创伤性脑损伤治疗的临床前测试。

Pre-Clinical Testing of Therapies for Traumatic Brain Injury.

机构信息

1 Department of Anesthesiology, University of Texas Medical Branch , Galveston, Texas.

2 Department of Neurological Surgery, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.

出版信息

J Neurotrauma. 2018 Dec 1;35(23):2737-2754. doi: 10.1089/neu.2018.5778. Epub 2018 Aug 30.

Abstract

Despite the large number of promising neuroprotective agents identified in experimental traumatic brain injury (TBI) studies, none has yet shown meaningful improvements in long-term outcome in clinical trials. To develop recommendations and guidelines for pre-clinical testing of pharmacological or biological therapies for TBI, the Moody Project for Translational Traumatic Brain Injury Research hosted a symposium attended by investigators with extensive experience in pre-clinical TBI testing. The symposium participants discussed issues related to pre-clinical TBI testing including experimental models, therapy and outcome selection, study design, data analysis, and dissemination. Consensus recommendations included the creation of a manual of standard operating procedures with sufficiently detailed descriptions of modeling and outcome measurement procedures to permit replication. The importance of the selection of clinically relevant outcome variables, especially related to behavior testing, was noted. Considering the heterogeneous nature of human TBI, evidence of therapeutic efficacy in multiple, diverse (e.g., diffuse vs. focused) rodent models and a species with a gyrencephalic brain prior to clinical testing was encouraged. Basing drug doses, times, and routes of administration on pharmacokinetic and pharmacodynamic data in the test species was recommended. Symposium participants agreed that the publication of negative results would reduce costly and unnecessary duplication of unsuccessful experiments. Although some of the recommendations are more relevant to multi-center, multi-investigator collaborations, most are applicable to pre-clinical therapy testing in general. The goal of these consensus guidelines is to increase the likelihood that therapies that improve outcomes in pre-clinical studies will also improve outcomes in TBI patients.

摘要

尽管在实验性创伤性脑损伤 (TBI) 研究中已经确定了大量有前途的神经保护剂,但在临床试验中,没有一种药物在长期结果上显示出有意义的改善。为了制定 TBI 药物或生物治疗的临床前测试建议和指南,Moody 创伤性脑损伤转化研究项目主办了一次研讨会,邀请了在临床前 TBI 测试方面具有丰富经验的研究人员参加。研讨会参与者讨论了与临床前 TBI 测试相关的问题,包括实验模型、治疗和结果选择、研究设计、数据分析和传播。共识建议包括创建一份标准操作程序手册,其中对建模和结果测量程序进行了足够详细的描述,以允许复制。强调了选择与临床相关的结果变量的重要性,特别是与行为测试相关的变量。考虑到人类 TBI 的异质性,鼓励在多种、不同的(例如,弥漫性与聚焦性)啮齿动物模型中以及在临床测试前具有脑回的物种中证明治疗效果。建议根据测试物种中的药代动力学和药效学数据来确定药物剂量、时间和给药途径。研讨会参与者一致认为,公布阴性结果将减少昂贵且不必要的重复进行不成功的实验。虽然有些建议更适用于多中心、多研究人员合作,但大多数建议适用于一般的临床前治疗测试。这些共识指南的目标是增加在临床前研究中改善结果的治疗方法也能改善 TBI 患者结果的可能性。

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