Anti-inflammatory Effect of MgSO₄ in Patients With Moderate Traumatic Brain Injury by Measurming Nucleotide-binding Oligomerization Domain-Like Receptor Pyrin Domain-containing 3 (NLRP3) Inflammasome-a Multiprotein Complex

Anti-Inflammatory Effect of Magnesium Sulfate on the Outcomes of Patients With Moderate Traumatic Brain Injury.

The primary objective of this study is to evaluate the biochemical efficacy of Magnesium Sulfate (MgSO₄) as an anti-inflammatory therapeutic agent in patients suffering from moderate traumatic brain injury (TBI) at Assiut University Hospitals by measuring Nucleotide-binding oligomerization domain-Like Receptor Pyrin domain-containing 3 (NLRP3) inflammasome-a multiprotein complex.

Study Overview

• Status: Not yet recruiting
• Conditions: Traumatic Brain Injuries
• Intervention / Treatment: Drug: Magnesium sulfate (MgSO4); Drug: Normal Saline

Detailed Description

Traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability worldwide, disrupting both individual lives and healthcare systems. The pathophysiology of TBI is characterized by a biphasic process. The primary injury occurs at the moment of impact, resulting in immediate mechanical tissue disruption. This is followed by a complex cascade of cellular and molecular changes known as secondary brain injury, which develops hours to days later.

A cornerstone of this secondary injury pathway is neuroinflammation, driven by the activation of resident microglia and the infiltration of peripheral immune cells. Central to this inflammatory response is the assembly and activation of the Nucleotide-binding oligomerization domain-Like Receptor Pyrin domain-containing 3 (NLRP3) inflammasome-a multiprotein complex that triggers the maturation and release of potent pro-inflammatory cytokines, specifically interleukin-1β (IL-1β) and interleukin-18 (IL-18), accelerating neuronal apoptosis and blood-brain barrier dysfunction.

Magnesium sulfate (MgSO₄) has emerged as a promising neuroprotective candidate due to its multifaceted mechanism of action. Primarily, magnesium acts as a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, thereby mitigating glutamate-mediated excitotoxicity. Emerging molecular evidence further indicates that magnesium exerts potent anti-inflammatory effects by downregulating nuclear factor kappa B (NF-κB) activation and directly inhibiting the assembly of the NLRP3 inflammasome. Consequently, evaluating the clinical and molecular efficacy of MgSO₄ in TBI patients could offer a viable therapeutic pathway to suppress secondary neuroinflammation and optimize neurological recovery.

NLRP3 Inflammasome is a multiprotein complex consisting of three core components:

1. Sensor (NLRP3)
2. Adaptor (ASC)
3. Effector (Caspase-1)

Its activation is regulated by a two-signal framework:

1. Priming (Signal 1): Activates the nuclear factor kappa B(NF-κB) pathway to produce baseline NLRP3 components and inactive proteins (Pro-IL-1β, P ro-IL-18 andPro-IL-6).
2. Activation (Signal 2): Triggered by cellular stress signals (such as Ca 2+ influx, K efflux, and mitochondrial distress).

Active Caspase-1 processes cytokines into their potent active forms and triggers a inflammatory cell death.

Magnesium sulfate (MgSO₄) has emerged as a promising neuroprotective candidate.

Magnesium sulfate exerts potent anti-inflammatory effects that can inhibit NLRP3 Inflammasome activation through 4 mechanisms:

1. downregulating nuclear factor kappa B (NF-κB) activation and directly inhibiting the assembly of the NLRP3 inflammasome
2. preventing extracellular Ca2+ influx and intracellular release
3. Reducing K Efflux
4. Preserving Mitochondrial Integrity

• Study Type: Interventional
• Enrollment (Estimated): 64
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Ehab Samir, Assistant lecturer; Phone Number: +201003078676; Email: hobasamir12@gmail.com
• Study Contact Backup: Name: Ghada Abolfadl, Prof.; Phone Number: +201005802086; Email: ghadafadl@aun.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Male and female patients aged 18 to 60 years.
2. Sustained a closed head trauma with the study drug infusion initiated within 8 hours of the injury.
3. TBI confirmed by history and clinical examination.
4. Patients with moderate (GCS = 9-12) traumatic brain injury.
5. Evidence of TBI confirmed by abnormalities consistent with trauma on CT scan upon admission (diffuse injury II-IV, evacuated and non-evacuated mass lesion, Marshall's CT Classification ).
6. Hemodynamic stability at the time of enrollment.

Exclusion Criteria:

1. Patient Refusal
2. Prolonged and/or uncorrectable hypoxia (PaO₂ < 60 mmHg) or persistent hypotension (systolic blood pressure < 90 mmHg) at the time of randomization.
3. Cardiopulmonary arrest.
4. Concomitant spinal cord injury.
5. Pregnant or lactating females.
6. Penetrating head injury.
7. Associated other extra-cranial trauma or systemic polytrauma.
8. Undergoing surgical interventions during the study.
9. Pre-existing severe cardiac arrhythmia, heart block, or significant myocardial damage (documented on ECG).
10. Known history of chronic renal failure or abnormal baseline renal function.
11. Known hypersensitivity or allergic reaction to magnesium sulfate.
12. Patients on chronic steroid therapy.

13. BMI>35 kg/m2.

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group (A): Will receive intravenous magnesium sulfate MgSO₄.; 32 patients will receive; Loading Dose: Administered within 8 hours of trauma at a dose of 50 mg/kg via IV infusion over 1 hour.; Maintenance Dose: Administered at 25 mg/kg every 12 hours (twice daily) for 48 hours.	Drug: Magnesium sulfate (MgSO4); evaluate the biochemical efficacy of Magnesium Sulfate (MgSO₄) as an anti-inflammatory therapeutic agent in patients suffering from moderate traumatic brain injury (TBI)
Experimental: Group (B): Will receive intravenous normal saline as a placebo.; 32 patients Will receive intravenous normal saline as a placebo.	Drug: Normal Saline; evaluate the biochemical efficacy of Magnesium Sulfate (MgSO₄) as an anti-inflammatory therapeutic agent in patients suffering from moderate traumatic brain injury (TBI)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measured by the change in serum concentrations of the NLRP3 inflammasome complex	Molecular Anti-inflammatory Response: Measured by the change in serum concentrations of the NLRP3 inflammasome complex components from baseline (T₀) to 48 hours post-intervention (T₄₈), quantified via Enzyme-Linked Immunosorbent Assay (ELISA)	Measured by the change in serum concentrations of the NLRP3 inflammasome complex components from baseline (T₀) to 48 hours post-intervention (T₄₈), quantified via Enzyme-Linked Immunosorbent Assay (ELISA)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Glasgow Coma Scale (GCS) score	Glasgow Coma Scale (GCS) score	day 7 post-injury and one month
Incidence of hypermagnesemia-related toxicity or drug-related adverse events	measurement of magnesium sulfate on admission and post intervention	48 hours
ESR, CRP and serum Magnesium levels on admission (T₀) and 48 hours post-intervention (T₄₈)	ESR, CRP and serum Magnesium levels on admission (T₀) and 48 hours post-intervention (T₄₈)	48 hours

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): October 1, 2026
• Primary Completion (Estimated): November 1, 2027
• Study Completion (Estimated): January 1, 2028

Study Registration Dates

• First Submitted: August 10, 2026
• First Submitted That Met QC Criteria: August 10, 2026
• First Posted (Actual): August 13, 2026

Study Record Updates

• Last Update Posted (Actual): August 13, 2026
• Last Update Submitted That Met QC Criteria: August 10, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Keywords: anti-inflammatory effect of magnesium sulfate
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Brain Injuries; Brain Injuries, Traumatic; Sulfur Compounds; Pharmaceutical Preparations; Inorganic Chemicals; Crystalloid Solutions; Isotonic Solutions; Solutions; Sulfur Acids; Sulfates; Sulfuric Acids; Magnesium Compounds; Magnesium Sulfate; Saline Solution
• Other Study ID Numbers: effect of MgSO₄ in TBI

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No