Anti-Inflammatory Effect of Magnesium Sulfate on the Outcomes of Patients With Moderate Traumatic Brain Injury.
试验速览
- 阶段
- 4 期
- 状态
- 尚未招募
- 入组人数
- 64
- 主要终点
- Measured by the change in serum concentrations of the NLRP3 inflammasome complex
研究概览
简要总结
The primary objective of this study is to evaluate the biochemical efficacy of Magnesium Sulfate (MgSO₄) as an anti-inflammatory therapeutic agent in patients suffering from moderate traumatic brain injury (TBI) at Assiut University Hospitals by measuring Nucleotide-binding oligomerization domain-Like Receptor Pyrin domain-containing 3 (NLRP3) inflammasome-a multiprotein complex.
详细描述
Traumatic brain injury (TBI) remains a leading cause of mortality and long-term disability worldwide, disrupting both individual lives and healthcare systems. The pathophysiology of TBI is characterized by a biphasic process. The primary injury occurs at the moment of impact, resulting in immediate mechanical tissue disruption. This is followed by a complex cascade of cellular and molecular changes known as secondary brain injury, which develops hours to days later.
A cornerstone of this secondary injury pathway is neuroinflammation, driven by the activation of resident microglia and the infiltration of peripheral immune cells. Central to this inflammatory response is the assembly and activation of the Nucleotide-binding oligomerization domain-Like Receptor Pyrin domain-containing 3 (NLRP3) inflammasome-a multiprotein complex that triggers the maturation and release of potent pro-inflammatory cytokines, specifically interleukin-1β (IL-1β) and interleukin-18 (IL-18), accelerating neuronal apoptosis and blood-brain barrier dysfunction.
Magnesium sulfate (MgSO₄) has emerged as a promising neuroprotective candidate due to its multifaceted mechanism of action. Primarily, magnesium acts as a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor, thereby mitigating glutamate-mediated excitotoxicity. Emerging molecular evidence further indicates that magnesium exerts potent anti-inflammatory effects by downregulating nuclear factor kappa B (NF-κB) activation and directly inhibiting the assembly of the NLRP3 inflammasome. Consequently, evaluating the clinical and molecular efficacy of MgSO₄ in TBI patients could offer a viable therapeutic pathway to suppress secondary neuroinflammation and optimize neurological recovery.
NLRP3 Inflammasome is a multiprotein complex consisting of three core components:
- Sensor (NLRP3)
- Adaptor (ASC)
- Effector (Caspase-1)
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Other
- 盲法
- Triple (Participant, Care Provider, Investigator)
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Male and female patients aged 18 to 60 years.
- •Sustained a closed head trauma with the study drug infusion initiated within 8 hours of the injury.
- •TBI confirmed by history and clinical examination.
- •Patients with moderate (GCS = 9-12) traumatic brain injury.
- •Evidence of TBI confirmed by abnormalities consistent with trauma on CT scan upon admission (diffuse injury II-IV, evacuated and non-evacuated mass lesion, Marshall's CT Classification ).
- •Hemodynamic stability at the time of enrollment.
排除标准
- •Patient Refusal
- •Prolonged and/or uncorrectable hypoxia (PaO₂ < 60 mmHg) or persistent hypotension (systolic blood pressure < 90 mmHg) at the time of randomization.
- •Cardiopulmonary arrest.
- •Concomitant spinal cord injury.
- •Pregnant or lactating females.
- •Penetrating head injury.
- •Associated other extra-cranial trauma or systemic polytrauma.
- •Undergoing surgical interventions during the study.
- •Pre-existing severe cardiac arrhythmia, heart block, or significant myocardial damage (documented on ECG).
- •Known history of chronic renal failure or abnormal baseline renal function.
- •Known hypersensitivity or allergic reaction to magnesium sulfate.
- •Patients on chronic steroid therapy.
- •BMI>35 kg/m
研究组 & 干预措施
Group (A): Will receive intravenous magnesium sulfate MgSO₄.
32 patients will receive
- Loading Dose: Administered within 8 hours of trauma at a dose of 50 mg/kg via IV infusion over 1 hour.
- Maintenance Dose: Administered at 25 mg/kg every 12 hours (twice daily) for 48 hours.
干预措施: Magnesium sulfate (MgSO4) (Drug)
Group (B): Will receive intravenous normal saline as a placebo.
32 patients Will receive intravenous normal saline as a placebo.
干预措施: Normal Saline (Drug)
结局指标
主要结局
Measured by the change in serum concentrations of the NLRP3 inflammasome complex
时间窗: Measured by the change in serum concentrations of the NLRP3 inflammasome complex components from baseline (T₀) to 48 hours post-intervention (T₄₈), quantified via Enzyme-Linked Immunosorbent Assay (ELISA)
Molecular Anti-inflammatory Response: Measured by the change in serum concentrations of the NLRP3 inflammasome complex components from baseline (T₀) to 48 hours post-intervention (T₄₈), quantified via Enzyme-Linked Immunosorbent Assay (ELISA)
次要结局
- Glasgow Coma Scale (GCS) score(day 7 post-injury and one month)
- Incidence of hypermagnesemia-related toxicity or drug-related adverse events(48 hours)
- ESR, CRP and serum Magnesium levels on admission (T₀) and 48 hours post-intervention (T₄₈)(48 hours)
研究者
Ehab William Samir
Principal Investigator
Assiut University