- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03534154
Developing and Validating Blood and Imaging BIOmarkers of AXonal Injury Following Traumatic Brain Injury (BIO-AX-TBI)
March 29, 2022 updated by: Imperial College London
Observational longitudinal study assessing outcomes following moderate-severe traumatic brain injury (TBI).
Study Overview
Status
Completed
Conditions
Detailed Description
Traumatic brain injury (TBI) occurs when the brain is physically damaged, for example after a car crash.
It is common and survivors often have major on-going problems.
It is very difficult to predict how patients will do after TBI.
One reason for this is that clinicians and researchers are unable to measure all the effects of TBI.
An important factor is that the connections between nerve cells are damaged by the impact on the brain of an injury (axonal injury).
This damage has been difficult to measure in the past, but new ways to scan the brain and more sensitive ways of picking up the effects of this injury in the blood could change this.
In other parts of medicine tests of this type have had a dramatic effect on how clinicians treat patients.
For example, the products of heart muscle damage that have leaked into the blood can be used identify a heart attack and guide treatment.
Clinicians need similar tests to be available in TBI.
This should be possible as the products of axonal injury also leak into the blood and researchers have a sensitive way to pick this up.
An accurate test for axonal injury would guide treatment choices and allow clinicians to predict how patients will recover.
The investigators have brought together an international team who have been working on different aspects of this problem for many years.
Together the investigators will conduct a large study to identify the best measures of axonal injury.
The investigators will carefully test whether these measures help predict outcomes and will study where the blood markers come from using a safe method to measure the effects of axonal injury directly from the brain.
The work links into some large projects that have already started and will use a standard way to assess patients after their injury.
This is important because it will allow researchers to share results across studies.
The investigators hope the work will allow us to identify a blood marker for TBI that could be widely used to quickly identify the presence of axonal injury.
The investigators will also show what brain imaging measure is best at picking up axonal injury and how best to combine the measures to best predict how patients recover.
This will allow doctors to diagnose problems after TBI more accurately, choose the right treatments and give patients and their families accurate advice about what will happen after discharge from hospital.
Study Type
Observational
Enrollment (Actual)
313
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Milan, Italy
- Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico
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Milan, Italy
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri"
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Ljubljana, Slovenia
- University Medical Centre
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Lausanne, Switzerland
- Centre Hospitalier Universitaire Vaudois
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London, United Kingdom, W12 0NN
- Imperial College London
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 78 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Non-Probability Sample
Study Population
250 traumatic brain injury patients from ITU / major trauma ward.
Description
Inclusion Criteria:
- A diagnosis of moderate/severe traumatic brain injury (TBI) as classified using the Mayo classification system;
- Healthy controls will be age-matched to our TBI patients and will not have a history of significant neurological or psychiatric conditions.
Exclusion Criteria:
- Unwillingness or inability to follow the procedures required
- Bilateral fixed dilated pupils
- For MRI, contra-indication to MRI scanning, assessed by a standard pre-MRI questionnaire (e.g. presence of ferromagnetic implants in the body, claustrophobia, pregnancy) if considered for the imaging strand of the study.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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TBI - MRI / bloods / cognitive / clinical outcomes
Work package 1.
In a large multi-centre cohort of adult moderate/severe TBI patients we aim to identify the most informative plasma biomarker(s) of the severity of axonal injury.
We will characterise their time course, focusing on neurofilament light (NFL) and tau, and relate these to magnetic resonance imaging (MRI) measures of axonal injury.
Using logistic regression we will then test whether these measures contribute to the prediction of clinical outcome at twelve months
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Magnetic Resonance Imaging
Sampling of serum
Battery of tests to assess cognitive function, patient outcomes
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TBI - Advanced MRI / bloods / cognitive / clinical outcomes
Work package 2. In a subgroup of the patients recruited to WP1 we will use advanced MRI and longitudinal assessments to provide a more detailed description of the relationship between the plasma biomarkers and outcome after TBI.
We will test whether advanced diffusion and myelin integrity measures correlate with plasma biomarkers and whether early plasma biomarker levels predict neurodegeneration measured by progressive atrophy after TBI.
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Magnetic Resonance Imaging
Sampling of serum
Battery of tests to assess cognitive function, patient outcomes
Advanced MRI
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TBI - microdialysis / adv. MRI / cognitive / clinical
Work package 3.
In a second subgroup of patients recruited to WP1 we will combine microdialysis, neuroimaging and plasma sampling of axonal proteins to provide a deeper understanding of the mechanisms of axonal injury progression and use this approach to investigate the axonal origin of the plasma biomarkers.
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Magnetic Resonance Imaging
Sampling of serum
Battery of tests to assess cognitive function, patient outcomes
Advanced MRI
Monitoring of cerebral fluid protein levels
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Healthy volunteer
Single assessment using MRI, bloods and cognitive testing.
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Magnetic Resonance Imaging
Sampling of serum
Battery of tests to assess cognitive function, patient outcomes
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change in diffusion tensor imaging measures over time
Time Frame: 10 days - 6 weeks, 6 months and 12 months
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Fractional anisotropy (FA)
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10 days - 6 weeks, 6 months and 12 months
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Brain atrophy rates
Time Frame: 10 days - 6 weeks, 6 months and 12 months
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Brain tissue volume changes over time.
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10 days - 6 weeks, 6 months and 12 months
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Change in levels of fluid biomarkers in blood
Time Frame: 0-5 days, 5-10 days, 10 days - 6 weeks, 6 months and 12 months
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Neurofilament light and Tau protein
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0-5 days, 5-10 days, 10 days - 6 weeks, 6 months and 12 months
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Change in levels of fluid biomarkers in cerebral fluid
Time Frame: 48 hours to 7 days
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Neurofilament light and Tau protein
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48 hours to 7 days
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: David Sharp, Imperial College London
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 30, 2017
Primary Completion (Actual)
April 30, 2021
Study Completion (Actual)
December 30, 2021
Study Registration Dates
First Submitted
April 27, 2018
First Submitted That Met QC Criteria
May 11, 2018
First Posted (Actual)
May 23, 2018
Study Record Updates
Last Update Posted (Actual)
March 31, 2022
Last Update Submitted That Met QC Criteria
March 29, 2022
Last Verified
March 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 230221
- MR/R004528/1 (Other Grant/Funding Number: ERA-NET)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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