目的:抗癫痫治疗的临床前多中心癫痫生物信息学研究(EpiBioS4Rx)联盟的项目1旨在确定创伤性脑损伤(TBI)后抗癫痫治疗的临床前生物标志物。芬兰的国际参与中心,澳大利亚,美国已经做出了一致的努力来确保协议的统一。这里,我们通过评估时机来评估协调过程的成功,覆盖范围,和研究地点之间的表现。
方法:我们收集了有关动物饲养条件的数据,外侧流体冲击损伤模型的产生,术后护理,死亡率,TBI后生理监测,采血时间和质量,MR成像时间和协议,以及使用通用数据元素进行视频脑电图(EEG)随访的持续时间。通过比较项目早期和后期阶段的程序准确性来评估协调学习效果。
结果:研究地点之间的动物饲养条件相当,但术后护理程序不同。冲击压力,呼吸暂停的持续时间,扶正反射,和急性死亡率在研究地点之间存在差异(p<0.001)。使用复合神经评分测试评估的TBI后D2的TBI严重程度在两个部位之间相似。但急性躯体运动缺陷的恢复情况各不相同(p<0.001)。在UEF的最终队列中共有99%的大鼠,100%在莫纳什,79%的加州大学洛杉矶分校在所有时间点都采集了血液样本。采样时间在第(D)2天(p<0.05)而不是D9天(p>0.05)不同。UEF中4%的样品血浆质量较差,1%在莫纳什和14%在加州大学洛杉矶分校。超过97%的最终队列在所有研究地点的所有时间点进行MR成像。D2和D9的成像时间没有差异(p>0.05),但在D30变化,5个月,和离体时间点(p<0.001)。完成每月高密度视频脑电图随访的大鼠百分比和在损伤后第7个月用于癫痫发作检测以诊断创伤后癫痫的视频脑电图记录的持续时间在部位之间不同(p<0.001),然而,PTE的患病率(UEF21%,莫纳什22%,加州大学洛杉矶分校23%)在这些地点之间具有可比性(p>0.05)。急性死亡率的降低和血浆质量随时间的增加反映了TBI生产和血液采样方案中的学习效果。
结论:我们的研究首次证明了方案协调的可行性,用于开展创伤后癫痫生物标志物和治疗发现的临床前多中心临床试验。
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.
METHODS: 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.
CONCLUSIONS: 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.