Minocycline for Aneurysmal Subarachnoid Hemorrhage (MASH)
Status:
Active, not recruiting
Trial end date:
2022-06-30
Target enrollment:
Participant gender:
Summary
Previous work has demonstrated patients presenting with ruptured aneurysms that develop
radiographic and clinical vasospasm have a higher permeability of the blood brain membrane.
Matrix metalloproteinase 9 (MMP9) has been studied and recently implicated in both the
pathogenesis of the blood brain barrier breakdown and vasogenic edema of ischemia strokes,
and is suggested to be an accurate biomarker to predict the onset of cerebral vasospasm after
subarachnoid hemorrhage. The therapeutic benefit of minocycline, an MMP9 inhibitor, has been
investigated in ischemic stroke population, however its role in the treatment of cerebral
vasospasm from ruptured aneurysms remains unknown. Our project has two main goals: to further
confirm MMP9 has a reliable biomarker for the onset of cerebral vasospasm, and secondarily to
investigate any possible therapeutic benefit that minocycline has in the vasospasm
population. Vasospasm continues to be one of the major contributors of morbidity and
mortality in the ruptured aneurysm population, and close monitoring of the neurologic exam
during the 'vasospasm window' usually requires two weeks in the intensive care unit in most
academic settings. As such, if we are better able to predict which patients are at risk of
developing vasospasm based on MMP9 levels, we will be better able to anticipate the need for
intervention and therefore mitigate the risk of vasospasm induced ischemic strokes,
ultimately resulting in better outcomes in the ruptured aneurysm population. Further, if we
are able to identify minocycline as a therapeutic agent to deter, or lessen the severity of
vasospasm, we can possibly improve neurologic outcomes, decrease hospital stays, ultimately
providing an improved and more cost-effective treatment strategy to our patients.