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Translational Research in Neurocritical Care

By Currents Editor posted 11-23-2020 11:05

  

By Yama Akbari MD, PhD, and Michael L. James MD, FAHA

Acknowledgement: ROSC Currents Taskforce (Shraddha Mainali, MD; Jennifer Kim, MD, PhD; Ruchi Jha, MD; Tom Lawson, CNP; Minjee Kim, MD; Cassia Righy, MD, PhD; Caitlin Brown, PharmD)

Translational research “moves [work] in a bidirectional manner from one type of research to another – from basic research to patient-oriented research, to population-based research, and back – and involves collaboration among scientists from multiple disciplines.”1 In neurocritical care, translational research is especially important because much of the care we provide as neurointensivists lacks Level I evidence; thus, clinicians yearn for clarity as we operate in a world in which any preclinical or early preliminary clinical data may be of high potential relevance.

Currently, massive amounts of basic and preclinical research support the science of neurocritical care, ultimately leading to better care of our patients. Nevertheless, the gap between foundational basic research and clinical care remains, lacking that critical bridge of translational research. The importance of this point cannot be underestimated, especially given the lack of efficacious treatments for critically ill brain-injured patients.2 Examples include failure of more than 1,000 neuroprotective agents in the clinical setting after showing promise in the discovery and preclinical settings. However, failures of the past must not deter us from proceeding with hope because without translational research, no advancement from bench to bedside, or back, will occur. 

To this end, since the inception of the journal, Neurocritical Care has retained and curated manuscripts relating to the basic and translational science of neurointensive care.

Providing a venue promoting translational successes allows paradigm shifts in our care to develop faster. Two examples of recent (potentially) successful translational investigations include the development of SUR1 inhibitors3, now undergoing Phase 3 trials for cerebral edema, and apolipoprotein E-mimetic peptides4, recently completing Phase 2 trials for acute intracerebral hemorrhage (in review for Neurocritical Care).

Sometimes, just giving a platform talk or poster presentation of basic science research at the Neurocritical Care Society (NCS) Annual Meeting can lead to lively discussions, which in turn lead to grant proposals, successful funding and translational “first-in-human” projects, something we have both personally experienced and have found very rewarding.5 Such examples represent potential paradigm shifts that can occur through translation of basic science to the clinical setting.

A major goal of the NCS is to promote basic and translational research that can ultimately benefit neurocritically ill patients. One way that the NCS is promoting this tide is by increasing the number of high-quality publications in Neurocritical Care, as well as invitations for abstract submissions on translational research at the NCS Annual Meeting. 

Neurocritical Care is strongly encouraging manuscript submissions from the NCS membership, especially across a wide and diverse range of topics from the international community that makes up our Society’s membership. Additionally, Neurocritical Care strenuously encourages NCS members to promote the journal to others when attending scientific meetings and discovering work related to neurocritical care. When you come across good science, whether in poster, platform or informal discussion, think of Neurocritical Care.

Often, small scientific meetings may lack affiliation with a related journal for publication. Examples include World Intracranial Hemorrhage Conference (WICH), Collaterals, Cooperative Studies on Brain Injury Depolarizations (COSBID), Society for Brain Mapping and Therapeutics, among many others. If there are other meetings that you attend or know about, please contact us. Reminding scientists performing good work of your journal opens the pathway for their science to be promoted in print and across social media, enabling further dissemination and collaborations within our community of clinicians, clinician-scientists and scientists. 

Currently, Neurocritical Care publishes (on average) one to two basic/translational science articles per issue with a rejection rate of approximately 50% of these submissions. While the impact factor of submissions has improved in recent years, higher-quality studies are vigorously sought. To meet this goal, Neurocritical Care has recently taken special initiatives to focus on specific themed issues centered on basic/preclinical/translational science. For example, Neurocritical Care has dedicated an upcoming issue to Cortical Spreading Depolarizations, for which a general call for manuscripts will occur. Work on cortical spreading depolarizations is a great example of how basic and preclinical research of a clinical phenomenon has translated back to first-in-human studies in the Neuro ICU.6

Long-term goals of the NCS and Neurocritical Care include increased translational research to further promote paradigm shifts in clinical care around the world. Steps to achieve this overarching mission include creating research forums and groups to promote networking between basic, translational, and clinical scientists and clinicians; sharing funding opportunities among interested parties to enable them to carry on such research with others; and continuing to highlight your best work in Neurocritical Care.

If you have other thoughts or ideas to promote basic/translational science in the NCS and Neurocritical Care, please let us know! Contact Yama Akbari and Luke James.

References:

  1. Rubio, D. M. et al. Defining translational research: implications for training. Acad. Med. 85, 470–5 (2010).
  2. Warner, D. S., James, M. L., Laskowitz, D. T. & Wijdicks, E. F. Translational research in acute central nervous system injury: lessons learned and the future. JAMA Neurol. 71, 1311–8 (2014).
  3. Simard, J. M. et al. Glibenclamide in Cerebral Ischemia and Stroke. Neurocrit. Care 20, 319–333 (2014).
  4. Laskowitz, D. T. et al. The apoE-mimetic Peptide, COG1410, Improves Functional Recovery in a Murine Model of Intracerebral Hemorrhage. Neurocrit. Care 16, 316–326 (2012).
  5. Wilson, R. et al. Optical Imaging Predicts Neurological Recovery in a Preclinical Model of Cardiac Arrest and Resuscitation. Neurocrit. Care 27, S4 (2017).
  6. Shuttleworth, C. W. et al. Which Spreading Depolarizations Are Deleterious To Brain Tissue? Neurocrit. Care 32, 317–322 (2020).

 

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