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Llovera G, Langhauser F, Isla Cainzos S, Hoppen M, Abberger H, Mohamud Yusuf A, Mencl S, Heindl S, Ricci A, Haupeltshofer S, Kuchenbecker-Pöls L, Gunzer M, Hansen W, Hermann DM, Gelderblom M, Schmidt-Pogoda A, Minnerup J, Kleinschnitz C, Magnus T, Liesz A. Stroke of Consistency: Streamlining Multicenter Protocols for Enhanced Reproducibility of Infarct Volumes in Preclinical Stroke Research. Stroke 2024; 55:2522-2527. [PMID: 39315830 DOI: 10.1161/strokeaha.124.047232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/23/2024] [Accepted: 08/12/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND The discrepancy between experimental research and clinical trial outcomes is a persistent challenge in preclinical studies, particularly in stroke research. A possible factor contributing to this issue is the lack of standardization across experimental stroke models, leading to poor reproducibility in multicenter studies. This study addresses this gap by aiming to enhance reproducibility and the efficacy of multicenter studies through the harmonization of protocols and training of involved personnel. METHODS We established a set of standard operating procedures for various stroke models and the Neuroscore. These standard operating procedures were implemented across multiple research centers, followed by specialized, in-person training for all participants. We measured the variability in infarct volume both before and after the implementation of these standardized protocols and training sessions. RESULTS The standardization process led to a significant reduction in variability of infarct volume across different stroke models (40%-50% reduction), demonstrating the effectiveness of our harmonized protocols and training. Additionally, the implementation of the Neuroscore system across centers showed low variability and consistent results up to 28 days poststroke, underscoring its utility in chronic phase evaluations. CONCLUSIONS The harmonization of protocols and surgeon training significantly reduced variability in experimental outcomes across different centers. This improvement can increase the comparability of data between research groups and enhance the statistical power of multicenter studies. Our findings also establish the Neuroscore as a reliable tool for long-term assessment in stroke research, paving the way for more consistent and impactful multicenter preclinical studies.
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Affiliation(s)
- Gemma Llovera
- Institute for Stroke and Dementia Research, Ludwig Maximilians University (LMU) University Hospital, LMU Munich, Germany (G.L., S. Heindl, A.R., A.L.)
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (G.L., A.L.)
| | - Friederike Langhauser
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Sara Isla Cainzos
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany (S.I.C., L.K.-P., M. Gelderblom, T.M.)
| | - Maike Hoppen
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany (M.H., A.S.-P., J.M.)
| | - Hanna Abberger
- Institute of Medical Microbiology, University Hospital Essen (H.A., W.H.), University of Duisburg-Essen, Germany
| | - Ayan Mohamud Yusuf
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Stine Mencl
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Steffanie Heindl
- Institute for Stroke and Dementia Research, Ludwig Maximilians University (LMU) University Hospital, LMU Munich, Germany (G.L., S. Heindl, A.R., A.L.)
| | - Alessio Ricci
- Institute for Stroke and Dementia Research, Ludwig Maximilians University (LMU) University Hospital, LMU Munich, Germany (G.L., S. Heindl, A.R., A.L.)
| | - Steffen Haupeltshofer
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Lennart Kuchenbecker-Pöls
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany (S.I.C., L.K.-P., M. Gelderblom, T.M.)
| | - Matthias Gunzer
- Institute for experimental Immunology and Imaging (M. Gunzer), University of Duisburg-Essen, Germany
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (M. Gunzer)
| | - Wiebke Hansen
- Institute of Medical Microbiology, University Hospital Essen (H.A., W.H.), University of Duisburg-Essen, Germany
| | - Dirk M Hermann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Matthias Gelderblom
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany (S.I.C., L.K.-P., M. Gelderblom, T.M.)
| | - Antje Schmidt-Pogoda
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany (M.H., A.S.-P., J.M.)
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany (M.H., A.S.-P., J.M.)
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Germany (F.L., A.M.Y., S.M., S. Haupeltshofer, D.M.H., C.K.)
| | - Tim Magnus
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany (S.I.C., L.K.-P., M. Gelderblom, T.M.)
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, Ludwig Maximilians University (LMU) University Hospital, LMU Munich, Germany (G.L., S. Heindl, A.R., A.L.)
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (G.L., A.L.)
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Turner RJ, Farr TD. Climbing the STAIRs to SPAN the Clinical Translation Gap: Recent Advances in Multicenter Preclinical Stroke Trials. Stroke 2024; 55:2366-2369. [PMID: 38445476 DOI: 10.1161/strokeaha.124.045998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Renée J Turner
- Discipline of Anatomy and Pathology, School of Biomedicine, The University of Adelaide, SA, Australia (R.J.T.)
| | - Tracy D Farr
- Division of Physiology, Phramacology and Neuroscience, School of Life Sciences, University of Nottingham, United Kingdom (T.D.F.)
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Ndode-Ekane XE, Ali I, Santana-Gomez CE, Casillas-Espinosa PM, Andrade P, Smith G, Paananen T, Manninen E, Immonen R, Puhakka N, Ciszek R, Hämäläinen E, Brady RD, Silva J, Braine E, Hudson MR, Yamakawa G, Jones NC, Shultz SR, Wright D, Harris N, Gröhn O, Staba RJ, O'Brien TJ, Pitkänen A. Successful harmonization in EpiBioS4Rx biomarker study on post-traumatic epilepsy paves the way towards powered preclinical multicenter studies. Epilepsy Res 2024; 199:107263. [PMID: 38056191 DOI: 10.1016/j.eplepsyres.2023.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Project 1 of the Preclinical Multicenter Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) consortium aims to identify preclinical biomarkers for antiepileptogenic therapies following traumatic brain injury (TBI). The international participating centers in Finland, Australia, and the United States have made a concerted effort to ensure protocol harmonization. Here, we evaluate the success of harmonization process by assessing the timing, coverage, and performance between the study sites. METHOD We collected data on animal housing conditions, lateral fluid-percussion injury model production, postoperative care, mortality, post-TBI physiological monitoring, timing of blood sampling and quality, MR imaging timing and protocols, and duration of video-electroencephalography (EEG) follow-up using common data elements. Learning effect in harmonization was assessed by comparing procedural accuracy between the early and late stages of the project. RESULTS The animal housing conditions were comparable between the study sites but the postoperative care procedures varied. Impact pressure, duration of apnea, righting reflex, and acute mortality differed between the study sites (p < 0.001). The severity of TBI on D2 post TBI assessed using the composite neuroscore test was similar between the sites, but recovery of acute somato-motor deficits varied (p < 0.001). A total of 99% of rats included in the final cohort in UEF, 100% in Monash, and 79% in UCLA had blood samples taken at all time points. The timing of sampling differed on day (D)2 (p < 0.05) but not D9 (p > 0.05). Plasma quality was poor in 4% of the samples in UEF, 1% in Monash and 14% in UCLA. More than 97% of the final cohort were MR imaged at all timepoints in all study sites. The timing of imaging did not differ on D2 and D9 (p > 0.05), but varied at D30, 5 months, and ex vivo timepoints (p < 0.001). The percentage of rats that completed the monthly high-density video-EEG follow-up and the duration of video-EEG recording on the 7th post-injury month used for seizure detection for diagnosis of post-traumatic epilepsy differed between the sites (p < 0.001), yet the prevalence of PTE (UEF 21%, Monash 22%, UCLA 23%) was comparable between the sites (p > 0.05). A decrease in acute mortality and increase in plasma quality across time reflected a learning effect in the TBI production and blood sampling protocols. SIGNIFICANCE Our study is the first demonstration of the feasibility of protocol harmonization for performing powered preclinical multi-center trials for biomarker and therapy discovery of post-traumatic epilepsy.
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Affiliation(s)
- Xavier Ekolle Ndode-Ekane
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Idrish Ali
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Cesar E Santana-Gomez
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Pedro Andrade
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Gregory Smith
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tomi Paananen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Eppu Manninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Riikka Immonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Noora Puhakka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Robert Ciszek
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Elina Hämäläinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Australia
| | - Juliana Silva
- Department of Neuroscience, Monash University, Australia
| | - Emma Braine
- Department of Neuroscience, Monash University, Australia
| | - Matthew R Hudson
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia
| | - Glenn Yamakawa
- Department of Neuroscience, Monash University, Australia
| | - Nigel C Jones
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - David Wright
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Neil Harris
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Olli Gröhn
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Richard J Staba
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Australia; Department of Neurology, Alfred Health, Australia; Department of Medicine, The University of Melbourne, Australia
| | - Asla Pitkänen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland.
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Sri S, Greenstein A, Granata A, Collcutt A, Jochems ACC, McColl BW, Castro BD, Webber C, Reyes CA, Hall C, Lawrence CB, Hawkes C, Pegasiou-Davies CM, Gibson C, Crawford CL, Smith C, Vivien D, McLean FH, Wiseman F, Brezzo G, Lalli G, Pritchard HAT, Markus HS, Bravo-Ferrer I, Taylor J, Leiper J, Berwick J, Gan J, Gallacher J, Moss J, Goense J, McMullan L, Work L, Evans L, Stringer MS, Ashford MLJ, Abulfadl M, Conlon N, Malhotra P, Bath P, Canter R, Brown R, Ince S, Anderle S, Young S, Quick S, Szymkowiak S, Hill S, Allan S, Wang T, Quinn T, Procter T, Farr TD, Zhao X, Yang Z, Hainsworth AH, Wardlaw JM. A multi-disciplinary commentary on preclinical research to investigate vascular contributions to dementia. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 5:100189. [PMID: 37941765 PMCID: PMC10628644 DOI: 10.1016/j.cccb.2023.100189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
Although dementia research has been dominated by Alzheimer's disease (AD), most dementia in older people is now recognised to be due to mixed pathologies, usually combining vascular and AD brain pathology. Vascular cognitive impairment (VCI), which encompasses vascular dementia (VaD) is the second most common type of dementia. Models of VCI have been delayed by limited understanding of the underlying aetiology and pathogenesis. This review by a multidisciplinary, diverse (in terms of sex, geography and career stage), cross-institute team provides a perspective on limitations to current VCI models and recommendations for improving translation and reproducibility. We discuss reproducibility, clinical features of VCI and corresponding assessments in models, human pathology, bioinformatics approaches, and data sharing. We offer recommendations for future research, particularly focusing on small vessel disease as a main underpinning disorder.
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Affiliation(s)
- Sarmi Sri
- UK Dementia Research Institute Headquarters, 6th Floor Maple House, London W1T 7NF, UK
| | - Adam Greenstein
- Division of Cardiovascular Sciences, The University of Manchester, Manchester M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Alessandra Granata
- Department of Clinical Neurosciences, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0BB, UK
| | - Alex Collcutt
- UK Dementia Research Institute Headquarters, 6th Floor Maple House, London W1T 7NF, UK
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Barry W McColl
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Blanca Díaz Castro
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Caleb Webber
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, UK
| | - Carmen Arteaga Reyes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Catherine Hall
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Catherine B Lawrence
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Cheryl Hawkes
- Biomedical and Life Sciences, Lancaster University, Lancaster, UK
| | | | - Claire Gibson
- School of Psychology, University of Nottingham, Nottingham NG7 2UH, UK
| | - Colin L Crawford
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Denis Vivien
- Physiopathology and Imaging of Neurological Disorders (PhIND), Normandie University, UNICAEN, INSERM UMR-S U1237, , GIP Cyceron, Institute Blood and Brain @ Caen-Normandie (BB@C), Caen, France
- Department of clinical research, Caen-Normandie University Hospital, Caen, France
| | - Fiona H McLean
- Division of Systems Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Frances Wiseman
- UK Dementia Research Institute, University College London, London WC1N 3BG, UK
| | - Gaia Brezzo
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Giovanna Lalli
- UK Dementia Research Institute Headquarters, 6th Floor Maple House, London W1T 7NF, UK
| | - Harry A T Pritchard
- Division of Cardiovascular Sciences, The University of Manchester, Manchester M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hugh S Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Isabel Bravo-Ferrer
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Jade Taylor
- Division of Cardiovascular Sciences, The University of Manchester, Manchester M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - James Leiper
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jason Berwick
- Department of Psychology, University of Sheffield, Sheffield, UK
- Neuroscience Institute, University of Sheffield, Sheffield, UK
- Healthy Lifespan Institute, University of Sheffield, Sheffield, UK
| | - Jian Gan
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - John Gallacher
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jonathan Moss
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- The Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, UK
| | - Jozien Goense
- Neuroscience Program, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- Department of Psychology, University of Illinois, Urbana-Champaign, Champaign, IL, USA
- Department of Bioengineering, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana-Champaign, Urbana, IL, USA
- School of Psychology and Neuroscience, University of Glasgow, UK
| | - Letitia McMullan
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
| | - Lorraine Work
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow; Glasgow; UK
| | - Lowri Evans
- Division of Cardiovascular Sciences, The University of Manchester, Manchester M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - MLJ Ashford
- Division of Systems Medicine, School of Medicine, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Mohamed Abulfadl
- Dementia Research Group, Department of Clinical Neurosciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK
| | - Nina Conlon
- Division of Cardiovascular Sciences, The University of Manchester, Manchester M13 9PL, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
- UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, UK
| | - Philip Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, UK; Stroke, Medicine Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rebecca Canter
- Dementia Discovery Fund, SV Health Managers LLP, London, UK
| | - Rosalind Brown
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
| | - Selvi Ince
- Dementia Research Group, Department of Clinical Neurosciences, Bristol Medical School, University of Bristol, Bristol BS10 5NB, UK
| | - Silvia Anderle
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, East Sussex, UK
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK
| | - Simon Young
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Sophie Quick
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
| | - Stefan Szymkowiak
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, UK
| | - Steve Hill
- Centre for Discovery Brain Sciences, Chancellor's Building, The University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Cardiff, Cardiff University, Cardiff CF24 4HQ, UK
| | - Stuart Allan
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tao Wang
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Division of Evolution, Infection and Genomic Sciences, Faculty of Biology Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Terry Quinn
- College of Medical Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Tessa Procter
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, UK
| | - Tracy D Farr
- School of Life Sciences, Physiology, Pharmacology, and Neuroscience Division, Medical School, University of Nottingham, Nottingham NG7 2UH, UK
| | - Xiangjun Zhao
- Division of Evolution, Infection and Genomic Sciences, Faculty of Biology Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Zhiyuan Yang
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research Institute, St George's University of London SW17 0RE, UK
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
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Zuo H, Yu L, Campbell SM, Yamamoto SS, Yuan Y. The implementation of target trial emulation for causal inference: a scoping review. J Clin Epidemiol 2023; 162:29-37. [PMID: 37562726 DOI: 10.1016/j.jclinepi.2023.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES We aim to investigate the implementation of Target Trial Emulation (TTE) for causal inference, involving research topics, frequently used strategies, and issues indicating the need for future improvements. STUDY DESIGN AND SETTING We performed a scoping review by following the Joanna Briggs Institute (JBI) guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A health research-focused librarian searched multiple medical databases, and two independent reviewers completed screening and extraction within covidence review management software. RESULTS Our search resulted in 1,240 papers, of which 96 papers were eligible for data extraction. Results show a significant increase in the use of TTE in 2018 and 2021. The study topics varied and focused primarily on cancer, cardiovascular and cerebrovascular diseases, and infectious diseases. However, not all papers specified well all three critical components for generating robust causal evidence: time-zero, random assignment simulation, and comparison strategy. Some common issues were observed from retrieved papers, and key limitations include residual confounding, limited generalizability, and a lack of reporting guidance that need to be improved. CONCLUSION Uneven adherence to the TTE framework exists, and future improvements are needed to progress applications using causal inference with observational data.
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Affiliation(s)
- Hanxiao Zuo
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
| | - Lin Yu
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta T6G 2R7, Canada
| | - Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
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6
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Hunniford VT, Grudniewicz A, Fergusson DA, Montroy J, Grigor E, Lansdell C, Lalu MM. A systematic assessment of preclinical multilaboratory studies and a comparison to single laboratory studies. eLife 2023; 12:e76300. [PMID: 36892457 PMCID: PMC10168693 DOI: 10.7554/elife.76300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/08/2023] [Indexed: 03/10/2023] Open
Abstract
Background Multicentric approaches are widely used in clinical trials to assess the generalizability of findings, however, they are novel in laboratory-based experimentation. It is unclear how multilaboratory studies may differ in conduct and results from single lab studies. Here, we synthesized the characteristics of these studies and quantitatively compared their outcomes to those generated by single laboratory studies. Methods MEDLINE and Embase were systematically searched. Screening and data extractions were completed in duplicate by independent reviewers. Multilaboratory studies investigating interventions using in vivo animal models were included. Study characteristics were extracted. Systematic searches were then performed to identify single lab studies matched by intervention and disease. Difference in standardized mean differences (DSMD) was then calculated across studies to assess differences in effect estimates based on study design (>0 indicates larger effects in single lab studies). Results Sixteen multilaboratory studies met inclusion criteria and were matched to 100 single lab studies. The multicenter study design was applied across a diverse range of diseases, including stroke, traumatic brain injury, myocardial infarction, and diabetes. The median number of centers was four (range 2-6) and the median sample size was 111 (range 23-384) with rodents most frequently used. Multilaboratory studies adhered to practices that reduce the risk of bias significantly more often than single lab studies. Multilaboratory studies also demonstrated significantly smaller effect sizes than single lab studies (DSMD 0.72 [95% confidence interval 0.43-1]). Conclusions Multilaboratory studies demonstrate trends that have been well recognized in clinical research (i.e. smaller treatment effects with multicentric evaluation and greater rigor in study design). This approach may provide a method to robustly assess interventions and the generalizability of findings between laboratories. Funding uOttawa Junior Clinical Research Chair; The Ottawa Hospital Anesthesia Alternate Funds Association; Canadian Anesthesia Research Foundation; Government of Ontario Queen Elizabeth II Graduate Scholarship in Science and Technology.
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Affiliation(s)
- Victoria T Hunniford
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
- Telfer School of Management, University of OttawaOttawaCanada
| | | | - Dean A Fergusson
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
- Faculty of Medicine, University of OttawaOttawaCanada
- Department of Surgery, University of OttawaOttawaCanada
- School of Epidemiology and Public Health, University of OttawaOttawaCanada
| | - Joshua Montroy
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
| | - Emma Grigor
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
- Faculty of Medicine, University of OttawaOttawaCanada
| | - Casey Lansdell
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
| | - Manoj M Lalu
- Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research InstituteOttawaCanada
- School of Epidemiology and Public Health, University of OttawaOttawaCanada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of OttawaOttawaCanada
- Regenerative Medicine Program, The Ottawa Hospital Research InstituteOttawaCanada
- Department of Cellular and Molecular Medicine, University of OttawaOttawaCanada
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7
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Morais A, Locascio JJ, Sansing LH, Lamb J, Nagarkatti K, Imai T, van Leyen K, Aronowski J, Koenig JI, Bosetti F, Lyden P, Ayata C. Embracing Heterogeneity in The Multicenter Stroke Preclinical Assessment Network (SPAN) Trial. Stroke 2023; 54:620-631. [PMID: 36601951 PMCID: PMC9870939 DOI: 10.1161/strokeaha.122.040638] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Stroke Preclinical Assessment Network (SPAN) is a multicenter preclinical trial platform using rodent models of transient focal cerebral ischemia to address translational failure in experimental stroke. In addition to centralized randomization and blinding and large samples, SPAN aimed to introduce heterogeneity to simulate the heterogeneity embodied in clinical trials for robust conclusions. Here, we report the heterogeneity introduced by allowing the 6 SPAN laboratories to vary most of the biological and experimental model variables and the impact of this heterogeneity on middle cerebral artery occlusion (MCAo) performance. We included the modified intention-to-treat population of the control mouse cohort of the first SPAN trial (n=421) and examined the biological and procedural independent variables and their covariance. We then determined their impact on the dependent variables cerebral blood flow drop during MCAo, time to achieve MCAo, and total anesthesia duration using multivariable analyses. We found heterogeneity in biological and procedural independent variables introduced mainly by the site. Consequently, all dependent variables also showed heterogeneity among the sites. Multivariable analyses with the site as a random effect variable revealed filament choice as an independent predictor of cerebral blood flow drop after MCAo. Comorbidity, sex, use of laser Doppler flow to monitor cerebral blood flow, days after trial onset, and maintaining anesthesia throughout the MCAo emerged as independent predictors of time to MCAo. Total anesthesia duration was predicted by most independent variables. We present with high granularity the heterogeneity introduced by the biological and model selections by the testing sites in the first trial of cerebroprotection in rodent transient filament MCAo by SPAN. Rather than trying to homogenize all variables across all sites, we embraced the heterogeneity to better approximate clinical trials. Awareness of the heterogeneity, its sources, and how it impacts the study performance may further improve the study design and statistical modeling for future multicenter preclinical trials.
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Affiliation(s)
- Andreia Morais
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Joseph J. Locascio
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT USA
| | - Jessica Lamb
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
| | - Karisma Nagarkatti
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
| | - Takahiko Imai
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Klaus van Leyen
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Jaroslaw Aronowski
- Department of Neurology, McGovern Medical School, University of Texas HSC, Houston, TX, USA
| | - James I. Koenig
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Francesca Bosetti
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Patrick Lyden
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA USA
| | - Cenk Ayata
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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8
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Yperzeele L, Shoamanesh A, Venugopalan YV, Chapman S, Mazya MV, Charalambous M, Caso V, Hacke W, Bath PM, Koltsov I. Key design elements of successful acute ischemic stroke treatment trials. Neurol Res Pract 2023; 5:1. [PMID: 36600257 PMCID: PMC9814432 DOI: 10.1186/s42466-022-00221-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We review key design elements of positive randomized controlled trials (RCTs) in acute ischemic stroke (AIS) treatment and summarize their main characteristics. METHOD We searched Medline, Pubmed and Cochrane databases for positive RCTs in AIS treatment. Trials were included if (1) they had a randomized controlled design, with (at least partial) blinding for endpoints, (2) they tested against placebo (or on top of standard therapy in a superiority design) or against approved therapy; (3) the protocol was registered and/or published before trial termination and unblinding (if required at study commencement); (4) the primary endpoint was positive in the intention to treat analysis; and (5) the study findings led to approval of the investigational product and/or high ranked recommendations. A topical approach was used, therefore the findings were summarized as a narrative review. FINDINGS Seventeen positive RCTs met the inclusion criteria. The majority of trials included less than 1000 patients (n = 15), had highly selective inclusion criteria (n = 16), used the modified Rankin score as a primary endpoint (n = 15) and had a frequentist design (n = 16). Trials tended to be national (n = 12), investigator-initiated and performed with public funding (n = 11). DISCUSSION Smaller but selective trials are useful to identify efficacy in a particular subgroup of stroke patients. It may also be of advantage to limit the number of participating countries and centers to avoid heterogeneity in stroke management and bureaucratic burden. CONCLUSION The key characteristics of positive RCTs in AIS treatment described here may assist in the design of further trials investigating a single intervention with a potentially high effect size.
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Affiliation(s)
- L. Yperzeele
- grid.411414.50000 0004 0626 3418Antwerp NeuroVascular Center and Stroke Unit, Department of Neurology, University Hospital Antwerp, Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - A. Shoamanesh
- grid.415102.30000 0004 0545 1978Division of Neurology, McMaster University / Population Health Research Institute, Hamilton, Canada
| | - Y. V. Venugopalan
- grid.413618.90000 0004 1767 6103Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Chapman
- grid.27755.320000 0000 9136 933XDepartment of Neurology, University of Virginia, Charlottesville, USA
| | - M. V. Mazya
- grid.24381.3c0000 0000 9241 5705Department of Neurology, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M. Charalambous
- grid.15810.3d0000 0000 9995 3899Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus ,grid.8534.a0000 0004 0478 1713Laboratory of Cognitive and Neurological Sciences, Neurology Unit, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - V. Caso
- grid.9027.c0000 0004 1757 3630Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - W. Hacke
- Department of Neurology, Ruprechts Karl University, Heidelberg, Germany
| | - P. M. Bath
- grid.4563.40000 0004 1936 8868Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - I. Koltsov
- grid.78028.350000 0000 9559 0613Cerebrovascular Diseases Laboratory, Pirogov Russian National Research Medical University, Moscow, Russia ,grid.78028.350000 0000 9559 0613Neurology, Neurosurgery, and Medical Genetics Department, Pirogov Russian National Research Medical University, Moscow, Russia ,Neuroimmunology Department, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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9
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Robust preclinical evidence in somatic cell genome editing: A key driver of responsible and efficient therapeutic innovations. Drug Discov Today 2021; 26:2238-2243. [PMID: 34161846 DOI: 10.1016/j.drudis.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022]
Abstract
Somatic cell genome editing (SCGE) is highly promising for therapeutic innovation. This study demonstrates that the majority of 46 preclinical SCGE studies discussed in reviews as particularly promising for clinical translation do not report on key elements for robust and confirmatory research practices: randomization, blinding, sample size calculation, data handling, pre-registration, multi-centric study design, and independent confirmation. We present the here-examined reporting standards and the new National Institutes of Health (NIH) funding criteria for SCGE research as a viable solution to protect this promising field from backlashes. We argue that the implementation of the novel methodological standards provides the opportunity for SCGE research to become a lighthouse example for trustworthy and useful translational research.
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10
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Lei Y, Sehnert B, Voll RE, Jacobs-Cachá C, Soler MJ, Sanchez-Niño MD, Ortiz A, Bülow RD, Boor P, Anders HJ. A multicenter blinded preclinical randomized controlled trial on Jak1/2 inhibition in MRL/MpJ-Fas mice with proliferative lupus nephritis predicts low effect size. Kidney Int 2021; 99:1331-1341. [DOI: 10.1016/j.kint.2021.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022]
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11
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Gurusamy KS, Moher D, Loizidou M, Ahmed I, Avey MT, Barron CC, Davidson B, Dwek M, Gluud C, Jell G, Katakam K, Montroy J, McHugh TD, Osborne NJ, Ritskes-Hoitinga M, van Laarhoven K, Vollert J, Lalu M. Clinical relevance assessment of animal preclinical research (RAA) tool: development and explanation. PeerJ 2021; 9:e10673. [PMID: 33569250 DOI: 10.7717/peerj.10673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/09/2020] [Indexed: 12/09/2022] Open
Abstract
Background Only a small proportion of preclinical research (research performed in animal models prior to clinical trials in humans) translates into clinical benefit in humans. Possible reasons for the lack of translation of the results observed in preclinical research into human clinical benefit include the design, conduct, and reporting of preclinical studies. There is currently no formal domain-based assessment of the clinical relevance of preclinical research. To address this issue, we have developed a tool for the assessment of the clinical relevance of preclinical studies, with the intention of assessing the likelihood that therapeutic preclinical findings can be translated into improvement in the management of human diseases. Methods We searched the EQUATOR network for guidelines that describe the design, conduct, and reporting of preclinical research. We searched the references of these guidelines to identify further relevant publications and developed a set of domains and signalling questions. We then conducted a modified Delphi-consensus to refine and develop the tool. The Delphi panel members included specialists in evidence-based (preclinical) medicine specialists, methodologists, preclinical animal researchers, a veterinarian, and clinical researchers. A total of 20 Delphi-panel members completed the first round and 17 members from five countries completed all three rounds. Results This tool has eight domains (construct validity, external validity, risk of bias, experimental design and data analysis plan, reproducibility and replicability of methods and results in the same model, research integrity, and research transparency) and a total of 28 signalling questions and provides a framework for researchers, journal editors, grant funders, and regulatory authorities to assess the potential clinical relevance of preclinical animal research. Conclusion We have developed a tool to assess the clinical relevance of preclinical studies. This tool is currently being piloted.
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Affiliation(s)
- Kurinchi S Gurusamy
- Research Department of Surgical Biotechnology, University College London, London, England, UK.,Surgery and Interventional Trials Unit, University College London, London, England, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marilena Loizidou
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, Scotland, UK
| | - Marc T Avey
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Carly C Barron
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brian Davidson
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Miriam Dwek
- School of Life Sciences, University of Westminster, London, England, UK
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copehagen, Denmark
| | - Gavin Jell
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Kiran Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copehagen, Denmark
| | - Joshua Montroy
- Department of Anesthesiology and Pain Medicine, Blueprint Translational Research Group, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa Hospital, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, England, UK
| | | | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kees van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Jan Vollert
- Pain Research, Department of Surgery & Cancer, Imperial College, London, England, UK.,Center of Biomedicine and Medical Technology Mannheim CBTM, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manoj Lalu
- Department of Anesthesiology and Pain Medicine, Blueprint Translational Research Group, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa Hospital, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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12
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Tettamanti M, Beretta S, Pignataro G, Fumagalli S, Perego C, Sironi L, Pedata F, Amantea D, Bacigaluppi M, Vinciguerra A, Valente A, Diamanti S, Mariani J, Viganò M, Santangelo F, Zoia CP, Rogriguez-Menendez V, Castiglioni L, Rzemieniec J, Dettori I, Bulli I, Coppi E, Gullotta GS, Bagetta G, Martino G, Ferrarese C, De Simoni MG. Multicentre translational Trial of Remote Ischaemic Conditioning in Acute Ischaemic Stroke (TRICS): protocol of multicentre, parallel group, randomised, preclinical trial in female and male rat and mouse from the Italian Stroke Organization (ISO) Basic Science network. BMJ OPEN SCIENCE 2020; 4:e100063. [PMID: 35047692 PMCID: PMC8647600 DOI: 10.1136/bmjos-2020-100063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/15/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Multicentre preclinical randomised controlled trials (pRCT) are emerging as a necessary step to confirm efficacy and improve translation into the clinic. The aim of this project is to perform two multicentre pRCTs (one in rats and one in mice) to investigate the efficacy of remote ischaemic conditioning (RIC) in an experimental model of severe ischaemic stroke. Methods and analysis Seven research laboratories within the Italian Stroke Organization (ISO) Basic Science network will participate in the study. Transient endovascular occlusion of the proximal right middle cerebral artery will be performed in two species (rats and mice) and in both sexes. Animals will be randomised to receive RIC by transient surgical occlusion of the right femoral artery, or sham surgery, after reperfusion. Blinded outcome assessment will be performed for dichotomised functional neuroscore (primary endpoint) and infarct volume (secondary endpoint) at 48 hours. A sample size of 80 animals per species will yield 82% power to detect a significant difference of 30% in the primary outcome in both pRCTs. Analyses will be performed in a blind status and according to an intention-to-treat paradigm. The results of this study will provide robust, translationally oriented, high-quality evidence on the efficacy of RIC in multiple species of rodents with large ischaemic stroke. Ethics and dissemination This is approved by the Animal Welfare Regulatory Body of the University of Milano Bicocca, under project license from the Italian Ministry of Health. Trial results will be subject to publication according to the definition of the outcome presented in this protocol. Trial registration number PCTE0000177.
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Affiliation(s)
- Mauro Tettamanti
- Department of Neuroscience Research, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy
| | - Simone Beretta
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Giuseppe Pignataro
- Department of Pharmacology, University of Naples Federico II, Napoli, Campania, Italy
| | - Stefano Fumagalli
- Department of Neuroscience Research, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy
| | - Carlo Perego
- Department of Neuroscience Research, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy
| | - Luigi Sironi
- Department of Pharmacology, University of Milan, Milano, Lombardia, Italy
| | - Felicita Pedata
- Department of Pharmacology, University of Florence, Firenze, Toscana, Italy
| | - Diana Amantea
- Department of Pharmacology, Università della Calabria, Arcavacata di Rende, Calabria, Italy
| | - Marco Bacigaluppi
- Department of Neurology, San Raffaele Hospital, Milano, Lombardia, Italy
| | - Antonio Vinciguerra
- Department of Pharmacology, University of Naples Federico II, Napoli, Campania, Italy
| | - Alessia Valente
- Department of Neuroscience Research, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy
| | - Susanna Diamanti
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Jacopo Mariani
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Martina Viganò
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | | | - Chiara Paola Zoia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | | | - Laura Castiglioni
- Department of Pharmacology, University of Milan, Milano, Lombardia, Italy
| | - Joanna Rzemieniec
- Department of Pharmacology, University of Milan, Milano, Lombardia, Italy
| | - Ilaria Dettori
- Department of Pharmacology, University of Florence, Firenze, Toscana, Italy
| | - Irene Bulli
- Department of Pharmacology, University of Florence, Firenze, Toscana, Italy
| | - Elisabetta Coppi
- Department of Pharmacology, University of Florence, Firenze, Toscana, Italy
| | | | - Giacinto Bagetta
- Department of Pharmacology, Università della Calabria, Arcavacata di Rende, Calabria, Italy
| | - Gianvito Martino
- Department of Neurology, San Raffaele Hospital, Milano, Lombardia, Italy
| | - Carlo Ferrarese
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| | - Maria Grazia De Simoni
- Department of Neuroscience Research, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Lombardia, Italy
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13
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Bath PM, Appleton JP, England T. The Hazard of Negative (Not Neutral) Trials on Treatment of Acute Stroke: A Review. JAMA Neurol 2020; 77:114-124. [PMID: 31790551 DOI: 10.1001/jamaneurol.2019.4107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance While there are a limited number of beneficial treatments for acute stroke (eg, stroke units, reperfusion, aspirin, hemicraniectomy), there are more negative (as opposed to neutral) interventions spanning multiple different mechanisms of action. To reduce the risk of future negative studies, it is vital to understand why previous interventions appeared to cause harm. Observations The limited number of beneficial treatments for acute ischemic stroke are far outnumbered by negative (not neutral) interventions that worsened outcomes in randomized clinical trials (RCTs), including those with putative neuroprotectant, anticoagulant, anti-inflammatory, free radical-scavenging, hemorrhagic, or vasoactive activity. Other agents reduced thrombolytic efficiency or exhibited neuropsychiatric or cardiac toxicity. In intracerebral hemorrhage, platelet transfusion was hazardous. Although reperfusion treatments should be given as soon as possible, very early intervention with other strategies may instead be hazardous, as has been seen with physical therapy and vasodepressors. Conclusions and Relevance The lessons learned from negative stroke RCTs are vital for designing future studies. Multicenter preclinical studies are necessary, and animals that die must be included in analyses. Randomized clinical trials must assess multiple neurological, vascular, cardiac, and general safety effects, whether these are on target or off target. All preclinical trials and RCTs must be published in full. Learning from the past will help to reduce the number of negative stroke RCTs in the future.
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Affiliation(s)
- Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, England.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, England.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Timothy England
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, England
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14
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McFall A, Hietamies TM, Bernard A, Aimable M, Allan SM, Bath PM, Brezzo G, Carare RO, Carswell HV, Clarkson AN, Currie G, Farr TD, Fowler JH, Good M, Hainsworth AH, Hall C, Horsburgh K, Kalaria R, Kehoe P, Lawrence C, Macleod M, McColl BW, McNeilly A, Miller AA, Miners S, Mok V, O’Sullivan M, Platt B, Sena ES, Sharp M, Strangward P, Szymkowiak S, Touyz RM, Trueman RC, White C, McCabe C, Work LM, Quinn TJ. UK consensus on pre-clinical vascular cognitive impairment functional outcomes assessment: Questionnaire and workshop proceedings. J Cereb Blood Flow Metab 2020; 40:1402-1414. [PMID: 32151228 PMCID: PMC7307003 DOI: 10.1177/0271678x20910552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/21/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Assessment of outcome in preclinical studies of vascular cognitive impairment (VCI) is heterogenous. Through an ARUK Scottish Network supported questionnaire and workshop (mostly UK-based researchers), we aimed to determine underlying variability and what could be implemented to overcome identified challenges. Twelve UK VCI research centres were identified and invited to complete a questionnaire and attend a one-day workshop. Questionnaire responses demonstrated agreement that outcome assessments in VCI preclinical research vary by group and even those common across groups, may be performed differently. From the workshop, six themes were discussed: issues with preclinical models, reasons for choosing functional assessments, issues in interpretation of functional assessments, describing and reporting functional outcome assessments, sharing resources and expertise, and standardization of outcomes. Eight consensus points emerged demonstrating broadly that the chosen assessment should reflect the deficit being measured, and therefore that one assessment does not suit all models; guidance/standardisation on recording VCI outcome reporting is needed and that uniformity would be aided by a platform to share expertise, material, protocols and procedures thus reducing heterogeneity and so increasing potential for collaboration, comparison and replication. As a result of the workshop, UK wide consensus statements were agreed and future priorities for preclinical research identified.
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Affiliation(s)
- Aisling McFall
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Tuuli M Hietamies
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Ashton Bernard
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Margaux Aimable
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Stuart M Allan
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience,
University of Nottingham, Nottingham, UK
| | - Gaia Brezzo
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton,
UK
| | - Hilary V Carswell
- University of Strathclyde, Strathclyde Institute of Pharmacy and
Biomedical Science, Glasgow, UK
| | - Andrew N Clarkson
- The Department of Anatomy, Brain Health Research Centre and
Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Gillian Currie
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Tracy D Farr
- School of Life Sciences, University of Nottingham, Nottingham ,
UK
| | - Jill H Fowler
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Mark Good
- School of Psychology, Cardiff University, Cardiff, UK
| | - Atticus H Hainsworth
- Molecular & Clinical Sciences Research Institute, St
George’s University of London, London, UK
| | - Catherine Hall
- School of Psychology, University of Sussex, Brighton, UK
| | - Karen Horsburgh
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Rajesh Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle Upon
Tyne, UK
| | - Patrick Kehoe
- Institute of Clinical Neurosciences, University of Bristol,
Bristol, UK
| | - Catherine Lawrence
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Barry W McColl
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, Edinburgh Medical School,
University of Edinburgh, Edinburgh, UK
| | - Alison McNeilly
- School of Medicine, University of Dundee, Ninewells Hospital,
Dundee, Scotland
| | - Alyson A Miller
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Scott Miners
- Institute of Clinical Neurosciences, University of Bristol,
Bristol, UK
| | - Vincent Mok
- Gerald Choa Neuroscience Centre, Therese Pei Fong Chow Research
Centre for Prevention of Dementia, Division of Neurology, Department of Medicine
and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Michael O’Sullivan
- Faculty of Medicine, The University of Queensland, Queensland,
Australia
| | - Bettina Platt
- Institute of Medical Sciences, University of Aberdeen,
Aberdeen, Scotland
| | - Emily S Sena
- Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
| | - Matthew Sharp
- Faculty of Medicine, University of Southampton, Southampton,
UK
| | - Patrick Strangward
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Stefan Szymkowiak
- Centre for Discovery Brain Sciences, University of Edinburgh,
Edinburgh, UK
- UK Dementia Research Institute, Edinburgh Medical School,
University of Edinburgh, Edinburgh, UK
| | - Rhian M Touyz
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | | | - Claire White
- Lydia Becker Institute of Immunology and Inflammation, Division
of Neuroscience and Experimental Psychology, School of Biological Sciences,
Faculty of Biology, Medicine and Health, The University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK
| | - Chris McCabe
- Institute of Neuroscience & Psychology, College of Medical,
Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorraine M Work
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
| | - Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, College of
Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow,
UK
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15
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Iadecola C, Buckwalter MS, Anrather J. Immune responses to stroke: mechanisms, modulation, and therapeutic potential. J Clin Invest 2020; 130:2777-2788. [PMID: 32391806 PMCID: PMC7260029 DOI: 10.1172/jci135530] [Citation(s) in RCA: 372] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Stroke is the second leading cause of death worldwide and a leading cause of disability. Most strokes are caused by occlusion of a major cerebral artery, and substantial advances have been made in elucidating how ischemia damages the brain. In particular, increasing evidence points to a double-edged role of the immune system in stroke pathophysiology. In the acute phase, innate immune cells invade brain and meninges and contribute to ischemic damage, but may also be protective. At the same time, danger signals released into the circulation by damaged brain cells lead to activation of systemic immunity, followed by profound immunodepression that promotes life-threatening infections. In the chronic phase, antigen presentation initiates an adaptive immune response targeted to the brain, which may underlie neuropsychiatric sequelae, a considerable cause of poststroke morbidity. Here, we briefly review these pathogenic processes and assess the potential therapeutic value of targeting immunity in human stroke.
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Affiliation(s)
- Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Marion S. Buckwalter
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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16
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Button KS, Chambers CD, Lawrence N, Munafò MR. Grassroots Training for Reproducible Science: A Consortium-Based Approach to the Empirical Dissertation. PSYCHOLOGY LEARNING AND TEACHING-PLAT 2019. [DOI: 10.1177/1475725719857659] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a widely acknowledged need to improve the reliability and efficiency of scientific research to increase the credibility of the published scientific literature and accelerate discovery. Widespread improvement requires a cultural shift in both thinking and practice, and better education will be instrumental to achieve this. Here we argue that education in reproducible science should start at the grassroots. We present our model of consortium-based student projects to train undergraduates in reproducible team science. We discuss how with careful design we have aligned collaboration with the current conventions for individual student assessment. We reflect on our experiences of several years running the GW4 Undergraduate Psychology Consortium offering insights we hope will be of practical use to others wishing to adopt a similar approach. We consider the pedagogical benefits of our approach in equipping students with 21st-century skills. Finally, we reflect on the need to shift incentives to reward to team science in global research and how this applies to the reward structures of student assessment.
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Affiliation(s)
| | - Christopher D. Chambers
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, UK
| | | | - Marcus R. Munafò
- MRC Integrative Epidemiology Unit at the University of Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, UK
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17
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Cramer JV, Gesierich B, Roth S, Dichgans M, Düring M, Liesz A. In vivo widefield calcium imaging of the mouse cortex for analysis of network connectivity in health and brain disease. Neuroimage 2019; 199:570-584. [PMID: 31181333 DOI: 10.1016/j.neuroimage.2019.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/10/2023] Open
Abstract
The organization of brain areas in functionally connected networks, their dynamic changes, and perturbations in disease states are subject of extensive investigations. Research on functional networks in humans predominantly uses functional magnetic resonance imaging (fMRI). However, adopting fMRI and other functional imaging methods to mice, the most widely used model to study brain physiology and disease, poses major technical challenges and faces important limitations. Hence, there is great demand for alternative imaging modalities for network characterization. Here, we present a refined protocol for in vivo widefield calcium imaging of both cerebral hemispheres in mice expressing a calcium sensor in excitatory neurons. We implemented a stringent protocol for minimizing anesthesia and excluding movement artifacts which both imposed problems in previous approaches. We further adopted a method for unbiased identification of functional cortical areas using independent component analysis (ICA) on resting-state imaging data. Biological relevance of identified components was confirmed using stimulus-dependent cortical activation. To explore this novel approach in a model of focal brain injury, we induced photothrombotic lesions of the motor cortex, determined changes in inter- and intrahemispheric connectivity at multiple time points up to 56 days post-stroke and correlated them with behavioral deficits. We observed a severe loss in interhemispheric connectivity after stroke, which was partially restored in the chronic phase and associated with corresponding behavioral motor deficits. Taken together, we present an improved widefield calcium imaging tool accounting for anesthesia and movement artifacts, adopting an advanced analysis pipeline based on human fMRI algorithms and with superior sensitivity to recovery mechanisms in mouse models compared to behavioral tests. This tool will enable new studies on interhemispheric connectivity in murine models with comparability to human imaging studies for a wide spectrum of neuroscience applications in health and disease.
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Affiliation(s)
- Julia V Cramer
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Benno Gesierich
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Roth
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 80336, Munich, Germany
| | - Marco Düring
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), 80336, Munich, Germany.
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18
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Balkaya MG, Trueman RC, Boltze J, Corbett D, Jolkkonen J. Behavioral outcome measures to improve experimental stroke research. Behav Brain Res 2018; 352:161-171. [DOI: 10.1016/j.bbr.2017.07.039] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/18/2017] [Accepted: 07/27/2017] [Indexed: 01/22/2023]
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19
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Horsburgh K, Wardlaw JM, van Agtmael T, Allan SM, Ashford MLJ, Bath PM, Brown R, Berwick J, Cader MZ, Carare RO, Davis JB, Duncombe J, Farr TD, Fowler JH, Goense J, Granata A, Hall CN, Hainsworth AH, Harvey A, Hawkes CA, Joutel A, Kalaria RN, Kehoe PG, Lawrence CB, Lockhart A, Love S, Macleod MR, Macrae IM, Markus HS, McCabe C, McColl BW, Meakin PJ, Miller A, Nedergaard M, O'Sullivan M, Quinn TJ, Rajani R, Saksida LM, Smith C, Smith KJ, Touyz RM, Trueman RC, Wang T, Williams A, Williams SCR, Work LM. Small vessels, dementia and chronic diseases - molecular mechanisms and pathophysiology. Clin Sci (Lond) 2018; 132:851-868. [PMID: 29712883 PMCID: PMC6700732 DOI: 10.1042/cs20171620] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/08/2018] [Accepted: 02/21/2018] [Indexed: 12/14/2022]
Abstract
Cerebral small vessel disease (SVD) is a major contributor to stroke, cognitive impairment and dementia with limited therapeutic interventions. There is a critical need to provide mechanistic insight and improve translation between pre-clinical research and the clinic. A 2-day workshop was held which brought together experts from several disciplines in cerebrovascular disease, dementia and cardiovascular biology, to highlight current advances in these fields, explore synergies and scope for development. These proceedings provide a summary of key talks at the workshop with a particular focus on animal models of cerebral vascular disease and dementia, mechanisms and approaches to improve translation. The outcomes of discussion groups on related themes to identify the gaps in knowledge and requirements to advance knowledge are summarized.
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Affiliation(s)
- Karen Horsburgh
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, U.K.
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Tom van Agtmael
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Stuart M Allan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | | | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, U.K
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Jason Berwick
- Department of Psychology, University of Sheffield, Sheffield, U.K
| | - M Zameel Cader
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Roxana O Carare
- Faculty of Medicine, University of Southampton, Southampton, U.K
| | - John B Davis
- Alzheimer's Research UK Oxford Drug Discovery Institute, University of Oxford, Oxford, U.K
| | - Jessica Duncombe
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Tracy D Farr
- School of Life Sciences, Nottingham University, Nottingham, U.K
| | - Jill H Fowler
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Jozien Goense
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, U.K
| | - Alessandra Granata
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, U.K
| | | | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research Institute, St Georges University of London, London, U.K
| | - Adam Harvey
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Cheryl A Hawkes
- Faculty of Science, Technology, Engineering & Mathematics, Open University, Milton Keynes, U.K
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, Paris, France
| | - Rajesh N Kalaria
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, U.K
| | | | - Catherine B Lawrence
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | | | - Seth Love
- Clinical Neurosciences, University of Bristol, Bristol, U.K
| | - Malcolm R Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - I Mhairi Macrae
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, U.K
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, U.K
| | - Chris McCabe
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, U.K
| | - Barry W McColl
- The Roslin Institute & R(D)SVS, UK Dementia Research Institute, University of Edinburgh, Edinburgh, U.K
| | - Paul J Meakin
- Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Dundee, U.K
| | - Alyson Miller
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Maiken Nedergaard
- University of Rochester Medical Center, Rochester, NY, USA and University of Copenhagen's Center of Basic and Translational Neuroscience, Copenhagen, Denmark
| | - Michael O'Sullivan
- Mater Centre for Neuroscience and Queensland Brain Institute, Brisbane, Australia
| | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Rikesh Rajani
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, Paris, France
| | - Lisa M Saksida
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, U.K
| | - Kenneth J Smith
- Department of Neuroinflammation, UCL Institute of Neurology, London, U.K
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | - Tao Wang
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Anna Williams
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, U.K
| | | | - Lorraine M Work
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
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20
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Xiong XY, Liu L, Yang QW. Refocusing Neuroprotection in Cerebral Reperfusion Era: New Challenges and Strategies. Front Neurol 2018; 9:249. [PMID: 29740385 PMCID: PMC5926527 DOI: 10.3389/fneur.2018.00249] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022] Open
Abstract
Pathophysiological processes of stroke have revealed that the damaged brain should be considered as an integral structure to be protected. However, promising neuroprotective drugs have failed when translated to clinical trials. In this review, we evaluated previous studies of neuroprotection and found that unsound patient selection and evaluation methods, single-target treatments, etc., without cerebral revascularization may be major reasons of failed neuroprotective strategies. Fortunately, this may be reversed by recent advances that provide increased revascularization with increased availability of endovascular procedures. However, the current improved effects of endovascular therapy are not able to match to the higher rate of revascularization, which may be ascribed to cerebral ischemia/reperfusion injury and lacking of neuroprotection. Accordingly, we suggest various research strategies to improve the lower therapeutic efficacy for ischemic stroke treatment: (1) multitarget neuroprotectant combinative therapy (cocktail therapy) should be investigated and performed based on revascularization; (2) and more efforts should be dedicated to shifting research emphasis to establish recirculation, increasing functional collateral circulation and elucidating brain–blood barrier damage mechanisms to reduce hemorrhagic transformation. Therefore, we propose that a comprehensive neuroprotective strategy before and after the endovascular treatment may speed progress toward improving neuroprotection after stroke to protect against brain injury.
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Affiliation(s)
- Xiao-Yi Xiong
- Department of Neurology, Xinqiao Hospital, The Army Medical University (Third Military Medical University), Chongqing, China
| | - Liang Liu
- Department of Neurology, Xinqiao Hospital, The Army Medical University (Third Military Medical University), Chongqing, China
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital, The Army Medical University (Third Military Medical University), Chongqing, China
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21
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Felizardo AA, Marques DVB, Caldas IS, Gonçalves RV, Novaes RD. Could age and aging change the host response to systemic parasitic infections? A systematic review of preclinical evidence. Exp Gerontol 2018; 104:17-27. [PMID: 29366738 DOI: 10.1016/j.exger.2018.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 01/03/2023]
Abstract
The impact of age and aging in the evolution of systemic parasitic infections remains poorly understood. We conducted a systematic review from preclinical models of Chagas disease, leishmaniasis, malaria, sleeping sickness and toxoplasmosis. From a structured and comprehensive search in electronic databases, 29 studies were recovered and included in the review. Beyond the characteristics of the experimental models, parasitological and immunological outcomes, we also discussed the quality of current evidence. Our findings indicated that throughout aging, parasitemia and mortality were consistently reduced in Chagas disease and malaria, but were similar or increased in leishmaniasis and highly variable in toxoplasmosis. While a marked humoral response in older animals was related to the anti-T. cruzi protective phenotype, cellular responses mediated by a polarized Th1 phenotype were associated with a more effective defense against Plasmodium infection. Conversely, in leishmaniasis, severe infections and high mortality rates were potentially related to attenuation of humoral response and an imbalance between Th1 and Th2 phenotypes. Due to the heterogeneous parasitological outcomes and limited immunological data, the role of aging on toxoplasmosis evolution remains unclear. From a detailed description of the methodological bias, more controlled researches could avoid the systematic reproduction of inconsistent and poorly reproducible experimental designs.
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Affiliation(s)
- Amanda Aparecida Felizardo
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil; Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - Débora Vasconcelos Bastos Marques
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil; Department of Pathology and Parasitology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - Ivo Santana Caldas
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil; Department of Pathology and Parasitology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | | | - Rômulo Dias Novaes
- Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil; Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil.
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22
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Marbacher S. Can Quality Improvement Tools Overcome the Translational Roadblock—the Vital Influence of the Researcher. Transl Stroke Res 2017; 8:203-205. [DOI: 10.1007/s12975-017-0524-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
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23
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Munafò MR, Nosek BA, Bishop DVM, Button KS, Chambers CD, Percie du Sert N, Simonsohn U, Wagenmakers EJ, Ware JJ, Ioannidis JPA. A manifesto for reproducible science. Nat Hum Behav 2017; 1:0021. [PMID: 33954258 PMCID: PMC7610724 DOI: 10.1038/s41562-016-0021] [Citation(s) in RCA: 1194] [Impact Index Per Article: 170.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Improving the reliability and efficiency of scientific research will increase the credibility of the published scientific literature and accelerate discovery. Here we argue for the adoption of measures to optimize key elements of the scientific process: methods, reporting and dissemination, reproducibility, evaluation and incentives. There is some evidence from both simulations and empirical studies supporting the likely effectiveness of these measures, but their broad adoption by researchers, institutions, funders and journals will require iterative evaluation and improvement. We discuss the goals of these measures, and how they can be implemented, in the hope that this will facilitate action toward improving the transparency, reproducibility and efficiency of scientific research.
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Affiliation(s)
- Marcus R. Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN UK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Brian A. Nosek
- Department of Psychology, University of Virginia, Charlottesville, 22904 Virginia USA
- Center for Open Science, Charlottesville, 22903 Virginia USA
| | - Dorothy V. M. Bishop
- Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford, OX1 3UD UK
| | | | - Christopher D. Chambers
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ UK
| | - Nathalie Percie du Sert
- National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), London, NW1 2BE UK
| | - Uri Simonsohn
- The Wharton School, University of Pennsylvania, Philadelphia, 19104 Pennsylvania USA
| | - Eric-Jan Wagenmakers
- Department of Psychology, University of Amsterdam, Amsterdam, 1018 WT Netherlands
| | | | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, 94304 California USA
- Department of Medicine and Department of Health Research and Policy, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, 94305 California USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, 94305 California USA
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24
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Wodarski R, Delaney A, Ultenius C, Morland R, Andrews N, Baastrup C, Bryden LA, Caspani O, Christoph T, Gardiner NJ, Huang W, Kennedy JD, Koyama S, Li D, Ligocki M, Lindsten A, Machin I, Pekcec A, Robens A, Rotariu SM, Voß S, Segerdahl M, Stenfors C, Svensson CI, Treede RD, Uto K, Yamamoto K, Rutten K, Rice AS. Cross-centre replication of suppressed burrowing behaviour as an ethologically relevant pain outcome measure in the rat: a prospective multicentre study. Pain 2016; 157:2350-65. [PMID: 27643836 PMCID: PMC5028161 DOI: 10.1097/j.pain.0000000000000657] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022]
Abstract
Burrowing, an ethologically relevant rodent behaviour, has been proposed as a novel outcome measure to assess the global impact of pain in rats. In a prospective multicentre study using male rats (Wistar, Sprague-Dawley), replication of suppressed burrowing behaviour in the complete Freund adjuvant (CFA)-induced model of inflammatory pain (unilateral, 1 mg/mL in 100 µL) was evaluated in 11 studies across 8 centres. Following a standard protocol, data from participating centres were collected centrally and analysed with a restricted maximum likelihood-based mixed model for repeated measures. The total population (TP-all animals allocated to treatment; n = 249) and a selected population (SP-TP animals burrowing over 500 g at baseline; n = 200) were analysed separately, assessing the effect of excluding "poor" burrowers. Mean baseline burrowing across studies was 1113 g (95% confidence interval: 1041-1185 g) for TP and 1329 g (1271-1387 g) for SP. Burrowing was significantly suppressed in the majority of studies 24 hours (7 studies/population) and 48 hours (7 TP, 6 SP) after CFA injections. Across all centres, significantly suppressed burrowing peaked 24 hours after CFA injections, with a burrowing deficit of -374 g (-479 to -269 g) for TP and -498 g (-609 to -386 g) for SP. This unique multicentre approach first provided high-quality evidence evaluating suppressed burrowing as robust and reproducible, supporting its use as tool to infer the global effect of pain on rodents. Second, our approach provided important informative value for the use of multicentre studies in the future.
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Affiliation(s)
- Rachel Wodarski
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
- Eli Lilly and Company, Erl Wood Manor, Windlesham, United Kingdom
| | - Ada Delaney
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Camilla Ultenius
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
| | - Rosie Morland
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Nick Andrews
- Department of Neurobiology, Boston Children's Hospital, MA, USA
| | - Catherine Baastrup
- Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Luke A. Bryden
- CNS Disease Division Research Germany, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach an der Riss, Germany
| | - Ombretta Caspani
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Thomas Christoph
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Natalie J. Gardiner
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Wenlong Huang
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | | | - Suguru Koyama
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Dominic Li
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Marcin Ligocki
- Eli Lilly and Company, Erl Wood Manor, Windlesham, United Kingdom
| | | | - Ian Machin
- Deal, Kent, United Kingdom. L. A. Bryden is now with the Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom. W. Huang is now with the Institute of Medical Sciences, University of Aberdeen, United Kingdom. C. Stenfors is now with the R&D CNS Research, Orion Corporation, Orion Pharma, Espoo, Finland
| | - Anton Pekcec
- CNS Disease Division Research Germany, Boehringer Ingelheim Pharma GmbH and Co KG, Biberach an der Riss, Germany
| | - Angela Robens
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Sanziana M. Rotariu
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Sabrina Voß
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Marta Segerdahl
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
- H. Lundbeck A/S, Valby, Denmark
| | - Carina Stenfors
- Neuroscience CNSP iMED, AstraZeneca R&D Södertälje, Södertälje, Sweden
| | - Camilla I. Svensson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Centre for Biomedicine and Medical Technology Mannheim (CBTM), Heidelberg University, Mannheim, Germany
| | - Katsuhiro Uto
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Kazumi Yamamoto
- Laboratory for Pharmacology, Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, Shizuoka, Japan
| | - Kris Rutten
- Department of Pharmacology and Biomarker Development, Translational Science and Strategy, Grünenthal GmbH, Aachen, Germany
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery and Cancer, Imperial College, London, United Kingdom
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Multicenter Evaluation of Geometric Accuracy of MRI Protocols Used in Experimental Stroke. PLoS One 2016; 11:e0162545. [PMID: 27603704 PMCID: PMC5014410 DOI: 10.1371/journal.pone.0162545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/24/2016] [Indexed: 11/19/2022] Open
Abstract
It has recently been suggested that multicenter preclinical stroke studies should be carried out to improve translation from bench to bedside, but the accuracy of magnetic resonance imaging (MRI) scanners routinely used in experimental stroke has not yet been evaluated. We aimed to assess and compare geometric accuracy of preclinical scanners and examine the longitudinal stability of one scanner using a simple quality assurance (QA) protocol. Six 7 Tesla animal scanners across six different preclinical imaging centers throughout Europe were used to scan a small structural phantom and estimate linear scaling errors in all orthogonal directions and volumetric errors. Between-scanner imaging consisted of a standard sequence and each center's preferred sequence for the assessment of infarct size in rat models of stroke. The standard sequence was also used to evaluate the drift in accuracy of the worst performing scanner over a period of six months following basic gradient calibration. Scaling and volumetric errors using the standard sequence were less variable than corresponding errors using different stroke sequences. The errors for one scanner, estimated using the standard sequence, were very high (above 4% scaling errors for each orthogonal direction, 18.73% volumetric error). Calibration of the gradient coils in this system reduced scaling errors to within ±1.0%; these remained stable during the subsequent 6-month assessment. In conclusion, despite decades of use in experimental studies, preclinical MRI still suffers from poor and variable geometric accuracy, influenced by the use of miscalibrated systems and various types of sequences for the same purpose. For effective pooling of data in multicenter studies, centers should adopt standardized procedures for system QA and in vivo imaging.
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Bath PM. William M. Feinberg Award for Excellence in Clinical Stroke: High Explosive Treatment for Ultra-Acute Stroke: Hype of Hope. Stroke 2016; 47:2423-6. [PMID: 27444258 DOI: 10.1161/strokeaha.116.013243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Philip M Bath
- From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom.
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Llovera G, Hofmann K, Roth S, Salas-Pérdomo A, Ferrer-Ferrer M, Perego C, Zanier ER, Mamrak U, Rex A, Party H, Agin V, Fauchon C, Orset C, Haelewyn B, De Simoni MG, Dirnagl U, Grittner U, Planas AM, Plesnila N, Vivien D, Liesz A. Results of a preclinical randomized controlled multicenter trial (pRCT): Anti-CD49d treatment for acute brain ischemia. Sci Transl Med 2016; 7:299ra121. [PMID: 26246166 DOI: 10.1126/scitranslmed.aaa9853] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Numerous treatments have been reported to provide a beneficial outcome in experimental animal stroke models; however, these treatments (with the exception of tissue plasminogen activator) have failed in clinical trials. To improve the translation of treatment efficacy from bench to bedside, we have performed a preclinical randomized controlled multicenter trial (pRCT) to test a potential stroke therapy under circumstances closer to the design and rigor of a clinical randomized control trial. Anti-CD49d antibodies, which inhibit the migration of leukocytes into the brain, were previously investigated in experimental stroke models by individual laboratories. Despite the conflicting results from four positive and one inconclusive preclinical studies, a clinical trial was initiated. To confirm the preclinical results and to test the feasibility of conducting a pRCT, six independent European research centers investigated the efficacy of anti-CD49d antibodies in two distinct mouse models of stroke in a centrally coordinated, randomized, and blinded approach. The results pooled from all research centers revealed that treatment with CD49d-specific antibodies significantly reduced both leukocyte invasion and infarct volume after the permanent distal occlusion of the middle cerebral artery, which causes a small cortical infarction. In contrast, anti-CD49d treatment did not reduce lesion size or affect leukocyte invasion after transient proximal occlusion of the middle cerebral artery, which induces large lesions. These results suggest that the benefits of immune-targeted approaches may depend on infarct severity and localization. This study supports the feasibility of performing pRCTs.
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Affiliation(s)
- Gemma Llovera
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Kerstin Hofmann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Stefan Roth
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Angelica Salas-Pérdomo
- Department of Brain Ischemia and Neurodegeneration, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain. Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Maura Ferrer-Ferrer
- Department of Brain Ischemia and Neurodegeneration, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain. Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Carlo Perego
- Neuroscience Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, 20156 Milan, Italy
| | - Elisa R Zanier
- Neuroscience Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, 20156 Milan, Italy
| | - Uta Mamrak
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Andre Rex
- Department of Experimental Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) and German Center for Cardiovascular Diseases (DZHK), Berlin sites; Excellence Cluster NeuroCure, 10117 Berlin, Germany
| | - Hélène Party
- INSERM, UMR-S U919, Université de Caen Basse-Normandie, team Serine Proteases and Pathophysiology of the neurovascular Unit, GIP Cyceron, F-14074 Caen Cedex, France
| | - Véronique Agin
- INSERM, UMR-S U919, Université de Caen Basse-Normandie, team Serine Proteases and Pathophysiology of the neurovascular Unit, GIP Cyceron, F-14074 Caen Cedex, France
| | - Claudine Fauchon
- Experimental Stroke Research Platform (ESRP), IBiSA platform, Centre Universitaire de Ressources Biologiques (CURB), Université de Caen Basse-Normandie, F-14074 Caen Cedex, France
| | - Cyrille Orset
- INSERM, UMR-S U919, Université de Caen Basse-Normandie, team Serine Proteases and Pathophysiology of the neurovascular Unit, GIP Cyceron, F-14074 Caen Cedex, France. Experimental Stroke Research Platform (ESRP), IBiSA platform, Centre Universitaire de Ressources Biologiques (CURB), Université de Caen Basse-Normandie, F-14074 Caen Cedex, France
| | - Benoît Haelewyn
- INSERM, UMR-S U919, Université de Caen Basse-Normandie, team Serine Proteases and Pathophysiology of the neurovascular Unit, GIP Cyceron, F-14074 Caen Cedex, France. Experimental Stroke Research Platform (ESRP), IBiSA platform, Centre Universitaire de Ressources Biologiques (CURB), Université de Caen Basse-Normandie, F-14074 Caen Cedex, France
| | - Maria-Grazia De Simoni
- Neuroscience Department, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, 20156 Milan, Italy
| | - Ulrich Dirnagl
- Department of Experimental Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) and German Center for Cardiovascular Diseases (DZHK), Berlin sites; Excellence Cluster NeuroCure, 10117 Berlin, Germany
| | - Ulrike Grittner
- Department of Biostatistics and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, 12203 Berlin, Germany
| | - Anna M Planas
- Department of Brain Ischemia and Neurodegeneration, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain. Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany
| | - Denis Vivien
- INSERM, UMR-S U919, Université de Caen Basse-Normandie, team Serine Proteases and Pathophysiology of the neurovascular Unit, GIP Cyceron, F-14074 Caen Cedex, France. Experimental Stroke Research Platform (ESRP), IBiSA platform, Centre Universitaire de Ressources Biologiques (CURB), Université de Caen Basse-Normandie, F-14074 Caen Cedex, France
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Feodor-Lynen-Straße 17, 81377 Munich, Germany. Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany.
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Llovera G, Liesz A. The next step in translational research: lessons learned from the first preclinical randomized controlled trial. J Neurochem 2016; 139 Suppl 2:271-279. [PMID: 26968835 DOI: 10.1111/jnc.13516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 12/13/2022]
Abstract
For years, low reproducibility of preclinical trials and poor translation of promising preclinical therapies to the clinic have posed major challenges to translational research in most biomedical fields. To overcome the limitations that stand between experimental and clinical research, international consortia have attempted to establish standardized guidelines for study design and for reporting the resulting data. In addition, multicenter preclinical randomized controlled trials (pRCTs) have been proposed as a suitable tool for 'bridging the gap' between experimental research and clinical trials. We recently reported the design and results of the first such pRCT in which we confirmed the feasibility of using a coordinated approach with standardized protocols in collaboration with independent multinational research centers. However, despite its successes, this first pRCT also had several difficulties, particularly with respect to following the protocols established in the study design and analyzing the data. Here, we review our experiences performing the study, and we analyze and discuss the lessons learned from performing the first pRCT. Moreover, we provide suggestions regarding how obstacles can be overcome to improve the performance and outcome of future pRCT studies. Translational research is hampered by low reproducibility of preclinical studies and countless failed clinical trials. International consortia have proposed preclinical multicenter trials as an intermediate step to overcome this 'translational roadblock'. We have recently performed the first such preclinical randomized controlled trial (pRCT) by adopting key elements of clinical study design to preclinical research. In this review, we discuss the lessons learned from this trial and provide suggestions how to optimize future pRCTs. This article is part of the 60th Anniversary special issue.
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Affiliation(s)
- Gemma Llovera
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany. .,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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Maysami S, Wong R, Pradillo JM, Denes A, Dhungana H, Malm T, Koistinaho J, Orset C, Rahman M, Rubio M, Schwaninger M, Vivien D, Bath PM, Rothwell NJ, Allan SM. A cross-laboratory preclinical study on the effectiveness of interleukin-1 receptor antagonist in stroke. J Cereb Blood Flow Metab 2016; 36:596-605. [PMID: 26661169 PMCID: PMC4776311 DOI: 10.1177/0271678x15606714] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/21/2015] [Indexed: 11/16/2022]
Abstract
Stroke represents a global challenge and is a leading cause of permanent disability worldwide. Despite much effort, translation of research findings to clinical benefit has not yet been successful. Failure of neuroprotection trials is considered, in part, due to the low quality of preclinical studies, low level of reproducibility across different laboratories and that stroke co-morbidities have not been fully considered in experimental models. More rigorous testing of new drug candidates in different experimental models of stroke and initiation of preclinical cross-laboratory studies have been suggested as ways to improve translation. However, to our knowledge, no drugs currently in clinical stroke trials have been investigated in preclinical cross-laboratory studies. The cytokine interleukin 1 is a key mediator of neuronal injury, and the naturally occurring interleukin 1 receptor antagonist has been reported as beneficial in experimental studies of stroke. In the present paper, we report on a preclinical cross-laboratory stroke trial designed to investigate the efficacy of interleukin 1 receptor antagonist in different research laboratories across Europe. Our results strongly support the therapeutic potential of interleukin 1 receptor antagonist in experimental stroke and provide further evidence that interleukin 1 receptor antagonist should be evaluated in more extensive clinical stroke trials.
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Affiliation(s)
- Samaneh Maysami
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Raymond Wong
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Jesus M Pradillo
- Faculty of Life Sciences, University of Manchester, Manchester, UK Department of Pharmacology, Medicine School, University Complutense of Madrid, Spain
| | - Adam Denes
- Faculty of Life Sciences, University of Manchester, Manchester, UK Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Hiramani Dhungana
- Department of Neurobiology, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tarja Malm
- Department of Neurobiology, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jari Koistinaho
- Department of Neurobiology, A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Cyrille Orset
- Inserm, Inserm UMR-S U919, Université de Caen Basse Normandie, GIP Cyceron, Caen, France
| | - Mahbubur Rahman
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany Department of Pharmaceutical Sciences, North South University, Bashundhara, Dhaka, Bangladesh
| | - Marina Rubio
- Inserm, Inserm UMR-S U919, Université de Caen Basse Normandie, GIP Cyceron, Caen, France
| | - Markus Schwaninger
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Denis Vivien
- Inserm, Inserm UMR-S U919, Université de Caen Basse Normandie, GIP Cyceron, Caen, France
| | - Philip M Bath
- Stroke, Division of Clinical Neuroscience, University of Nottingham, City Hospital Campus, Nottingham, UK
| | - Nancy J Rothwell
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Stuart M Allan
- Faculty of Life Sciences, University of Manchester, Manchester, UK
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Gibson CL, Bath PM. Feasibility of progesterone treatment for ischaemic stroke. J Cereb Blood Flow Metab 2016; 36:487-91. [PMID: 26661235 PMCID: PMC4776310 DOI: 10.1177/0271678x15616782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/11/2015] [Indexed: 11/18/2022]
Abstract
Two multi-centre phase III clinical trials examining the protective potential of progesterone following traumatic brain injury have recently failed to demonstrate any improvement in outcome. Thus, it is timely to consider how this impacts on the translational potential of progesterone treatment for ischaemic stroke. A wealth of experimental evidence supports the neuroprotective properties of progesterone, and associated metabolites, following various types of central nervous system injury. In particular, for ischaemic stroke, studies have also begun to reveal possible mechanisms of such neuroprotection. However, the results in traumatic brain injury now question whether further clinical development of progesterone for ischaemic stroke is relevant.
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Affiliation(s)
- Claire L Gibson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Philip M Bath
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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31
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Milidonis X, Marshall I, Macleod MR, Sena ES. Magnetic resonance imaging in experimental stroke and comparison with histology: systematic review and meta-analysis. Stroke 2015; 46:843-51. [PMID: 25657177 DOI: 10.1161/strokeaha.114.007560] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Because the new era of preclinical stroke research demands improvements in validity and generalizability of findings, moving from single site to multicenter studies could be pivotal. However, the conduct of magnetic resonance imaging (MRI) in stroke remains ill-defined. We sought to assess the variability in the use of MRI for evaluating lesions post stroke and to examine the possibility as an alternative to gold standard histology for measuring the infarct size. METHODS We identified animal studies of ischemic stroke reporting lesion sizes using MRI. We assessed the degree of heterogeneity and reporting of scanning protocols, postprocessing methods, study design characteristics, and study quality. Studies performing histological evaluation of infarct size were further selected to compare with corresponding MRI using meta-regression. RESULTS Fifty-four articles undertaking a total of 78 different MRI scanning protocols met the inclusion criteria. T2-weighted imaging was most frequently used (83% of the studies), followed by diffusion-weighted imaging (43%). Reporting of the imaging parameters was adequate, but heterogeneity between studies was high. Twelve studies assessed the infarct size using both MRI and histology at corresponding time points, with T2-weighted imaging-based treatment effect having a significant positive correlation with histology (; P<0.001). CONCLUSIONS Guidelines for standardized use and reporting of MRI in preclinical stroke are urgently needed. T2-weighted imaging could be used as an effective in vivo alternative to histology for estimating treatment effects based on the extent of infarction; however, additional studies are needed to explore the effect of individual parameters.
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Affiliation(s)
- Xenios Milidonis
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ian Marshall
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Malcolm R Macleod
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Emily S Sena
- From the Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
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32
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Neuroprotection for ischaemic stroke: Current status and challenges. Pharmacol Ther 2015; 146:23-34. [DOI: 10.1016/j.pharmthera.2014.09.003] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
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Green AR, Nutt DJ. Pharmacology should be at the centre of all preclinical and clinical studies on new psychoactive substances (recreational drugs). J Psychopharmacol 2014; 28:711-8. [PMID: 24674814 DOI: 10.1177/0269881114528593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Despite the publication of a substantial body of preclinical and clinical information on recent recreational drugs such as 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy') and cathinone compounds such as mephedrone there remains a disturbing lack of consensus as to how dangerous these compounds are to the health of the individual and to society in general. This perspective proposes that use of good pharmacological practice should be mandatory in all preclinical and clinical studies. Its use will assist both translation and reverse translation of information produced in animals and clinical subjects. We propose several basic rules to be followed in all future studies. Preclinical studies should employ pharmacokinetic-pharmacodynamic integration thereby exposing animals to known or calculable drug concentrations. This will provide results relevant to pharmacology rather than toxicology and, crucially, data relevant to human drug use. Full experimental detail should be routinely provided, to allow comparison with other similar work. In clinical studies evidence should be provided that the drug under investigation has been ingested by the subjects being examined, and details given of all other drugs being ingested. Drug-drug interactions are an unavoidable confound but studies of a size that allows reliable statistical evaluation and preferably allows sub-group analysis, particularly by using meta-analysis, should help with this problem. This may require greater collaboration between investigative groups, as routinely occurs during pharmaceutical clinical trials. Other proposals include greater integration of preclinical and clinical scientists in both preclinical and clinical studies and changes in the law regarding Good Manufacturing Process (GMP) sourcing of drug for human studies.
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Affiliation(s)
- A Richard Green
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - David J Nutt
- Division of Neurosciences and Mental Health, Imperial College London, London, UK
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The need for randomization in animal trials: an overview of systematic reviews. PLoS One 2014; 9:e98856. [PMID: 24906117 PMCID: PMC4048216 DOI: 10.1371/journal.pone.0098856] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/07/2014] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives Randomization, allocation concealment, and blind outcome assessment have been shown to reduce bias in human studies. Authors from the Collaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES) collaboration recently found that these features protect against bias in animal stroke studies. We extended the scope the work from CAMARADES to include investigations of treatments for any condition. Methods We conducted an overview of systematic reviews. We searched Medline and Embase for systematic reviews of animal studies testing any intervention (against any control) and we included any disease area and outcome. We included reviews comparing randomized versus not randomized (but otherwise controlled), concealed versus unconcealed treatment allocation, or blinded versus unblinded outcome assessment. Results Thirty-one systematic reviews met our inclusion criteria: 20 investigated treatments for experimental stroke, 4 reviews investigated treatments for spinal cord diseases, while 1 review each investigated treatments for bone cancer, intracerebral hemorrhage, glioma, multiple sclerosis, Parkinson's disease, and treatments used in emergency medicine. In our sample 29% of studies reported randomization, 15% of studies reported allocation concealment, and 35% of studies reported blinded outcome assessment. We pooled the results in a meta-analysis, and in our primary analysis found that failure to randomize significantly increased effect sizes, whereas allocation concealment and blinding did not. In our secondary analyses we found that randomization, allocation concealment, and blinding reduced effect sizes, especially where outcomes were subjective. Conclusions Our study demonstrates the need for randomization, allocation concealment, and blind outcome assessment in animal research across a wide range of outcomes and disease areas. Since human studies are often justified based on results from animal studies, our results suggest that unduly biased animal studies should not be allowed to constitute part of the rationale for human trials.
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Pedder H, Vesterinen HM, Macleod MR, Wardlaw JM. Systematic review and meta-analysis of interventions tested in animal models of lacunar stroke. Stroke 2014; 45:563-70. [PMID: 24385271 DOI: 10.1161/strokeaha.113.003128] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE A total of 25% of strokes are lacunar, and these are pathophysiologically different from large artery strokes. Despite emerging evidence of a substantial impact on physical disability and dementia, little attention has been paid to the development of specific treatments. The optimal use of the animal models of lacunar stroke used to test candidate interventions is not known. METHODS We conducted a systematic review and meta-analysis of studies testing candidate interventions in animal models of lacunar stroke. We used random-effects meta-analysis to assess the impact of study characteristics and trim and fill to seek evidence of publication bias. RESULTS The efficacy of 43 distinct interventions was described in 57 publications. The median number of quality checklist items scored was 3 of 8 (interquartile range, 2-4). Many models reflected mechanisms of limited relevance to lacunar stroke. Meta-analysis of results from 27 studies showed that on average, infarct size and neurobehavioral outcome were improved by 34.2% (24.1-44.2) and 0.82 standardized mean difference (0.51-1.14), respectively. Four interventions improved both infarct size and neurobehavioral outcome but there were insufficient data for this finding to be considered robust. For infarct size, efficacy was lower in studies reporting blinding and higher in studies reporting randomization. For neurobehavior, efficacy was lower in randomized studies. For infarct size there was evidence of publication bias. CONCLUSIONS No intervention has yet been tested in sufficient range and depth to support translation to clinical trial. There is limited reporting of measures to reduce the risk of bias and evidence for a substantial publications bias.
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Affiliation(s)
- Hugo Pedder
- From the Department of Clinical Neurosciences, Western General Hospital, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Abstract
In this primer, Malcolm Macleod outlines the use of meta-analysis to assess the validity of the outcome reported for preclinical studies and explores the reasons why Lisa Bero and colleagues find that industry-funded studies show smaller effect sizes than non-industry-funded studies do. We know that clinical trials sponsored by the pharmaceutical industry are likely to exaggerate benefit and minimise harms. But do these biases extend to their sponsorship of non-human animal research? Using systematic review and meta-analysis Bero and colleagues show that, in the case of statins, things are a little more complicated. While the conclusions of industry-sponsored studies were indeed more enthusiastic than warranted by their data, the data themselves painted a picture more conservative than was seen in non-industry-sponsored studies. This behaviour is consistent with maximising the return on investment, seeking robust data before embarking on a clinical trial, and, once that investment has been made, making every effort to “prove” that the drug is safe and effective if this is at all credible. The findings suggest that there is something different about industry-sponsored non-human animal research, perhaps reflecting higher standards than is the case elsewhere. Perhaps the academic community can learn something from our colleagues in the commercial sector.
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Affiliation(s)
- Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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37
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Ioannidis JPA, Greenland S, Hlatky MA, Khoury MJ, Macleod MR, Moher D, Schulz KF, Tibshirani R. Increasing value and reducing waste in research design, conduct, and analysis. Lancet 2014; 383:166-75. [PMID: 24411645 PMCID: PMC4697939 DOI: 10.1016/s0140-6736(13)62227-8] [Citation(s) in RCA: 957] [Impact Index Per Article: 95.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Correctable weaknesses in the design, conduct, and analysis of biomedical and public health research studies can produce misleading results and waste valuable resources. Small effects can be difficult to distinguish from bias introduced by study design and analyses. An absence of detailed written protocols and poor documentation of research is common. Information obtained might not be useful or important, and statistical precision or power is often too low or used in a misleading way. Insufficient consideration might be given to both previous and continuing studies. Arbitrary choice of analyses and an overemphasis on random extremes might affect the reported findings. Several problems relate to the research workforce, including failure to involve experienced statisticians and methodologists, failure to train clinical researchers and laboratory scientists in research methods and design, and the involvement of stakeholders with conflicts of interest. Inadequate emphasis is placed on recording of research decisions and on reproducibility of research. Finally, reward systems incentivise quantity more than quality, and novelty more than reliability. We propose potential solutions for these problems, including improvements in protocols and documentation, consideration of evidence from studies in progress, standardisation of research efforts, optimisation and training of an experienced and non-conflicted scientific workforce, and reconsideration of scientific reward systems.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, School of Medicine, Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
| | - Sander Greenland
- Department of Epidemiology and Department of Statistics, UCLA School of Public Health, Los Angeles, CA, USA
| | - Mark A Hlatky
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Health Services Research, Stanford University, Stanford, CA, USA
| | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemiology and Genomics Research Program, National Cancer Institute, Rockville, MD, USA
| | - Malcolm R Macleod
- Department of Clinical Neurosciences, University of Edinburgh School of Medicine, Edinburgh, UK
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kenneth F Schulz
- FHI 360, Durham, NC, USA; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert Tibshirani
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA
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Murrell J, Grandemange E, Woehrle F, Menard J, White K. Clinical Efficacy and Tolerability of Cimicoxib in Dogs with Osteoarthritis: A Multicentre Prospective Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojvm.2014.45010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wu S, Sena E, Egan K, Macleod M, Mead G. Edaravone Improves Functional and Structural Outcomes in Animal Models of Focal Cerebral Ischemia: A Systematic Review. Int J Stroke 2013; 9:101-6. [PMID: 24148907 DOI: 10.1111/ijs.12163] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Edaravone has been used in patients with acute ischemic stroke in Japan for over 10 years but does not have marketing authorization in Europe or America. Either patients in Europe and America are not receiving an effective treatment, or those in Asia are being given a treatment which is not effective. Finding out which of these is true will require further clinical trials, and a better understanding of its efficacy in animal models may help inform the design of those trials so that it might be tested under conditions where there is the greatest prospect of success. We systematically reviewed the efficacy of edaravone in animal models of focal ischemia and summarized data using weighted mean difference DerSimonian and Laird random-effects modeling. We used stratified meta-analysis and metaregression to assess the influence of study design and methodological quality. We identified 49 experiments describing outcome in 814 animals; 30 experiments (519 animals) reported functional and 35 experiments (503 animals) reported structural outcome. Edaravone improved functional and structural outcome by 30.3% (95% confidence interval 23.4–37.2%) and 25.5% (95% confidence interval, 21.1–29.9%), respectively. For functional outcome, there was an inverse relationship between study quality and effect size ( P < 0.0017). Effect sizes were larger in studies where randomization or blinded assessment was not reported. There was no evidence of publication bias. Edaravone is a promising treatment for stroke. However, because of the methodological weakness in current animal studies, no sufficient preclinical evidence is available to optimize the study design of clinical trials. Higher quality animal studies are expected to inform further clinical study.
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Affiliation(s)
- Simiao Wu
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK
- Sichuan University, West China Hospital, Department of Neurology, Chengdu, Sichuan, China
| | - Emily Sena
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, 245 Burgundy St., Heidelberg Vic 3084, Australia
| | - Kieren Egan
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Malcolm Macleod
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Gillian Mead
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, UK
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Abstract
Stroke is one of the leading causes of death worldwide and the biggest reason for long-term disability. Basic research has formed the modern understanding of stroke pathophysiology, and has revealed important molecular, cellular and systemic mechanisms. However, despite decades of research, most translational stroke trials that aim to introduce basic research findings into clinical treatment strategies - most notably in the field of neuroprotection - have failed. Among other obstacles, poor methodological and statistical standards, negative publication bias, and incomplete preclinical testing have been proposed as 'translational roadblocks'. In this article, we introduce the models commonly used in preclinical stroke research, discuss some of the causes of failed translational success and review potential remedies. We further introduce the concept of modeling 'care' of stroke patients, because current preclinical research models the disorder but does not model care or state-of-the-art clinical testing. Stringent statistical methods and controlled preclinical trials have been suggested to counteract weaknesses in preclinical research. We conclude that preclinical stroke research requires (1) appropriate modeling of the disorder, (2) appropriate modeling of the care of stroke patients and (3) an approach to preclinical testing that is similar to clinical testing, including Phase 3 randomized controlled preclinical trials as necessary additional steps before new therapies enter clinical testing.
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Affiliation(s)
- Philipp Mergenthaler
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10098 Berlin, Germany.
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Dirnagl U, Hakim A, Macleod M, Fisher M, Howells D, Alan SM, Steinberg G, Planas A, Boltze J, Savitz S, Iadecola C, Meairs S. A concerted appeal for international cooperation in preclinical stroke research. Stroke 2013; 44:1754-60. [PMID: 23598526 DOI: 10.1161/strokeaha.113.000734] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ulrich Dirnagl
- Department of Neurology and Experimental Neurology, Center for Stroke Research Berlin, Charité University Medicine, Campus Mitte, D-10098 Berlin, Germany.
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Howells DW, Sena ES, O'Collins V, Macleod MR. Improving the efficiency of the development of drugs for stroke. Int J Stroke 2012; 7:371-7. [PMID: 22712738 DOI: 10.1111/j.1747-4949.2012.00805.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The mortality and morbidity associated with stroke makes the development of new drugs a research priority. Recent unsuccessful clinical trials have reduced enthusiasm for the development of neuroprotective drugs. Here, we use empirical evidence derived from systematic reviews of stroke drug development to identify stages of drug development which might be improved. We then propose exemplar strategies which may be helpful, along with some basic economic modelling of what the impact of such strategies might be. This suggests that relatively straightforward measures might reduce the costs of drug development by $5·8 bn or 31%.
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Affiliation(s)
- David W Howells
- Florey Neuroscience Institutes, Melbourne Brain Centre, Heidelberg, Victoria, Australia.
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Macleod MR. Pharmacologic reduction of angiographic vasospasm in experimental subarachnoid hemorrhage: systematic review and meta-analysis. J Cereb Blood Flow Metab 2012; 32:1643-4. [PMID: 22534673 PMCID: PMC3434633 DOI: 10.1038/jcbfm.2012.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Malcolm R Macleod
- Department of Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, UK.
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International, multicenter randomized preclinical trials in translational stroke research: it's time to act. J Cereb Blood Flow Metab 2012; 32:933-5. [PMID: 22510602 PMCID: PMC3367233 DOI: 10.1038/jcbfm.2012.51] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Green AR, Aronson JK. From basic to clinical neuropharmacology: targetophilia or pharmacodynamics? Br J Clin Pharmacol 2012; 73:959-67. [PMID: 22360689 PMCID: PMC3391528 DOI: 10.1111/j.1365-2125.2012.04246.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Historically, much drug discovery and development in psychopharmacology tended to be empirical. However, over the last 20 years it has primarily been target oriented, with synthesis and selection of compounds designed to act at a specific neurochemical site. Such compounds are then examined in functional animal models of disease. There is little evidence that this approach (which we call 'targetophilia') has enhanced the discovery process and some indications that it may have retarded it. A major problem is the weakness of many animal models in mimicking the disease and the lack of appropriate biochemical markers of drug action in animals and patients. In this review we argue that preclinical studies should be conducted as if they were clinical studies in design, analysis, and reporting, and that clinical pharmacologists should be involved at the earliest stages, to help ensure that animal models reflect as closely as possible the clinical disease. In addition, their familiarity with pharmacokinetic-pharmacodynamic integration (PK-PD) would help ensure that appropriate dosing and drug measurement techniques are applied to the discovery process, thereby producing results with relevance to therapeutics. Better integration of experimental and clinical pharmacologists early in the discovery process would allow observations in animals and patients to be quickly exchanged between the two disciplines. This non-linear approach to discovery used to be the way research proceeded, and it resulted in productivity that has never been bettered. It also follows that occasionally 'look-see' studies, a proven technique for drug discovery, deserve to be reintroduced.
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Affiliation(s)
- A Richard Green
- School of Biomedical Sciences, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
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Dirnagl U, Fisher M. REPRINT: International, multicenter randomized preclinical trials in translational stroke research: it is time to act. Stroke 2012; 43:1453-4. [PMID: 22535274 DOI: 10.1161/strokeaha.112.653709] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Green AR, Gabrielsson J, Fone KCF. Translational neuropharmacology and the appropriate and effective use of animal models. Br J Pharmacol 2012; 164:1041-3. [PMID: 21545411 DOI: 10.1111/j.1476-5381.2011.01361.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This issue of the British Journal of Pharmacology is dedicated to reviews of the major animal models used in neuropharmacology to examine drugs for both neurological and psychiatric conditions. Almost all major conditions are reviewed. In general, regulatory authorities require evidence for the efficacy of novel compounds in appropriate animal models. However, the failure of many compounds in clinical trials following clear demonstration of efficacy in animal models has called into question both the value of the models and the discovery process in general. These matters are expertly reviewed in this issue and proposals for better models outlined. In this editorial, we further suggest that more attention be made to incorporate pharmacokinetic knowledge into the studies (quantitative pharmacology). We also suggest that more attention be made to ensure that full methodological details are published and recommend that journals should be more amenable to publishing negative data. Finally, we propose that new approaches must be used in drug discovery so that preclinical studies become more reflective of the clinical situation, and studies using animal models mimic the anticipated design of studies to be performed in humans, as closely as possible.
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Higgins P, Dawson J, Walters M. Nanomedicine: Nanotubes reduce stroke damage. NATURE NANOTECHNOLOGY 2011; 6:83-84. [PMID: 21278751 DOI: 10.1038/nnano.2011.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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van der Worp HB, Howells DW, Sena ES, Porritt MJ, Rewell S, O'Collins V, Macleod MR. Can animal models of disease reliably inform human studies? PLoS Med 2010; 7:e1000245. [PMID: 20361020 PMCID: PMC2846855 DOI: 10.1371/journal.pmed.1000245] [Citation(s) in RCA: 835] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
H. Bart van der Worp and colleagues discuss the controversies and possibilities of translating the results of animal experiments into human clinical trials.
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Affiliation(s)
- H Bart van der Worp
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands.
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