Translocator Protein and Inflammation After Traumatic Brain Injury

This study is currently recruiting participants.
Verified July 2012 by National Institutes of Health Clinical Center (CC)
Sponsor:
Collaborators:
Suburban Hospital
United States Uniformed Health Service
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) )
ClinicalTrials.gov Identifier:
NCT01547780
First received: March 6, 2012
Last updated: May 1, 2013
Last verified: July 2012
  Purpose

Background:

- People with traumatic brain injury (TBI) often have inflammation in the brain. A protein called the translocator protein (TSPO) is often present with inflammation. Researchers want to see if a radioactive chemical known as [11C]PBR28 can be used to study TSPO and inflammation in the brain of people with TBI.

Objectives:

- To test whether [11C]PBR28 can be used to study changes in the brain after a traumatic brain injury.

Eligibility:

  • Individuals at least 18 years of age who have had TBI and have had a brain scan that shows signs of inflammation.
  • Healthy volunteers at least 18 years of age.

Design:

  • Participants will be screened with a physical exam and medical history. Blood and urine samples will be collected.
  • All participants will have two brain scans during an outpatient visit. A magnetic resonance imaging scan will study brain activity. A positron emission tomography (PET) scan will use [11C]PBR28 to look for signs of TSPO and brain inflammation.
  • Participants with TBI will have two PET scans within 10 days of the head injury, and a PET scan around 90 days after the injury. They may also have MRI scans under this or another study. Tests of thinking, memory, and concentration will be used to study the effects of the injury and inflammation

Condition Intervention Phase
Traumatic Brain Injury
Healthy
Radiation: PET
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Pharmacokinetics/Dynamics Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Diagnostic
Official Title: PET Imaging of Translocator Protein in Subjects With Traumatic Brain Injury

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Binding of [(11)C]PBR28.

Secondary Outcome Measures:
  • Neurocognitive assessment scores and clinical evaluations

Estimated Enrollment: 40
Study Start Date: January 2012
Estimated Study Completion Date: May 2015
Intervention Details:
    Radiation: PET
    N/A
Detailed Description:

Objective: Brain damage following traumatic injury (TBI) results from both direct (eg, mechanical injury to the brain and vasculature) and indirect mechanisms (eg, secondary mechanisms such as inflammation). While CT and MRI can help visualize the result of inflammatory processes in the brain-for instance, the development of cerebral edema-neither method can be used to document active inflammation itself. The translocator protein (TSPO), which is highly expressed in microglia and reactive astrocytes, has been used as a biomarker in positron emission tomography (PET) to identify active inflammatory processes. Recently, our laboratory developed [(11)C]PBR28, a new PET ligand that images TSPO with high levels of specific binding. We have successfully used [(11)C]PBR28 to investigate a number of brain disorders such as epilepsy, multiple sclerosis, and HIV infection with minor cognitive motor disorder, and are detecting neuroinflammation. The current protocol aims to explore whether [(11)C]PBR28 PET imaging can show changes in subjects with TBI who have shown MRI abnormalities.

Study population: Twenty TBI subjects who have exhibited MRI abnormalities consistent with TBI and who are enrolled in one of two protocols-"Evaluation, Pathogenesis, and Outcome of Subjects with or Suspected Traumatic Brain Injury" (10-N-N122, PI Latour) or "Evaluation and Diagnosis of Potential Research Subjects with Traumatic Brain Injury (TBI), (11-NR-0084, PI: Raymond Dionne)-will be studied. In addition 20 healthy age-matched volunteers will be studied.

Design: This is an exploratory study to determine whether [(11)C]PBR28 can detect the increased TSPO associated with neuroinflammation by scanning subjects who have shown MRI abnormalities. Subjects with TBI will have up to three [(11)C]PBR28 PET scans, approximately matching the study time-points of the MRI scans performed in 10-N-N122; one to two PET scans will be performed within approximately 10 days of head injury, and a third PET scan will be performed approximately 90 days after injury. In addition to MRI data, clinical information obtained in 10-N-N122 and 11-NR-0084 will be used to evaluate the utility of the PET data in order to better understand the pathology of TBI.

Outcome Measures: In this exploratory study to investigate the ability of [(11)C]PBR28 PET to detect increases in TSPO, the primary goal will be to measure the magnitude and variance of any increases observed in [11C]PBR28 binding in areas of inflammation following TBI. Those data may be used to design future studies with a larger sample size.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria
  • INCLUSION CRITERIA:

SUBJECTS WITH TBI:

Subjects with TBI eligible for participation in this research study must meet the following inclusion criteria:

  1. Diagnosis of non-penetrating TBI caused by a head injury within 4 months.
  2. Ambulatory.
  3. Able to provide self consent without a legally-authorized representative based on the assessment of the Decision Making Capacity (DMC) by the Human Subjects Protection Unit (HSPU).
  4. Show abnormal MRI findings consistent with TBI in protocol 10-N-N122 or in the image database of the CNRM Image Processing Core if the subject is recruited from CNRM Recruitment Core protocol 11-NR-0084.
  5. Age 18 or older.

HEALTHY SUBJECTS:

  1. Healthy without past or present history of brain disease.
  2. Age 18 or older.

EXCLUSION CRITERIA:

Subjects with TBI are not eligible for participation in this research study if any of the following conditions exist:

  1. Present or past history of brain disease other than TBI.
  2. Subjects with abnormal MRI findings that suggest a diagnosis other than TBI or a second lesion such as brain tumor in addition to the changes consistent with TBI.
  3. Serious medical conditions, which make study procedures of the current study unsafe. Such serious medical conditions include uncontrolled epilepsy and multiple serious injuries. The Medical Advisory Investigator of this protocol will determine whether the subject needs to be excluded.
  4. Contraindication to MRI scanning including certain metal implants or devices such as: cardiac pacemaker, insulin infusion pump, implanted drug infusion device, cochlear, otologic, or ear implant, transdermal medication patch (Nitroglycerine) that cannot be removed for the study, body piercing(s), bone/joint pin, screw, nail, plate, wire sutures or surgical staples, shunts, cerebral aneurysms clips, shrapnel or other metal imbedded in a subject's body (such as from war wounds or accidents or previous work in metal fields or machines that may have left any metallic fragments in or near the subject's eyes).
  5. Conditions precluding entry into the scanners (e.g. morbid obesity, claustrophobia, etc.).
  6. In female subjects, pregnancy or breastfeeding.
  7. Exposure to research related radiation in the past year that, when combined with this study, would place subjects above the allowable limits.
  8. Positive results of urine drug screen on enrollment.

HEALTHY SUBJECTS ARE NOT ELIGIBLE FOR PARTICIPATION IN THIS RESEARCH IF ANY OF THE FOLLOWING CONDITIONS EXIST:

  1. Any past or present history of DSM Axis I disorder, with the exception of substance abuse that ended over 6 months prior to enrollment.
  2. Contraindication to MRI scanning including certain metal implants or devices such as: cardiac pacemaker, insulin infusion pump, implanted drug infusion device, cochlear, otologic, or ear implant, transdermal medication patch (Nitroglycerine) that cannot be removed for the study, body piercing(s), bone/joint pin, screw, nail, plate, wire sutures or surgical staples, shunts, cerebral aneurysms clips, shrapnel or other metal imbedded in a subject's body (such as from war wounds or accidents or previous work in metal fields or machines that may have left any metallic fragments in or near the subject's eyes).
  3. Conditions precluding entry into the scanners (e.g. morbid obesity, claustrophobia, etc.).
  4. In female subjects, pregnancy or breastfeeding.
  5. Clinically significant laboratory abnormalities, as defined as laboratory values that are out of normal range or require clinical workup and/or treatment.
  6. Exposure to research related radiation in the past year that, when combined with this study, would place subjects above the allowable limits.
  7. Previously determined as a low-affinity binder in another study on TSPO.
  8. Positive results of urine drug screen on enrollment.

HIV positive subjects are considered healthy as long as he/she does not show neuological or psychiatric symptoms based on history and physical exams.

  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01547780

Contacts
Contact: Holly Giesen (301) 435-8982 giesenh@intra.nimh.nih.gov
Contact: Masahiro Fujita, M.D. (301) 451-8898 fujitam@intra.nimh.nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)     800-411-1222 ext TTY8664111010     prpl@mail.cc.nih.gov    
Sponsors and Collaborators
Suburban Hospital
United States Uniformed Health Service
Investigators
Principal Investigator: Masahiro Fujita, M.D. National Institute of Mental Health (NIMH)
  More Information

Additional Information:
Publications:
Responsible Party: National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) )
ClinicalTrials.gov Identifier: NCT01547780     History of Changes
Other Study ID Numbers: 120063, 12-M-0063
Study First Received: March 6, 2012
Last Updated: May 1, 2013
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
MRI
Positron Emission Tomograhy (PET)
Inflammation
Microglial Activation
Traumatic Brain Injury
TBI

Additional relevant MeSH terms:
Inflammation
Brain Injuries
Pathologic Processes
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Wounds and Injuries

ClinicalTrials.gov processed this record on May 22, 2013