This proposal seeks support for a comprehensive clinical and laboratory center for the study of head injury. Our primary objective is to evaluate the efficacy of either IV administered superoxidase dismutase or scopolamine in improving morbidity and mortality in several head-injury humans. The rationale of this approach rests upon key laboratory tory findings which indicate that traumatic brain injury is associated withth the generation of damaging oxygen radicals which adversely influence the cerebral vasculature and the release of excitatory neurotransmittter which contribute to pathologic agonist-receptor interactions. The efficacy of these drugs will be assessed in a collaborative three- arm trialhere at the Medical College of Virginia and at the Maryland Institute for Emergency Medical Services Systems. Standardized outcome measures will be used by both groups and will be complemented by clinical studies directed toward assessment of cerebrovascular damage and brain function using non-invasive measures. The proposed laboratory studies will complement the clinical trial while providing new insights into those mechanisms possibly amenable to future therapeutic intervention. Having made the seminal observations regarding the damaging consequences of oxygen radicals and excessive neurotransmitter release, we now extend these observations along new lines of inquiry. The possible co- involvement of cholinergic muscarinic and glutamate NMDA receptors will be explored. Age related changes will be considered as will the protective effect of endogenous and exogenous opioid peptides. The interactive role of altered bloodbrain barrier status as well as other contributing forms of vascular compromise will be evaluated. Lastly, the potential that the increased release of excitatory transmitters contributes to radical formation will be explored. The goals of the proposed laboratory studies will further complement the trial and thus, will continue our longstanding tradition of strong clinical and laboratory interaction. Through the accomplishment of these goals we feel confident that we will be capable of improving outcome in patients with severe head injury.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Program Projects (P01)
Project #
5P01NS012587-18
Application #
3099403
Study Section
Neurological Disorders Program Project Review A Committee (NSPA)
Project Start
1979-04-01
Project End
1994-06-30
Budget Start
1993-04-01
Budget End
1994-06-30
Support Year
18
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Virginia Commonwealth University
Department
Type
Schools of Medicine
DUNS #
City
Richmond
State
VA
Country
United States
Zip Code
23298
Kleindienst, Andrea; Dunbar, Jana G; Glisson, Renee et al. (2013) The role of vasopressin V1A receptors in cytotoxic brain edema formation following brain injury. Acta Neurochir (Wien) 155:151-64
Fazzina, Giovanna; Amorini, Angela M; Marmarou, Christina R et al. (2010) The protein kinase C activator phorbol myristate acetate decreases brain edema by aquaporin 4 downregulation after middle cerebral artery occlusion in the rat. J Neurotrauma 27:453-61
Hartings, Jed A; Strong, Anthony J; Fabricius, Martin et al. (2009) Spreading depolarizations and late secondary insults after traumatic brain injury. J Neurotrauma 26:1857-66
Mazzeo, Anna Teresa; Brophy, Gretchen M; Gilman, Charlotte B et al. (2009) Safety and tolerability of cyclosporin a in severe traumatic brain injury patients: results from a prospective randomized trial. J Neurotrauma 26:2195-206
Samuelson, Rod; Mazzeo, Anna; Kunene, Nikki et al. (2006) Synthes Award For Resident Research On Craniofacial And Brain Injury: effect of cyclosporin A, topiramate, or 100% oxygen as proposed ""neuroprotective"" therapies on the neurochemical analytes in patients with severe traumatic brain injury. Clin Neurosurg 53:307-12
Stiefel, Michael F; Tomita, Yoshiyuki; Marmarou, Anthony (2005) Secondary ischemia impairing the restoration of ion homeostasis following traumatic brain injury. J Neurosurg 103:707-14
Stiefel, Michael F; Marmarou, Anthony (2002) Cation dysfunction associated with cerebral ischemia followed by reperfusion: a comparison of microdialysis and ion-selective electrode methods. J Neurosurg 97:97-103
Yamamoto, M; Marmarou, C R; Stiefel, M F et al. (1999) Neuroprotective effect of hypothermia on neuronal injury in diffuse traumatic brain injury coupled with hypoxia and hypotension. J Neurotrauma 16:487-500
Barzo, P; Marmarou, A; Fatouros, P et al. (1997) MRI diffusion-weighted spectroscopy of reversible and irreversible ischemic injury following closed head injury. Acta Neurochir Suppl 70:115-8
Marmarou, A; Barzo, P; Fatouros, P et al. (1997) Traumatic brain swelling in head injured patients: brain edema or vascular engorgement? Acta Neurochir Suppl 70:68-70

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