Inside the NIH StrokeNet

Joseph Broderick
Joseph Broderick

The National Institutes of Health (NIH) StrokeNet, which was initiated in 2013, currently involves 288 hospitals across the United States and is designed to serve as the infrastructure and pipeline for new potential treatments for patients with stroke and those at risk of stroke, according to the User’s Guide published in the journal Stroke.

NeuroNews now speaks to Joseph Broderick (Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, Cincinnati, USA), principal investigator of the National Coordinating Center for the NIH StrokeNet, about the ins and outs of the network and its progress thus far.

Why was the NIH StrokeNet established?

The NIH StrokeNet was established primarily to facilitate Phase II and Phase III Trials of acute stroke treatment, stroke prevention, and recovery after stroke. Having an infrastructure already in place substantially decreases the time for new stroke trials to get started and the infrastructure can be immediately focused on other trials when a trial is completed or stopped early. A second goal of the NIH StrokeNet is to train the next generation of clinical researchers in stroke with at least one new fellow at every of the 25 regional stroke centres every year. Industry collaboration is encouraged.

What is its organisational structure?

The NIH StrokeNet is composed of 25 Regional Stroke Centers in the USA. Each regional centre includes a number of hospitals and/or additional academic hospitals. These Regional Centers include Rehabilitation Hospitals as well as Children’s Hospitals. The National Coordinating Center is based at the University of Cincinnati and the National Data Management Center is based at the Medical University of South Carolina. The NIH StrokeNet represents a close collaboration with the NINDS who provide significant input and oversight to the activities of the network.

Since its initiation in 2013, how has StrokeNet been performing?

All parts of the network were not funded until mid-2014, and the first year and a half was focused on setting up the infrastructure and contracts, reliance agreements at each regional centre and participating hospitals with the central IRB at the University of Cincinnati, and the development and submission of new trials. The NIH StrokeNet centres currently participate in the CREST 2, MISTIE III, iDEF Trial, POINT, Rhapsody, and SHINE trials as well as other NIH funded stroke trials. Two trials which have come directly from the NIH StrokeNet investigators include the TeleRehab Trial (just started this autumn) and DEFUSE 3 which is just starting. A large number of trials have been submitted for review or will be submitted for review by June 2016.

What are the subgroups within the NIH StrokeNet and what roles do they play?

There are three working groups (Acute Treatment, Prevention, and Recovery/rehabilitation) who help investigators assess their trial design and feasibility. Some of the proposed trials have sprung out of these working groups. There are two major Cores: the Educational Core and the Imaging Core. The latter Core plays a major role in assessing the imaging components of proposed trials. There are also advisory groups (Minority Recruitment, Endovascular, Paediatric) who provide input as needed on proposed trials.

How would new hospitals go about joining StrokeNet and what are the key benefits of doing so?

Hospitals can contact one of the Regional Center principal investigators (this information can be found on NIH StrokeNet website) to see if they would qualify as a satellite site. However, it is up to the Regional Center to decide whether this is possible. Hospitals can also participate in future NIH Stroke Trials even if they are not part of the network, if there is a need for centres beyond the NIH StrokeNet and they can demonstrate the ability to recruit into a specific type of clinical trial.

Can you explain the education platform provided by StrokeNet? What are its benefits?

The platform provides a year of support for trainees to learn about stroke research. These trainees (including neurologists, as well as physicians from other specialties, pharmacists and physical therapists among others) have access to an extensive series of scientific and professional educational presentations, the opportunity to present their research at national meetings, local and national mentorship for trainees, and interaction with their peers and stroke leadership across the USA.

Are there any plans to link this network with national stroke networks in other countries? If so, what would the implications of that be?

Yes. Our leadership has been meeting with newly developing stroke networks in other countries for the past 12+ months. These other networks may decide to participate in some of our ongoing trials. They may be able to support their local stroke infrastructure and thus help facilitate quicker completion of trials. Networking also can allow for planning of similar trials in other countries which facilitates pooling of data when the trials are completed.