Biological Effects of Ultrasound Insonification of the Spleen

Healthy Volunteer Clinical Trial

Official title:

Biological Effects of Ultrasound Insonification of the Spleen

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03548116
• Other study ID #: 17-0859
• Status: Active, not recruiting
• Phase: N/A
• Start date: April 23, 2018
• Est. completion date: November 2022

Study information

• Verified date: December 2021
• Source: Northwell Health
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a seven-cohort, double-blinded, randomized, sham-controlled feasibility trial to determine whether organ-specific biological effects are achievable through selective ultrasound of the spleen utilizing low-energy insonification.

Description:

This study will consist of three study visits. At the screening visit, individuals will be asked to undergo a physical and neurological examination, a blood draw of 4 teaspoons, and a urine pregnancy test if of childbearing potential. The participants that clear study screening will be randomized to one of seven groups. The groups consist of: sham insonification at the hilum (connected probe or disconnected probe); half-powered insonification at the hilum; full-powered insonification at the hilum; sham insonification at the lower, middle, and upper spleen; half-powered insonification at the lower, middle, and upper spleen; and full-powered insonification at the lower, middle, and upper spleen. At the baseline visit, individuals will be asked to undergo a physical and neurological examination and a blood draw of 7 teaspoons before receiving ultrasound as per their assigned group. These individuals will then be asked to undergo a blood draw of 5 teaspoons at 1-hour and 2-hours after the ultrasound. Individuals will be asked to return 24 hours later for the follow-up visit, which will include a physical and neurological examination and a blood draw of 9 teaspoons. The blood samples collected before insonification, one hour after insonification, two hours after insonification, and twenty-four hours after insonification will be assessed for changes in biomarkers (substances in the body that indicate the status of a biological process or condition). These biomarkers include cytokines (proteins involved in the immune response), norepinephrine (chemical in the body that transmits signals), glucose (sugar in the blood), and blood cells that are involved in breathing, clotting, and the immune response. The study will be considered complete after completion of enrollment (10 participants in each group, for a study total of 70 participants), completion of study procedures by all participants, and the completion of analysis of identifiable study data.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 137
• Est. completion date: November 2022
• Est. primary completion date: March 13, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 45 Years

Eligibility

Inclusion Criteria:

• Individuals between 18 and 45 years of age
• Individuals without physical disabilities or conditions/diseases that may make them incapable of undergoing the study procedures or otherwise places them at a greater risk of harm
• Individuals without significant past medical or surgical histories that would render them at a greater risk of harm
• Individuals that are considered English Proficient due to the study requirements to follow verbal commands during the ultrasound session
• Individuals that are considered active as assessed by type of activity (i.e., walking, running, etc.) and number of hours a week performing the various activities
• Individuals able to attend all study visits at approximately the same time of day (i.e., 8 - 12 pm)
• Individuals that are able to comprehend the study goals and procedures, and are able to provide informed consent for participation

Exclusion Criteria:

• Individuals participating in another research study that may affect the conduct or results of this study
• Individuals considered substantially overweight or obese via body mass index (= 29)
• Individuals having or exhibiting any of the following:
• surgery in the past 90 days
• previous surgery of the spleen or splenectomy, esophagus, lungs, stomach, duodenum, or liver
• recent traumatic injury, including intracerebral hemorrhage and visceral injury
• end stage renal disease and/or uremia
• active malignancy
• previous leukemia and/or lymphoma
• human immunodeficiency virus infection or AIDS
• rheumatoid arthritis or other immune-mediated diseases (e.g. inflammatory bowel disease)
• arrhythmias, including but not limited to, atrial fibrillation, atrial flutter, clinically significant bradycardia, ventricular arrhythmias, and A-V block
• implanted pacemaker or cardioverter/defibrillator (AICD)
• a history of stable or unstable angina, myocardial infarction, angioplasty or coronary arterial by-pass grafting surgery
• history of stroke or TIA
• history of deep venous thrombosis (DVT) and/or pulmonary embolism (PE)
• previous episodes of pancreatitis
• spinal disorders
• chronic pain syndromes
• history of thrombosis or bleeding disorders
• stage III-IV pressure ulcers
• sickle cell anemia or other anemia syndromes
• monocytosis
• thrombocytopenia
• diagnosed with fever of unknown origin (FUO)
• previously or currently implanted vagus nerve stimulator
• previously or currently implanted spinal cord stimulator
• other chronically-implanted electronic medical device
• history of seizures
• history of cancer
• Individuals who have taken any of the following medications within one week of

receiving ultrasound delivery:

• anti-coagulant (Coumadin, Xarelto)
• anti-platelet (aspirin, Plavix)
• anti-inflammatory (aspirin, NSAIDs)
• anti-hypertensive (a-methyldopa)
• epinephrine-related drugs, norepinephrine-related drugs, and drugs that stimulate release of epinephrine and/or norepinephrine (Micronefrin, Asthmanefrin)
• immunosuppressive agents (steroids, newer immunomodulatory drugs)
• alpha and/or beta adrenoceptor blocking agents
• anti-seizure medications
• other medications, supplements, etc. that may interfere with the ultrasound delivery or study results
• Individuals with a substance abuse (alcoholism or other) problem
• Individuals that consumed alcohol within 4 days of the baseline visit
• Individuals currently using or have used tobacco or nicotine products within the past 1 month
• Individuals currently using or have used recreational drugs within the past 1 month
• Pregnant women
• Prisoners

Related Conditions & MeSH terms

• Healthy Volunteer

Intervention

Device:
• Ultrasound
A specially designed ultrasound will be placed against the abdomen of an individual in order to administer low levels of insonification to the spleen.
• Sham Ultrasound
A specially designed ultrasound will be placed against the abdomen of an individual in order to administer sham insonification to the spleen.

Locations

Country	Name	City	State
United States	Northwell Health's The Feinstein Institute for Medical Research	Manhasset	New York

Sponsors (2)

Lead Sponsor	Collaborator
John Pellerito	General Electric

Country where clinical trial is conducted

United States, 

References & Publications (7)

Birk DM, Yin D, Slavin KV. Regulation of Peripheral Nerve Stimulation Technology. Prog Neurol Surg. 2015;29:225-37. doi: 10.1159/000434674. Epub 2015 Sep 4. Review. — View Citation

Juan EJ, González R, Albors G, Ward MP, Irazoqui P. Vagus Nerve Modulation Using Focused Pulsed Ultrasound: Potential Applications and Preliminary Observations in a Rat. Int J Imaging Syst Technol. 2014 Mar 1;24(1):67-71. — View Citation

Koopman FA, Chavan SS, Miljko S, Grazio S, Sokolovic S, Schuurman PR, Mehta AD, Levine YA, Faltys M, Zitnik R, Tracey KJ, Tak PP. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc Natl Acad Sci U S A. 2016 Jul 19;113(29):8284-9. doi: 10.1073/pnas.1605635113. Epub 2016 Jul 5. — View Citation

Martelli D, McKinley MJ, McAllen RM. The cholinergic anti-inflammatory pathway: a critical review. Auton Neurosci. 2014 May;182:65-9. doi: 10.1016/j.autneu.2013.12.007. Epub 2013 Dec 24. Review. — View Citation

Parker JL, Cameron T. Technology for Peripheral Nerve Stimulation. Prog Neurol Surg. 2015;29:1-19. doi: 10.1159/000434651. Epub 2015 Sep 4. Review. — View Citation

Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest. 2007 Feb;117(2):289-96. Review. — View Citation

Zeng W, Pirzgalska RM, Pereira MM, Kubasova N, Barateiro A, Seixas E, Lu YH, Kozlova A, Voss H, Martins GG, Friedman JM, Domingos AI. Sympathetic neuro-adipose connections mediate leptin-driven lipolysis. Cell. 2015 Sep 24;163(1):84-94. doi: 10.1016/j.cell.2015.08.055. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Anti-inflammatory Response	The primary outcome to determine whether diagnostic-level ultrasound to the spleen has a biological effect is measured as a statistically significant change in the level of biomarkers associated with the inflammatory response following delivery of ultrasound.	The primary outcome will be assessed before ultrasound and at 1-hour, 2-hours, and 24-hours after receiving ultrasound.
Secondary	Transient Tissue Displacement	The secondary outcome to determine whether ultrasound delivery to the spleen leads to transient tissue displacement that is correlated to organ-specific biological effects is measured as a statistically significant correlation between the magnitude of transient displacement and the biological effects.	The secondary outcome will be assessed approximately every 15 seconds during the approximately 10-minute ultrasound.

External Links

•   Electrical Prescriptions
•   Stimulating Peripheral Activity to Relieve Conditions (SPARC)
•   Ultrasonic Stimulation of Peripheral Nervous Tissue