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在啮齿动物中进行多实验室临床前试验,以评估急性缺血性脑卒中治疗候选药物。

A multi-laboratory preclinical trial in rodents to assess treatment candidates for acute ischemic stroke.

机构信息

Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine of USC, Los Angeles, CA 90033, USA.

Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA 90033, USA.

出版信息

Sci Transl Med. 2023 Sep 20;15(714):eadg8656. doi: 10.1126/scitranslmed.adg8656.

Abstract

Human diseases may be modeled in animals to allow preclinical assessment of putative new clinical interventions. Recent, highly publicized failures of large clinical trials called into question the rigor, design, and value of preclinical assessment. We established the Stroke Preclinical Assessment Network (SPAN) to design and implement a randomized, controlled, blinded, multi-laboratory trial for the rigorous assessment of candidate stroke treatments combined with intravascular thrombectomy. Efficacy and futility boundaries in a multi-arm multi-stage statistical design aimed to exclude from further study highly effective or futile interventions after each of four sequential stages. Six independent research laboratories performed a standard focal cerebral ischemic insult in five animal models that included equal numbers of males and females: young mice, young rats, aging mice, mice with diet-induced obesity, and spontaneously hypertensive rats. The laboratories adhered to a common protocol and efficiently enrolled 2615 animals with full data completion and comprehensive animal tracking. SPAN successfully implemented treatment masking, randomization, prerandomization inclusion and exclusion criteria, and blinded assessment of outcomes. The SPAN design and infrastructure provide an effective approach that could be used in similar preclinical, multi-laboratory studies in other disease areas and should help improve reproducibility in translational science.

摘要

人类疾病可以在动物身上建模,以允许对潜在的新临床干预措施进行临床前评估。最近,大型临床试验的高度公开失败引发了对临床前评估的严格性、设计和价值的质疑。我们建立了卒中临床前评估网络(SPAN),以设计和实施一项随机、对照、盲法、多实验室试验,对联合血管内血栓切除术的候选卒中治疗进行严格评估。多臂多阶段统计设计中的功效和无效性边界旨在在四个连续阶段中的每一个阶段后排除高度有效或无效的干预措施。六个独立的研究实验室在包括等量雄性和雌性的五种动物模型中进行了标准的局灶性脑缺血损伤:年轻小鼠、年轻大鼠、衰老小鼠、饮食诱导肥胖小鼠和自发性高血压大鼠。实验室遵守共同的方案,并有效地招募了 2615 只动物,这些动物的数据完整,并且对动物进行了全面跟踪。SPAN 成功地实现了治疗掩蔽、随机化、预随机化纳入和排除标准以及结果的盲法评估。SPAN 的设计和基础设施提供了一种有效的方法,可以用于其他疾病领域的类似临床前、多实验室研究,并且应该有助于提高转化科学的可重复性。

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