The problem in neurotrauma has been translation from the bench to the bedside. In order to address challenge, we need to adopt the bedside as our clinical lab for study of traumatic brain injury (TBI), so as to identify patient subsets in which a given therapy has the most chance of success (Precision Medicine). Given this conceptual framework, three challenges exist. First we need robust biomarkers of efficacy or harm for therapies. While circulating biomarkers provide logistic convenience, a rational assessment suggests that these will need to be underpinned by imaging approaches that map spatially distributed pathophysiology and its impact on local tissue fate. Validating the relationship between biomarkers and target mechanisms may be facilitated by exploring interval phenotypes, where the process of interest is related to change in tissue fate over a relevant period. Second, we need to understand how such mapping of tissue fate relates to an integrated assessment of outcome. Finally, we need to use comparative effectiveness research (CER) to understand the effectiveness of these therapies in the overall clinical context of clinical disease. These challenges require the accumulation of large patient datasets coupled to novel approaches to study design and analysis. This talk will outline the way in which these challenges can be met through large multinational studies.
Prof. David Menon obtained his PhD in 2006 from London University. He is Principle Investigator in the Wolfson Brain Imaging Centre, and Co-Chair of the Acute Brain Injury Programme at the University of Cambridge, UK. He currently acts as Vice-Coordinator of the CENTER-TBI project, a €30 million European multicentre study of precision medicine and comparative effectiveness research in traumatic brain injury (TBI). His research interests include neurocritical care, secondary brain injury, neuroinflammation, and metabolic imaging of acute brain injury, using positron emission tomography and high field magnetic resonance imaging. Research in his group has been supported by funding from sources, including the Academy of Medical Sciences, the Medical Research Council, the European Commission’s FP7 Programme, the Royal College of Anaesthetists, the Evelyn Trust, and the Wellcome Foundation.