University of Oxford researchers have been awarded a grant from the National Institute for Health and Care Research (NIHR) to investigate whether anti-tumour necrosis factor (TNF) therapy can reduce or prevent delirium following surgical operations.
Post-operative delirium is an important problem, recognised as the most common surgical complication in older adults, occurring after many types of surgery. According to UK national audit data, 25 per cent of all hip fracture patients develop post-operative delirium. Hip fracture patients who develop delirium are twice as likely to die while in hospital and nearly four times more likely to require nursing home care compared with those who do not have delirium.
Patients who develop delirium are approximately four times more likely to develop cognitive memory deficit over three years, increasing to eight times higher likelihood over eight years. Every year, there are around 70,000 hip fractures in the UK and 300,000 in the US.
A team from the University of Oxford has found that the trauma associated with surgery leads to the release of proinflammatory mediators, especially TNF, which in turn leads to inflammation of a part of the brain called the hippocampus. The hippocampus is involved in memory and associated with learning and emotions.
The new trial, which will explore whether TNF therapy can reduce or prevent post-operative delirium and cognitive deficit, will be led by Professor Matt Costa of the University of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS).
Prof Costa (pictured left), Co-theme Lead for the NIHR Oxford Biomedical Research Centre (BRC) Musculoskeletal Theme, said: “Delirium is a terrible condition where patients get very confused and forget where and even who they are. It’s very distressing for the patients but also for their relatives.
“While most patients recover in the days after surgery, we now know that some patients with delirium develop permanent symptoms. This new trial is very exciting. If we can reduce the severity of delirium after surgery, we should be able to improve the long-term quality of life for this important group of patients.”
The study, designed as a multi-centre, randomised placebo-controlled trial in patients with hip fracture aged 60 years and above, is expected to be open for enrolment in the first half of 2023. As well as the NIHR, it is funded by 180 Life Sciences, a clinical stage biotech company.
“This is a major achievement by the team,” said Dr Jim Woody, CEO of 180 Life Sciences. “This dual funding model and collaboration between academia and industry leverages the expertise of both to develop new therapeutic strategies, for what we believe is a major unmet medical need, in the most effective way to benefit patients in the shortest possible timescale.”