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Role of Neutrophil Activation in Anaphylaxis to Curare (NASA)

This study is currently recruiting participants.
Verified February 2013 by Assistance Publique - Hôpitaux de Paris
Sponsor:
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris
ClinicalTrials.gov Identifier:
NCT01637220
First received: June 4, 2012
Last updated: March 4, 2013
Last verified: February 2013
History of Changes
  Purpose

In about 10% of preoperative anaphylactic reactions to curare (114 patients analyzed at the BICHAT Hospital), a classical mechanism (mast cell- and IgE-dependent) is not identified. The mechanisms underlying these atypical anaphylactic reactions are unknown. The investigators have developed at the Pasteur Institute a murine model of anaphylaxis in which neutrophils, IgG and Platelet Activating Factor (PAF) play predominant roles. In addition, preliminary results obtained at the BICHAT Hospital suggest the presence of specific IgG anti-quaternary ammonium in the sera of patients that had developed a shock to curare anesthesia, but not in controls exposed to curare anesthesia or in normal blood donors. Finally, the release of neutrophil extracellular traps (NETs), extracellular filaments made of DNA and histones, may contribute to respiratory symptoms.

HYPOTHESIS: Neutrophils are implicated in curare-induced anaphylactic reactions in humans. Activated by IgG-curare complexes, which aggregate IgG receptors, neutrophils release PAF and NETs that are implicated in the cardiac and respiratory distress during anaphylaxis. It is possible that the activation of neutrophils: 1) explains the clinical features of atypical anaphylactic reactions (non-IgE mediated), 2) participates also in part to classical anaphylactic reactions

GENERAL OBJECTIVE: Compare the percentage of circulating activated neutrophils in a group of patients immediately following a curare-induced shock (case) to that of a group of patients exposed to curare during anesthesia without developing a shock (control).

SECONDARY OBJECTIVES: A) the day of the shock, quantify and compare between case and controls, 1) the level of circulating anti-quaternary ammonium IgG by immuno fluorometry, 2) the expression of IgG receptors (FcR) on the surface of neutrophils by cytometry, 3) the levels of circulating PAF by mass spectrometry, 4) the amount of NETs by immunofluorescence.

B) 6 to 10 weeks after the shock perform, 1) cutaneous tests to curare, 2) a study of the capacity of stimulation of ex vivo neutrophils by IgG-curare complexes


Condition Intervention
Anaphylactic Shock to Curare
 Biological: Blood volume collected specifically for this study

Study Type: Observational
Study Design: Observational Model: Case Control
Time Perspective: Prospective
Official Title: Role of Neutrophil Activation in Anaphylaxis to Curare

Resource links provided by NLM:

MedlinePlus related topics: Shock
U.S. FDA Resources

Further study details as provided by Assistance Publique - Hôpitaux de Paris:

Primary Outcome Measures:
  • Percentage of circulating activated neutrophils in the group case compared to that of the group of control. [ Time Frame: 30min post-anaphylactic shock ] [ Designated as safety issue: No ]
    This measure will be based on the intensity of expression of the activation marker CD62L (L-selectin) by blood neutrophils using flow cytometry. Our preliminary data indicate that the Mean Fluorescence Intensity (MFI) of CD62L is >450 when considering " non-activated " neutrophils, and CD62L(MFI)<300 when considering " activated " neutrophils.


Secondary Outcome Measures:
  • the group case compared to the group of control. [ Time Frame: 30min post-anaphylactic shock ] [ Designated as safety issue: No ]
    Levels of anti-quaternary ammonium specific IgG in the plasma of "cases" than in the plasma of "controls"

  • the group case compared to the group of control. [ Time Frame: 30min post-anaphylactic shock ] [ Designated as safety issue: No ]
    Ex vivo activation capacity of blood neutrophils in the presence of neuromuscular blocking drug-IgG immune complexes

  • the group case compared to the group of control. [ Time Frame: 30min post-anaphylactic shock ] [ Designated as safety issue: No ]
    Presence of Neutrophil Extracellular Traps in the bronchial aspiration fluid of "cases"


Estimated Enrollment: 200
Study Start Date: August 2012
Estimated Study Completion Date: August 2014
Estimated Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
case, control
Blood volume collected specifically for this study
 Biological: Blood volume collected specifically for this study
  • case patient: 10 ml after the anaphylactic reaction, and during the Allergology-Anesthesia consult 6 to 8 weeks after the shock le choc.
  • Control patients: 20 ml following neuromuscular blocking drug injection
Other Name: Blood volume collected specifically for this study

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Selection of cases :

  • Any patient of age 18 and over:
  • Presenting with clinical signs compatible with a perioperative anaphylactic reaction to neuromuscular blocking drugs, whatever the grade of the anaphylactic reaction
  • That was treated following the French Patient Management 2011 guidelines

Selection of controls:

  • Any patient of age 18 and over
  • Hospitalized for a surgical intervention necessitating a neuromuscular blocking drug injection, without developing an anaphylactic reaction
  • That had been informed of the particulars of the study and that had consented to participate in this study
Criteria

Selection of cases :

INCLUSION CRITERIA:

  • Any patient of age 18 and over:
  • Presenting with clinical signs compatible with a perioperative anaphylactic reaction to neuromuscular blocking drugs, whatever the grade of the anaphylactic reaction
  • That was treated following the French Patient Management 2011 guidelines

EXCLUSION CRITERIA:

- patient dying during the anaphylactic shock

Selection of controls:

INCLUSION CRITERIA :

  • Any patient of age 18 and over
  • Hospitalized for a surgical intervention necessitating a neuromuscular blocking drug injection, without developing an anaphylactic reaction
  • That had been informed of the particulars of the study and that had consented to participate in this study

EXCLUSION CRITERIA: none

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01637220

Locations
France
Hospital BICHAT Recruiting
Paris, France, 75018
Contact: Sylvie Chollet-Martin, MD-PhD     +33-1-4025-8521     sylvie.martin@bch.aphp.fr    
Contact: Pierre Bruhns, PhD     +33-1-4568-8629     bruhns@pasteur.fr    
Principal Investigator: Sylvie Chollet-Martin, MD-PhD            
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Investigators
Principal Investigator: Sylvie Chollet-Martin, MD-PhD Assistance Publique - Hôpitaux de Paris
  More Information

No publications provided

Responsible Party: Assistance Publique - Hôpitaux de Paris
ClinicalTrials.gov Identifier: NCT01637220     History of Changes
Other Study ID Numbers: P110909, 2012-A00242-41
Study First Received: June 4, 2012
Last Updated: March 4, 2013
Health Authority: United States: Food and Drug Administration
France: Ministry of Health

Keywords provided by Assistance Publique - Hôpitaux de Paris:
Anaphylaxis
Neutrophils
Platelet activating factor
Neutrophil Extracellular Traps (NETs)

Additional relevant MeSH terms:
Anaphylaxis
Hypersensitivity, Immediate
Hypersensitivity
Immune System Diseases

ClinicalTrials.gov processed this record on May 23, 2013