Head Trauma Clinical Trial
Official title:
Anti-secretory Factor as a Treatment for Adults With Severe Traumatic Head Injury
Introduction/Background Brain swelling/brain edema can occur due to many pathologies of the
brain, such as infections, ischemia and trauma.
The edema can be either primarily intra-cellular or extra-cellular. The mechanisms by which
edema arise are not fully known but it is proposed that inside the damaged brain, fluid will
pass over the blood-brain barrier of the vessels into the extra-cellular space. The
accumulation of fluid will lead to an increase in distance between the cell and its closest
capillary, which may lead to energy failure and intra-cellular edema. The extra volume of the
fluid leads to increased intracranial pressure, which in turn leads to an increase in blood
pressure, aggravating the edema. In addition to the physiological changes that occur, the
edema will be increased by the immunological response to the tissue damage with release of
pro-inflammatory cytokines that give rise to both extra- and intra-cellular edema.
Today, no treatment has been proven efficient against traumatic brain edema. AF -
anti-secretory factor is a 41 kDa protein that exists in humans and most animals. It was
discovered due to its ability to inhibit experimental diarrhea.
AF has been proven to have an effect on Mb Menière and glaucoma. In animal models, AF has
been proven efficient in reducing increased intracranial pressure caused by trauma and virus
infection in the brain.
Salovum®, an egg yolk powder enriched in AF, is registered in the European Union as a medical
food.
Methods: 5 adult patients with severe traumatic brain injury will be included in the trial
via next of kin consent.
Medical interventions are protocol based. The protocol includes first, second and third
treatment levels.
Patients included in the trial, will receive two micro-dialysis (MD) catheters in addition to
standard treatment. One catheter will be placed in a separate burr hole close to the ICP and
LICOX catheter, the other MD catheter will be placed in vicinity of the damaged barin tissue.
Patients will receive Salovum® 6 hours after trial inclusion. Patient dosage is 1g/kg body
weight/24 hours, divided into 6 doses and administered orally, via tubing every 4 hours for 5
consecutive days.
Objective: Primary end-point is to investigate if Salovum® has a beneficiary effect on ICP.
Secondary endpoints are to investigate if Salovum® has a beneficiary effect on treatment
intensity levels (TIL), brain-oxygenation, microdialysis bio-chemistry and cytokine
expression in plasma and microdialysate.
MD will be analysed bedside hourly for patient management, and the remaining MD samples will
be frozen in -70° C for later analysis of cytokines.
An extra blood sample will be drawn twice daily, blood will be centrifuged and plasma will be
frozen in -70° C for later analysis of cytokines.
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