Efficacy of VAS203 (Ronopterin) in Patients With Moderate and Severe Traumatic Brain Injury

Inclusion Criteria:

1. Written informed consent from patient's legal guardian or legal representative ordeferred consent procedure, according to local requirements
2. 18 - 60 years of age, inclusive
3. Expected to survive more than 24 hours after admission
4. Traumatic Brain Injury (TBI) within the last 18 hours (infusion must not start earlierthan 6 hours after the injury)
5. TBI with Glasgow Coma Score (GCS) ≥ 3 requiring intracranial pressure (ICP) monitoringaccording to the assessment of the treating physician.
6. Catheter placement (intraventricular or intraparenchymal, only) for monitoring andmanagement of increased ICP
7. Systolic blood pressure ≥ 100 mmHg
8. Females of child-bearing potential must have a negative pregnancy test

Exclusion Criteria:

1. Penetrating head injury (e.g. missile, stab wound)
2. Concurrent, but not pre-existing, spinal cord injury
3. Bilateral fixed and dilated pupil (> 4 mm)
4. Cardiopulmonary resuscitation performed post injury, or extracranial injuries causingcontinuing bleeding likely to require multiple transfusions (> 4 units red bloodcells)
5. Coma due to an exclusive epidural hematoma (lucid interval and absence of structuralbrain damage on CT scan)
6. Coma suspected to be primarily due to other causes than head injury (e.g. drugoverdose intoxication, drowning/near drowning)
7. Known or CT scan evidence of pre-existing major cerebral damage
8. Patients who cannot be monitored with regard to their recovery (eGOS-I and QOLIBRI)
9. Patients and relatives of patients who don´t understand/speak Spanish, or English, orFrench, or German
10. Decompressive craniectomy, planned prior to randomisation
11. Polytraumatic patients with Injury Severity Score non-head > 18
12. Rhabdomyolysis with Creatine Kinase > 5000 IU/L
13. Injuries to ascending aorta and/or carotid arteries and vertebral arteries
14. Serum creatinine values > 1.2 mg/dL (106 µmol/L) (women), or > 1.5 mg/dL (133 µmol/L) (men)
15. Estimated glomerular filtration rate (eGFR) < 60 mL/min as calculated by ChronicKidney Disease Epidemiology Collaboration Formula
16. BMI < 18.5 kg/m2 and > 40 kg/m2, Body weight > 110 kg
17. Any severe concomitant condition (cancer; hematologic, renal, hepatic, coronarydisease; major psychiatric disorder; alcohol or drug abuse), that can be ascertainedat admission
18. Known to have received an experimental drug within 4 weeks prior to current injury