases

Interventions

Vagus Nerve Stimulation

Condition Hierarchy (Ancestors)

Immune System Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Autonomic Nervous System Diseases; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases

Intervention Hierarchy (Ancestors)

Electric Stimulation Therapy; Therapeutics

Central Study Contacts

Ian S Mutchnick, MD

CONTACT

5026295512; ianmutchnick@gmail.com

Meena A Vessell, MD

CONTACT

mavessel@texaschildrens.org

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Neurosurgery

Model Details: Prospective single-arm with internal control group

Study Record Dates

• First Submitted: April 15, 2019
• First Posted: May 17, 2019
• Study Start: April 1, 2021
• Primary Completion: December 13, 2025
• Study Completion (Estimated): December 31, 2026
• Last Updated: November 25, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

US (4)