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Lo Coco V, Lorusso R, Raffa GM, Malvindi PG, Pilato M, Martucci G, Arcadipane A, Zieliński K, Suwalski P, Kowalewski M. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: still the achille's heel. J Thorac Dis 2018; 10:6993-7004. [PMID: 30746245 DOI: 10.21037/jtd.2018.11.103] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is life-saving for potentially reversible heart failure and respiratory injuries not responsive to conventional therapies. Technological innovations have produced over the years significant improvements in ECMO devices (pump, cannula design and oxygenator) and have allowed a better risk/benefit profile. Alongside with recognized advantages in the treatment of very sick patients, ECMO remains an invasive procedure for mechanical circulatory support (MCS) and it is associated with complications that strongly influence the prognosis. Current review was designed to provide a comprehensive outline on ECMO complications, analyzing risk factors and strategies of management, focusing on adult population undergoing veno-arterial ECMO (VA-ECMO) therapy.
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Affiliation(s)
- Valeria Lo Coco
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giuseppe M Raffa
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | | | - Michele Pilato
- Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department of Anaesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy
| | - Antonio Arcadipane
- Department of Anaesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy
| | | | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.,Clinical Department of Cardiac Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.,Cardiothoracic Research Centre, Innovative Medical Forum, Bydgoszcz, Poland
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52
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Pro- and anti-inflammatory biomarkers and traumatic brain injury outcomes: A review. Cytokine 2018; 110:248-256. [DOI: 10.1016/j.cyto.2018.01.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
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53
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Gill J, Mustapic M, Diaz-Arrastia R, Lange R, Gulyani S, Diehl T, Motamedi V, Osier N, Stern RA, Kapogiannis D. Higher exosomal tau, amyloid-beta 42 and IL-10 are associated with mild TBIs and chronic symptoms in military personnel. Brain Inj 2018; 32:1277-1284. [PMID: 29913077 DOI: 10.1080/02699052.2018.1471738] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Identify biomarkers in peripheral blood that relate to chronic post-concussive and behavioural symptoms following traumatic brain injuries (TBIs) to ultimately improve clinical management. RESEARCH DESIGN We compared military personnel with mild TBIs (mTBIs) (n = 42) to those without TBIs (n = 22) in concentrations of tau, amyloid-beta (Aβ42) and cytokines (tumour necrosis factor alpha (TNFα, interleukin (IL)-6 and -10) in neuronal-derived exosomes from the peripheral blood. We utilized nanosight technology coupled with ultra-sensitivity immunoassay methods. We also examined the impact of post-concussive and behavioural symptoms including depression and post-traumatic stress disorder (PTSD) on these neuronal-derived markers. RESULTS We report that concentrations of exosomal tau (F1, 62 = 10.50), Aβ42 (F1, 61 = 5.32) and IL-10 (F1, 59 = 4.32) were elevated in the mTBI group compared to the controls. Within the mTBI group, regression models show that post-concussive symptoms were most related to exosomal tau elevations, whereas exosomal IL-10 levels were related to PTSD symptoms. CONCLUSIONS These findings suggest that chronic post-concussive symptoms following an mTBI relate to altered exosomal activity, and that greater tau pathology may underlie chronic post-concussive symptoms that develop following mTBIs. It also suggests that central inflammatory activity contributes to PTSD symptoms following an mTBI, providing necessary insights into the role of inflammation in chronic PTSD symptoms.
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Affiliation(s)
- Jessica Gill
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Maja Mustapic
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Ramon Diaz-Arrastia
- c Department of Neurology, School of Medicine , University of Pennsylvania , Philadelphia , PA , United States
| | - Rael Lange
- d Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , United States
| | - Seema Gulyani
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Tom Diehl
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Vida Motamedi
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Nicole Osier
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Robert A Stern
- e Neurosurgery, and Anatomy & Neurobiology , Boston University, Boston University Alzheimer's Disease and CTE Center , Boston , MA , United States
| | - Dimitrios Kapogiannis
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
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54
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Devoto C, Arcurio L, Fetta J, Ley M, Rodney T, Kanefsky R, Gill J. Inflammation Relates to Chronic Behavioral and Neurological Symptoms in Military Personnel with Traumatic Brain Injuries. Cell Transplant 2018; 26:1169-1177. [PMID: 28933225 PMCID: PMC5657728 DOI: 10.1177/0963689717714098] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Studies have shown that the presence of acute inflammation during recovery is indicative of poor outcomes after a traumatic brain injury (TBI); however, the role of chronic inflammation in predicting post-TBI-related symptoms remains poorly understood. The purpose of this study was to compare inflammatory biomarkers (tumor necrosis factor [TNF]-α, interleukin [IL]-6, and IL-10) in active duty personnel who either sustained or did not sustain a TBI. Service members were also assessed for post-traumatic stress disorder (PTSD), depression, and quality of life through self-reported measures. IL-6 and TNF-α concentrations were greater in the TBI group than in the control group. Of those with a TBI, IL-6 and TNF-α concentrations were greater in the high-PTSD group than the low-PTSD group. No significant differences were found in IL-10 or the IL-6/IL-10 ratios between those with low and high PTSD. Exploratory factor analysis was conducted to describe the latent structure of variables relating to emotional and physical health (i.e., Short Form 36 subcomponents, etc.) and their relationships within the TBI group with inflammatory cytokines. Four symptom profiles were found, with the third component most relating to PTSD and depression symptoms and high inflammation. This study indicates that the comorbidity of TBI and PTSD is associated with inflammation in a military sample, emphasizing the necessity for intervention in order to mitigate the risks associated with inflammation.
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Affiliation(s)
- Christina Devoto
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Lindsay Arcurio
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Joseph Fetta
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Mary Ley
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Tamar Rodney
- 2 Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Rebekah Kanefsky
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
| | - Jessica Gill
- 1 National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, USA
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55
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Shi Y, Zhang P, Wang G, Liu X, Sun X, Zhang X, Li H, Qi J, Ding L, Li T, Zhang R, Chen Y, Zhou J, Lv G, Tu Z. Description of organ-specific phenotype, and functional characteristics of tissue resident lymphocytes from liver transplantation donor and research on immune tolerance mechanism of liver. Oncotarget 2018; 9:15552-15565. [PMID: 29643992 PMCID: PMC5884647 DOI: 10.18632/oncotarget.24514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/25/2018] [Indexed: 12/14/2022] Open
Abstract
Aim Prior to transplantation, Donation after Cardiac Death (DCD) liver transplantation livers are perfused with preservation solution. Therefore, this provides an abundant source of human liver lymphocytes, as well as mesenteric lymph node and spleen for the study of lymphocyte subset diversity in the peripheral blood, lymph node, spleen and liver. Methods Lymphocyte subsets were isolated and purified from peripheral blood, lymph node, spleen and liver perfusion, the phenotypic and functional analysis of the tissue resident lymphocyte were performed by flow cytometry. Results In a direct comparison between blood, liver, lymph node and spleen cells from liver transplantation donors, the abundance of natural killer (NK) cells, CD3+CD56+NKT (NT) cells and CD8+ T cells in intrahapatic lymphocytes (IHL) did not match what was present in peripheral blood and other peripheral lymphoid organs. The activation state of peripheral blood-derived lymphocytes was significantly different from lymph node-, spleen- and liver-derived cells. Intriguingly, NK cells, CD4+ T cells, and CD8+ T cells from liver perfusion display more suppressive characteristics, that is, express and produce more anti-inflammatory cytokine interleukin (IL)-10, less inflammatory cytokine interferon (INF)-γ. Conclusion Our findings imply that different tissues entail resident lymphocyte subsets with a distinct phenotype and function considering the organ is well vascularized, particularly in liver. It is better to understand the mechanism of liver immune tolerance.
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Affiliation(s)
- Yunpeng Shi
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ping Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guangyi Wang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xingkai Liu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaodong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xin Zhang
- Department of Emergency Surgery, Jilin Province People's Hospital, Changchun, Jilin 130021, P.R. China
| | - Haijun Li
- Department of Surgery, Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, Jilin 130061, P.R. China
| | - Jun Qi
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lei Ding
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ting Li
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Ruoyan Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yuguo Chen
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jianpeng Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guoyue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Zhengkun Tu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.,Department of Surgery, Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, Jilin 130061, P.R. China
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56
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Ondruschka B, Schuch S, Pohlers D, Franke H, Dreßler J. Acute phase response after fatal traumatic brain injury. Int J Legal Med 2018; 132:531-539. [PMID: 29306988 DOI: 10.1007/s00414-017-1768-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/15/2017] [Indexed: 12/20/2022]
Abstract
An inflammatory response occurring after fatal traumatic brain injury (TBI) initiates time-dependent cascades of acute phase response. This may offer the potential to monitor postmortem biomarker levels of several pro-inflammatory cytokines to gain information about the cause of death and the trauma survival time. Cerebrospinal fluid (CSF) and serum samples were collected from forensic autopsies of 95 adult cadavers after postmortem intervals up to 6 days. The cases were divided according to their cause of death into fatal TBI (n = 46) with different survival times and age- and gender-matching non-TBI fatalities as controls (n = 49). Quantitative marker levels of interleukin-6 (IL-6), ferritin, soluble tumor necrosis factor receptor type 1, C-reactive protein, and lactate dehydrogenase were analyzed using immunoassays. Standardized statistical tests were performed to differentiate causes of death and survival time of TBI cases. The CSF IL-6, ferritin, and LDH levels after TBI were significantly higher than those in the controls (p < 0.001). Only serum IL-6 values showed comparable differences (p < 0.05). Both CSF and serum ferritin levels were discriminative between early and delayed death after TBI (p < 0.05). There were partly distinctive correlations between marker levels in both fluids with rising values after longer survival. There were up to moderate correlation between the marker levels and the postmortem interval due to postmortem hemolysis. However, neither CSF nor serum level ranges were affected by the age or gender of the subjects. This study is the first to measure all five proteins systematically in postmortem trauma cases. Ferritin and IL-6 proved themselves to be interesting postmortem biomarkers to provide specific information on the injury pattern and the survival time of traumatic fatalities. Such forensic investigations could serve as inexpensive and fast laboratory tests.
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Affiliation(s)
- Benjamin Ondruschka
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany.
| | - Sandra Schuch
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
| | - Dirk Pohlers
- Center of Diagnostics GmbH, Klinikum Chemnitz, Chemnitz, Germany
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Jan Dreßler
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Johannisallee 28, 04103, Leipzig, Germany
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57
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Moderate blast exposure results in increased IL-6 and TNFα in peripheral blood. Brain Behav Immun 2017; 65:90-94. [PMID: 28232173 PMCID: PMC5537025 DOI: 10.1016/j.bbi.2017.02.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022] Open
Abstract
A unique cohort of military personnel exposed to isolated blast was studied to explore acute peripheral cytokine levels, with the aim of identifying blast-specific biomarkers. Several cytokines, including interleukin (IL) 6, IL-10 and tumor necrosis factor alpha (TNFα) have been linked to pre-clinical blast exposure, but remained unstudied in clinical blast exposure. To address this gap, blood samples from 62 military personnel were obtained at baseline, and daily, during a 10-day blast-related training program; changes in the peripheral concentrations of IL-6, IL-10 and TNFα were evaluated using an ultrasensitive assay. Two groups of trainees were matched on age, duration of military service, and previous history of blast exposure(s), resulting in moderate blast cases and no/low blast controls. Blast exposures were measured using helmet sensors that determined the average peak pressure in pounds per square inch (psi). Moderate blast cases had significantly elevated concentrations of IL-6 (F1,60=18.81, p<0.01) and TNFα (F1,60=12.03, p<0.01) compared to no/low blast controls; levels rebounded to baseline levels the day after blast. On the day of the moderate blast exposure, the extent of the overpressure (psi) in those exposed correlated with IL-6 (r=0.46, p<0.05) concentrations. These findings indicate that moderate primary blast exposure results in changes, specifically acute and transient increases in peripheral inflammatory markers which may have implications for neuronal health.
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58
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DelSignore LA, Tasker RC. Treatment options for severe traumatic brain injuries in children: current therapies, challenges, and future prospects. Expert Rev Neurother 2017; 17:1145-1155. [PMID: 28918666 DOI: 10.1080/14737175.2017.1380520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Severe traumatic brain injury (TBI) afflicts many children and adults worldwide, resulting in high rates of morbidity and mortality. Recent therapeutic advances have focused on both surgical and medical treatment options, but none have been proven to reduce overall morbidity and mortality in this population. Areas covered: Several emerging therapies are addressed that focus on treating related secondary injuries and other clinical sequelae post-TBI during the acute injury phase (defined by authors as up to four weeks post-injury). Information and data were obtained from a PubMed search of recent literature and through reputable websites (e.g. Centers for Disease Control, ClinicalTrials.gov). Peer-reviewed original articles, review articles, and clinical guidelines were included. Expert commentary: The ongoing challenges related to conducting rigorous clinical trials in TBI have led to largely inconclusive findings regarding emerging beneficial therapies.
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Affiliation(s)
- Lisa A DelSignore
- a Department of Pediatrics, Division of Critical Care Medicine , Tufts Floating Hospital for Children, Tufts Medical School , Boston , MA , USA
| | - Robert C Tasker
- b Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Critical Care Medicine , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA.,c Department of Neurology , Boston Children's Hospital, Harvard Medical School , Boston , MA , USA
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59
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Thelin EP, Tajsic T, Zeiler FA, Menon DK, Hutchinson PJA, Carpenter KLH, Morganti-Kossmann MC, Helmy A. Monitoring the Neuroinflammatory Response Following Acute Brain Injury. Front Neurol 2017; 8:351. [PMID: 28775710 PMCID: PMC5517395 DOI: 10.3389/fneur.2017.00351] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are major contributors to morbidity and mortality. Following the initial insult, patients may deteriorate due to secondary brain damage. The underlying molecular and cellular cascades incorporate components of the innate immune system. There are different approaches to assess and monitor cerebral inflammation in the neuro intensive care unit. The aim of this narrative review is to describe techniques to monitor inflammatory activity in patients with TBI and SAH in the acute setting. The analysis of pro- and anti-inflammatory cytokines in compartments of the central nervous system (CNS), including the cerebrospinal fluid and the extracellular fluid, represent the most common approaches to monitor surrogate markers of cerebral inflammatory activity. Each of these compartments has a distinct biology that reflects local processes and the cross-talk between systemic and CNS inflammation. Cytokines have been correlated to outcomes as well as ongoing, secondary injury progression. Alongside the dynamic, focal assay of humoral mediators, imaging, through positron emission tomography, can provide a global in vivo measurement of inflammatory cell activity, which reveals long-lasting processes following the initial injury. Compared to the innate immune system activated acutely after brain injury, the adaptive immune system is likely to play a greater role in the chronic phase as evidenced by T-cell-mediated autoreactivity toward brain-specific proteins. The most difficult aspect of assessing neuroinflammation is to determine whether the processes monitored are harmful or beneficial to the brain as accumulating data indicate a dual role for these inflammatory cascades following injury. In summary, the inflammatory component of the complex injury cascade following brain injury may be monitored using different modalities. Using a multimodal monitoring approach can potentially aid in the development of therapeutics targeting different aspects of the inflammatory cascade and improve the outcome following TBI and SAH.
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Affiliation(s)
- Eric Peter Thelin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tamara Tajsic
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Frederick Adam Zeiler
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Rady Faculty of Health Sciences, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.,Clinician Investigator Program, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Maria Cristina Morganti-Kossmann
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Child Health, Barrow Neurological Institute at Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, Phoenix, AZ, United States
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Hazeldine J, Naumann DN, Toman E, Davies D, Bishop JRB, Su Z, Hampson P, Dinsdale RJ, Crombie N, Duggal NA, Harrison P, Belli A, Lord JM. Prehospital immune responses and development of multiple organ dysfunction syndrome following traumatic injury: A prospective cohort study. PLoS Med 2017; 14:e1002338. [PMID: 28719602 PMCID: PMC5515405 DOI: 10.1371/journal.pmed.1002338] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/31/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Almost all studies that have investigated the immune response to trauma have analysed blood samples acquired post-hospital admission. Thus, we know little of the immune status of patients in the immediate postinjury phase and how this might influence patient outcomes. The objective of this study was therefore to comprehensively assess the ultra-early, within 1-hour, immune response to trauma and perform an exploratory analysis of its relationship with the development of multiple organ dysfunction syndrome (MODS). METHODS AND FINDINGS The immune and inflammatory response to trauma was analysed in 89 adult trauma patients (mean age 41 years, range 18-90 years, 75 males) with a mean injury severity score (ISS) of 24 (range 9-66), from whom blood samples were acquired within 1 hour of injury (mean time to sample 42 minutes, range 17-60 minutes). Within minutes of trauma, a comprehensive leukocytosis, elevated serum pro- and anti-inflammatory cytokines, and evidence of innate cell activation that included neutrophil extracellular trap generation and elevated surface expression of toll-like receptor 2 and CD11b on monocytes and neutrophils, respectively, were observed. Features consistent with immune compromise were also detected, notably elevated numbers of immune suppressive CD16BRIGHT CD62LDIM neutrophils (82.07 x 106/l ± 18.94 control versus 1,092 x 106/l ± 165 trauma, p < 0.0005) and CD14+HLA-DRlow/- monocytes (34.96 x 106/l ± 4.48 control versus 95.72 x 106/l ± 8.0 trauma, p < 0.05) and reduced leukocyte cytokine secretion in response to lipopolysaccharide stimulation. Exploratory analysis via binary logistic regression found a potential association between absolute natural killer T (NKT) cell numbers and the subsequent development of MODS. Study limitations include the relatively small sample size and the absence of data relating to adaptive immune cell function. CONCLUSIONS Our study highlighted the dynamic and complex nature of the immune response to trauma, with immune alterations consistent with both activation and suppression evident within 1 hour of injury. The relationship of these changes, especially in NKT cell numbers, to patient outcomes such as MODS warrants further investigation.
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Affiliation(s)
- Jon Hazeldine
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - David N. Naumann
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Emma Toman
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - David Davies
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Jonathan R. B. Bishop
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Zhangjie Su
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Peter Hampson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Scar Free Foundation, Birmingham Centre for Burns Research, Birmingham, United Kingdom
| | - Robert J. Dinsdale
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Scar Free Foundation, Birmingham Centre for Burns Research, Birmingham, United Kingdom
| | - Nicholas Crombie
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Brierley Hill, West Midlands, United Kingdom
| | - Niharika Arora Duggal
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Paul Harrison
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Scar Free Foundation, Birmingham Centre for Burns Research, Birmingham, United Kingdom
| | - Antonio Belli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Janet M. Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Translating biomarkers from research to clinical use in pediatric neurocritical care: focus on traumatic brain injury and cardiac arrest. Curr Opin Pediatr 2017; 29:272-279. [PMID: 28319562 DOI: 10.1097/mop.0000000000000488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) and cardiac arrest are important causes of morbidity and mortality in children. Improved diagnosis and outcome prognostication using validated biomarkers could allow clinicians to better tailor therapies for optimal efficacy. RECENT FINDINGS Contemporary investigation has yielded plentiful biomarker candidates of central nervous system (CNS) injury, including macromolecules, genetic, inflammatory, oxidative, and metabolic biomarkers. Biomarkers have yet to be validated and translated into bedside point-of-care or cost-effective and efficient laboratory tests. Validation testing should consider developmental status, injury mechanism, and time trajectory with patient-centered outcomes. SUMMARY Recent investigation of biomarkers of CNS injury may soon improve diagnosis, management, and prognostication in children with traumatic brain injury and cardiac arrest.
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Vonder Haar C, Martens KM, Riparip LK, Rosi S, Wellington CL, Winstanley CA. Frontal Traumatic Brain Injury Increases Impulsive Decision Making in Rats: A Potential Role for the Inflammatory Cytokine Interleukin-12. J Neurotrauma 2017; 34:2790-2800. [PMID: 28376700 DOI: 10.1089/neu.2016.4813] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with the development of numerous psychiatric diseases. Of particular concern for TBI patients is the impact of chronic impulsivity on daily functioning. Despite the scope of the human problem, little has been done to address impulsivity in animal models of brain injury. In the current study, we examined the effects of either a severe or a milder bilateral frontal controlled cortical impact injury on impulsivity using the Delay Discounting Task (DDT), in which preference for smaller-sooner over larger-later rewards is indicative of greater impulsive choice. Both milder and severe TBI caused a significant, chronic increase in impulsive decision making. Despite these pronounced changes in performance of the DDT, memory function, as assessed by the Morris Water Maze, was not impaired in more mildly injured rats and only transiently impacted in the severe TBI group. Whereas a significant lesion was only evident in severely injured rats, analysis of cytokine levels within the frontal cortex revealed a selective increase in interleukin (IL)-12 that was associated with the magnitude of the change in impulsive choice caused by both milder and severe TBI. These findings suggest that tissue loss alone cannot explain the increased impulsivity observed, and that inflammatory pathways mediated by IL-12 may be a contributing factor. The findings from this study highlight the sensitivity of sophisticated behavioral measures designed to assess neuropsychiatric dysfunction in the detection of TBI-induced cognitive impairments and their utility in identifying potential mechanistic pathways and therapeutic targets.
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Affiliation(s)
- Cole Vonder Haar
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Kris M Martens
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Lara-Kirstie Riparip
- 2 Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco , San Francisco, California
| | - Susanna Rosi
- 2 Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco , San Francisco, California
| | - Cheryl L Wellington
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
| | - Catharine A Winstanley
- 1 Djavad Mowafaghian Centre for Brain Health, University of British Columbia , Vancouver, British Columbia, Canada
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Neurotrauma: The Crosstalk between Neurotrophins and Inflammation in the Acutely Injured Brain. Int J Mol Sci 2017; 18:ijms18051082. [PMID: 28524074 PMCID: PMC5454991 DOI: 10.3390/ijms18051082] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/25/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality among young individuals worldwide. Understanding the pathophysiology of neurotrauma is crucial for the development of more effective therapeutic strategies. After the trauma occurs, immediate neurologic damage is produced by the traumatic forces; this primary injury triggers a secondary wave of biochemical cascades together with metabolic and cellular changes, called secondary neural injury. In the scenario of the acutely injured brain, the ongoing secondary injury results in ischemia and edema culminating in an uncontrollable increase in intracranial pressure. These areas of secondary injury progression, or areas of “traumatic penumbra”, represent crucial targets for therapeutic interventions. Neurotrophins are a class of signaling molecules that promote survival and/or maintenance of neurons. They also stimulate axonal growth, synaptic plasticity, and neurotransmitter synthesis and release. Therefore, this review focuses on the role of neurotrophins in the acute post-injury response. Here, we discuss possible endogenous neuroprotective mechanisms of neurotrophins in the prevailing environment surrounding the injured areas, and highlight the crosstalk between neurotrophins and inflammation with focus on neurovascular unit cells, particularly pericytes. The perspective is that neurotrophins may represent promising targets for research on neuroprotective and neurorestorative processes in the short-term following TBI.
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Castranio EL, Mounier A, Wolfe CM, Nam KN, Fitz NF, Letronne F, Schug J, Koldamova R, Lefterov I. Gene co-expression networks identify Trem2 and Tyrobp as major hubs in human APOE expressing mice following traumatic brain injury. Neurobiol Dis 2017; 105:1-14. [PMID: 28502803 DOI: 10.1016/j.nbd.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 05/01/2017] [Accepted: 05/10/2017] [Indexed: 01/09/2023] Open
Abstract
Traumatic brain injury (TBI) is strongly linked to an increased risk of developing dementia, including chronic traumatic encephalopathy and possibly Alzheimer's disease (AD). APOEε4 allele of human Apolipoprotein E (APOE) gene is the major genetic risk factor for late onset AD and has been associated with chronic traumatic encephalopathy and unfavorable outcome following TBI. To determine if there is an APOE isoform-specific response to TBI we performed controlled cortical impact on 3-month-old mice expressing human APOE3 or APOE4 isoforms. Following injury, we used several behavior paradigms to test for anxiety and learning and found that APOE3 and APOE4 targeted replacement mice demonstrate cognitive impairments following moderate TBI. Transcriptional profiling 14days following injury revealed a significant effect of TBI, which was similar in both genotypes. Significantly upregulated by injury in both genotypes were mRNA expression and protein level of ABCA1 transporter and APOJ, but not APOE. To identify gene-networks correlated to injury and APOE isoform, we performed Weighted Gene Co-expression Network Analysis. We determined that the network mostly correlated to TBI in animals expressing both isoforms is immune response with major hub genes including Trem2, Tyrobp, Clec7a and Cd68. We also found a significant increase of TREM2, IBA-1 and GFAP protein levels in the brains of injured mice. We identified a network representing myelination that correlated significantly with APOE isoform in both injury groups. This network was significantly enriched in oligodendrocyte signature genes, such as Mbp and Plp1. Our results demonstrate unique and distinct gene networks at this acute time point for injury and APOE isoform, as well as a network driven by APOE isoform across TBI groups.
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Affiliation(s)
- Emilie L Castranio
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Anais Mounier
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Cody M Wolfe
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Kyong Nyon Nam
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Nicholas F Fitz
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Florent Letronne
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Jonathan Schug
- Functional Genomics Core, Department of Genetics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Radosveta Koldamova
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA.
| | - Iliya Lefterov
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Werhane ML, Evangelista ND, Clark AL, Sorg SF, Bangen KJ, Tran M, Schiehser DM, Delano-Wood L. Pathological vascular and inflammatory biomarkers of acute- and chronic-phase traumatic brain injury. Concussion 2017; 2:CNC30. [PMID: 30202571 PMCID: PMC6094091 DOI: 10.2217/cnc-2016-0022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022] Open
Abstract
Given the demand for developing objective methods for characterizing traumatic brain injury (TBI), research dedicated to evaluating putative biomarkers has burgeoned over the past decade. Since it is critical to elucidate the underlying pathological processes that underlie the higher diverse outcomes that follow neurotrauma, considerable efforts have been aimed at identifying biomarkers of both the acute- and chronic-phase TBI. Such information is not only critical for helping to elucidate the pathological changes that lead to poor long-term outcomes following TBI but it may also assist in the identification of possible prevention and interventions for individuals who sustain head trauma. In the current review, we discuss the potential role of vascular dysfunction and chronic inflammation in both acute- and chronic-phase TBI, and we also highlight existing studies that have investigated inflammation biomarkers associated with poorer injury outcome.
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Affiliation(s)
- Madeleine L Werhane
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Alexandra L Clark
- San Diego State University/University of California, San Diego (SDSU/UC San Diego) Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Scott F Sorg
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - My Tran
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- San Diego State University (SDSU), San Diego, CA 92182, USA
| | - Dawn M Schiehser
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
| | - Lisa Delano-Wood
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Center of Excellence for Stress & Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego (UCSD), La Jolla, CA 92093, USA
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Simon D, Evaldt J, Nabinger DD, Fontana MF, Klein MG, do Amaral Gomes J, Regner A. Plasma matrix metalloproteinase-9 levels predict intensive care unit mortality early after severe traumatic brain injury. Brain Inj 2017; 31:390-395. [PMID: 28156136 DOI: 10.1080/02699052.2016.1259501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Matrix metalloproteinase-9 (MMP-9) is an inducible metalloproteinase that can degrade the cerebrovascular matrix leading to disruption of the blood-brain barrier and exacerbation of oedema in neurotrauma. Therefore, our aim was to determine whether MMP-9 plasma levels were associated with intensive care unit (ICU) mortality after severe traumatic brain injury (TBI) despite the presence of extracerebral injuries. METHODS This cohort enrolled 80 patients who suffered severe TBI (Glasgow Coma Scale: 3-8 at hospital admission). The plasma MMP-9 level was determined by enzyme-linked immunosorbent assay assay at ICU admission. RESULTS Severe TBI was associated with a 32.5% ICU mortality rate. There was no association between the presence of extracerebral injuries (72.5% of the patients) and ICU mortality (P = 0.419). Higher plasma MMP-9 concentrations were associated with fatal outcome: 181.1 ± 16.0 ng/mL for survivors and 257.0 ± 23.2 ng/mL for nonsurvivors (mean ± S.E.M., P = 0.009). In contrast, there was no significant difference between MMP-9 levels and associated lesions: 220.8 ± 26.3 ng/mL for isolated TBI and 196.8 ± 15.8 ng/mL for patients with extracerebral injuries (P = 0.397). CONCLUSION Increased plasma MMP-9 levels predicted short-term fatal outcome following severe TBI, regardless the presence of extracerebral injuries.
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Affiliation(s)
- Daniel Simon
- a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde.,b Laboratório de Biomarcadores do Trauma.,c Curso de Medicina , Universidade Luterana do Brasil , Canoas , Brazil
| | - Joice Evaldt
- a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde
| | | | | | | | | | - Andrea Regner
- a Programa de Pós-Graduação em Biologia Celular e Molecular Aplicada à Saúde.,b Laboratório de Biomarcadores do Trauma.,c Curso de Medicina , Universidade Luterana do Brasil , Canoas , Brazil
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67
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Licastro F, Hrelia S, Porcellini E, Malaguti M, Di Stefano C, Angeloni C, Carbone I, Simoncini L, Piperno R. Peripheral Inflammatory Markers and Antioxidant Response during the Post-Acute and Chronic Phase after Severe Traumatic Brain Injury. Front Neurol 2016; 7:189. [PMID: 27853449 PMCID: PMC5089971 DOI: 10.3389/fneur.2016.00189] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is a mechanical insult to the brain caused by external forces and associated with inflammation and oxidative stress. The patients may show different profiles of neurological recovery and a combination of oxidative damage and inflammatory processes can affect their courses. It is known that an overexpression of cytokines can be seen in peripheral blood in the early hours/days after the injury, but little is known about the weeks and months encompassing the post-acute and chronic phases. In addition, no information is available about the antioxidant responses mediated by the major enzymes that regulate reactive oxygen species levels: superoxide dismutase, catalase, peroxidases, and GSH-related enzymes. This study investigates the 6-month trends of inflammatory markers and antioxidant responses in 22 severe TBI patients with prolonged disorders of consciousness, consecutively recruited in a dedicated neurorehabilitation facility. Patients with a high degree of neurological impairment often show an uncertain outcome. In addition, the profiles of plasma activities were related to the neurological recovery after 12 months. Venous peripheral blood samples were taken blindly as soon as clinical signs and laboratory markers confirmed the absence of infections, 3 and 6 months later. The clinical and neuropsychological assessment continued up to 12 months. Nineteen patients completed the follow-up. In the chronic phase, persistent high plasma levels of cytokines can interfere with cognitive functioning and higher post-acute levels of cytokines [interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL1b, IL6] are associated with poorer cognitive recoveries 12 months later. Moreover, higher IFN-γ, higher TNF-α, and lower glutathione peroxidase activity are associated with greater disability. The results add evidence of persistent inflammatory response, provide information about long-term imbalance of antioxidant activity, and suggest that the over-production of cytokines and the alteration of the redox homeostasis in the post-acute phase might adversely affect the neurological and functional recovery. Inflammatory and antioxidant activity markers might offer a feasible way to highlight some of the processes opposing recovery after a severe TBI.
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Affiliation(s)
- Federico Licastro
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Elisa Porcellini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Malaguti
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Cristina Di Stefano
- Neurorehabilitation Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Cristina Angeloni
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Ilaria Carbone
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Laura Simoncini
- Neurorehabilitation Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
| | - Roberto Piperno
- Neurorehabilitation Unit, Emergency Department, Maggiore Hospital, Bologna, Italy
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68
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Hazeldine J, Hampson P, Lord JM. The diagnostic and prognostic value of systems biology research in major traumatic and thermal injury: a review. BURNS & TRAUMA 2016; 4:33. [PMID: 27672669 PMCID: PMC5030723 DOI: 10.1186/s41038-016-0059-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/09/2016] [Indexed: 01/12/2023]
Abstract
As secondary complications remain a significant cause of morbidity and mortality amongst hospitalised trauma patients, the need to develop novel approaches by which to identify patients at risk of adverse outcome is becoming increasingly important. Centred on the idea that patients who experience “poor” outcome post trauma elicit a response to injury that is distinct from those who experience “good” outcome, tailored therapeutics is an emerging concept aimed at improving current treatment regimens by promoting patient-specific therapies. Making use of recent advancements in the fields of genomics, proteomics and metabolomics, numerous groups have undertaken a systems-based approach to analysing the acute immune and inflammatory response to major traumatic and thermal injury in an attempt to uncover a single or combination of biomarkers that can identify patients at risk of adverse outcome. Early results are encouraging, with all three approaches capable of discriminating patients with “good” outcome from those who develop nosocomial infections, sepsis and multiple organ failure, with differences apparent in blood samples acquired as early as 2 h post injury. In particular, genomic data is proving to be highly informative, identifying patients at risk of “poor” outcome with a higher degree of sensitivity and specificity than statistical models built upon data obtained from existing anatomical and physiological scoring systems. Here, focussing predominantly upon human-based research, we provide an overview of the findings of studies that have investigated the immune and inflammatory response to major traumatic and thermal injury at the genomic, protein and metabolite level, and consider both the diagnostic and prognostic potential of these approaches.
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Affiliation(s)
- Jon Hazeldine
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
| | - Peter Hampson
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK ; Healing Foundation Centre for Burns Research, Queen Elizabeth Hospital, Birmingham, B15 2WB UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre, Institute of Inflammation and Ageing, Birmingham University Medical School, Birmingham, B15 2TT UK
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69
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Sinha S, Raheja A, Samson N, Bhoi S, Selvi A, Sharma P, Sharma BS. Blood mitochondrial enzymatic assay as a predictor of long-term outcome in severe traumatic brain injury. J Clin Neurosci 2016; 30:31-38. [DOI: 10.1016/j.jocn.2015.10.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 02/07/2023]
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Di Battista AP, Rhind SG, Richards D, Churchill N, Baker AJ, Hutchison MG. Altered Blood Biomarker Profiles in Athletes with a History of Repetitive Head Impacts. PLoS One 2016; 11:e0159929. [PMID: 27458972 PMCID: PMC4961456 DOI: 10.1371/journal.pone.0159929] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023] Open
Abstract
The long-term health effects of concussion and sub-concussive impacts in sport are unknown. Growing evidence suggests both inflammation and neurodegeneration are pivotal to secondary injury processes and the etiology of neurodegenerative diseases. In the present study we characterized circulating brain injury and inflammatory mediators in healthy male and female athletes according to concussion history and collision sport participation. Eighty-seven university level athletes (male, n = 60; female, n = 27) were recruited before the start of the competitive season. Athletes were healthy at the time of the study (no medications, illness, concussion or musculoskeletal injuries). Dependent variables included 29 inflammatory and 10 neurological injury analytes assessed in the peripheral blood by immunoassay. Biomarkers were statistically evaluated using partial least squares multivariate analysis to identify possible relationships to self-reported previous concussion history, number of previous concussions and collision sport participation in male and female athletes. Multiple concussions were associated with increases in peripheral MCP-1 in females, and MCP-4 in males. Collision sport participation was associated with increases in tau levels in males. These results are consistent with previous experimental and clinical findings that suggest ongoing inflammatory and cerebral injury processes after repetitive mild head trauma. However, further validation is needed to correlate systemic biomarkers to repetitive brain impacts, as opposed to the extracranial effects common to an athletic population such as exercise and muscle damage.
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Affiliation(s)
- Alex P. Di Battista
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G. Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
| | - Doug Richards
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
| | - Nathan Churchill
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrew J. Baker
- Institute of Medical Science, University of Toronto, Toronto ON, Canada
- Departments of Critical Care, Anesthesia and Surgery, St. Michael’s Hospital, University of Toronto, Toronto ON, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael G. Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- * E-mail:
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Astrocyte Hypertrophy Contributes to Aberrant Neurogenesis after Traumatic Brain Injury. Neural Plast 2016; 2016:1347987. [PMID: 27274873 PMCID: PMC4870378 DOI: 10.1155/2016/1347987] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/11/2016] [Indexed: 02/07/2023] Open
Abstract
Traumatic brain injury (TBI) is a widespread epidemic with severe cognitive, affective, and behavioral consequences. TBIs typically result in a relatively rapid inflammatory and neuroinflammatory response. A major component of the neuroinflammatory response is astrocytes, a type of glial cell in the brain. Astrocytes are important in maintaining the integrity of neuronal functioning, and it is possible that astrocyte hypertrophy after TBIs might contribute to pathogenesis. The hippocampus is a unique brain region, because neurogenesis persists in adults. Accumulating evidence supports the functional importance of these newborn neurons and their associated astrocytes. Alterations to either of these cell types can influence neuronal functioning. To determine if hypertrophied astrocytes might negatively influence immature neurons in the dentate gyrus, astrocyte and newborn neurons were analyzed at 30 days following a TBI in mice. The results demonstrate a loss of radial glial-like processes extending through the granule cell layer after TBI, as well as ectopic growth and migration of immature dentate neurons. The results further show newborn neurons in close association with hypertrophied astrocytes, suggesting a role for the astrocytes in aberrant neurogenesis. Future studies are needed to determine the functional significance of these alterations to the astrocyte/immature neurons after TBI.
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Hepatic expression of serum amyloid A1 is induced by traumatic brain injury and modulated by telmisartan. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 185:2641-52. [PMID: 26435412 DOI: 10.1016/j.ajpath.2015.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 04/16/2015] [Accepted: 06/01/2015] [Indexed: 12/27/2022]
Abstract
Traumatic brain injury affects the whole body in addition to the direct impact on the brain. The systemic response to trauma is associated with the hepatic acute-phase response. To further characterize this response, we performed controlled cortical impact injury on male mice and determined the expression of serum amyloid A1 (SAA1), an apolipoprotein, induced at the early stages of the acute-phase response in liver and plasma. After cortical impact injury, induction of SAA1 was detectable in plasma at 6 hours post-injury and in liver at 1 day post-injury, followed by gradual diminution over time. In the liver, cortical impact injury increased neutrophil and macrophage infiltration, apoptosis, and expression of mRNA encoding the chemokines CXCL1 and CXCL10. An increase in angiotensin II AT1 receptor mRNA at 3 days post-injury was also observed. Administration of the AT1 receptor antagonist telmisartan 1 hour post-injury significantly decreased liver SAA1 levels and CXCL10 mRNA expression, but did not affect CXCL1 expression or the number of apoptotic cells or infiltrating leukocytes. To our knowledge, this is the first study to demonstrate that SAA1 is induced in the liver after traumatic brain injury and that telmisartan prevents this response. Elucidating the molecular pathogenesis of the liver after brain injury will assist in understanding the efficacy of therapeutic approaches to brain injury.
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73
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Hayashi T, Ago K, Nakamae T, Higo E, Ogata M. Interleukin (IL)-8 immunoreactivity of injured axons and surrounding oligodendrocytes in traumatic head injury. Forensic Sci Int 2016; 263:48-54. [PMID: 27065055 DOI: 10.1016/j.forsciint.2016.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
Interleukin (IL)-8 has been suggested to be a positive regulator of myelination in the central nervous system, in addition to its principal role as a chemokine for neutrophils. Immunostaining for beta-amyloid precursor protein (AβPP) is an effective tool for detecting traumatic axonal injury, although AβPP immunoreactivity can also indicate axonal injury due to hypoxic causes. In this study, we examined IL-8 and AβPP immunoreactivity in sections of corpus callosum obtained from deceased patients with blunt head injury and from equivalent control tissue. AβPP immunoreactivity was detected in injured axons, such as axonal bulbs and varicose axons, in 24 of 44 head injury cases. These AβPP immunoreactive cases had survived for more than 3h. The AβPP immunostaining pattern can be classified into two types: traumatic (Pattern 1) and non-traumatic (Pattern 2) axonal injuries, which we described previously [Hayashi et al. Int. J. Legal Med. 129 (2015) 1085-1090]. Three of 44 control cases also showed AβPP immunoreactive injured axons as Pattern 2. In contrast, IL-8 immunoreactivity was detected in 7 AβPP immunoreactive and in 2 non-AβPP immunoreactive head injury cases, but was not detected in any of the 44 control cases, including the 3 AβPP immunoreactive control cases. The IL-8 immunoreactive cases had survived from 3 to 24 days, whereas those cases who survived less than 3 days (n=29) and who survived 90 days (n=1) were not IL-8 immunoreactive. Moreover, IL-8 was detected as Pattern 1 axons only. In addition, double immunofluorescence analysis showed that IL-8 is expressed by oligodendrocytes surrounding injured axons. In conclusion, our results suggest that immunohistochemical detection of IL-8 may be useful as a complementary diagnostic marker of traumatic axonal injury.
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Affiliation(s)
- Takahito Hayashi
- Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
| | - Kazutoshi Ago
- Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Takuma Nakamae
- Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Eri Higo
- Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan
| | - Mamoru Ogata
- Department of Legal Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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Ma J, Wang J, Cheng J, Xiao W, Fan K, Gu J, Yu B, Yin G, Wu J, Ren J, Hou J, Jiang Y, Tan Y, Jin W. Impacts of Blast-Induced Traumatic Brain Injury on Expressions of Hepatic Cytochrome P450 1A2, 2B1, 2D1, and 3A2 in Rats. Cell Mol Neurobiol 2016; 37:111-120. [PMID: 26913515 DOI: 10.1007/s10571-016-0351-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/15/2016] [Indexed: 12/11/2022]
Abstract
The hepatic cytochrome P450 (CYP450) enzyme superfamily is one of the most important drug-metabolizing enzyme systems, which is responsible for the metabolism of a large number of clinically relevant medications used in traumatic brain injury (TBI) therapy. Modification of CYP450 expression may have important influences on drug metabolism and lead to untoward effects on those with narrow therapeutic windows. However, the impact of blast-induced TBI (bTBI) on the expression of CYP450 has received little attention. The subfamilies of CYP1A, 2B, 2D, and 3A account for about 85 % of all human drug metabolism of clinical significance. Therefore, in this study, we investigated the expressions of hepatic CYP1A2, CYP2B1, CYP2D1, and CYP3A2 in rats suffering bTBI. Meanwhile, we also measured some important cytokines in serum after injury, and calculated the correlation between these cytokines and the expressions of CYP1A2, CYP2B1, CYP2D1, and CYP3A2. The results showed that bTBI could significantly reduce mRNA expressions of CYP1A2, CYP2D1, and CYP3A2 at the early stage and induce the expressions from 48 h to 1 week after injury. The protein expressions of these CYP450s had all been downregulated from 24 to 48 h post- injury, and then began to elevate at 48 h after bTBI. The cytokines, IL-1β, IL-2, IL-6, and TNF-α, increased significantly in the early phase, and began to reduce at the delayed phase of bTBI. The serum levels of IL-1β, IL-6, and TNF-α but not IL-2 were significantly negative correlated with the mRNA expressions of CYP2B1 and CYP2D1 and the proteins expressions of CYP1A2, CYP2B1, CYP2D1, and CYP3A2. In conclusion, our work has, for the first time, indicated that bTBI has significant impact on the expressions of CYP1A2, CYP2B1, CYP2D1, and CYP3A2, which may be related to the cytokines induced by the injury.
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Affiliation(s)
- Jie Ma
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Junrui Wang
- Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Jingmin Cheng
- Department of Neurosurgery, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Wenjing Xiao
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Kaihua Fan
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Jianwen Gu
- Department of Neurosurgery, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China. .,Department of Neurosurgery, The 306th Hospital of PLA, NO.9, Anxiang Beili, Deshengmen, Chaoyang District, Beijing, 100101, People's Republic of China.
| | - Botao Yu
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China.
| | - Guangfu Yin
- College of Materials Science and Engineering, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Juan Wu
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Jiandong Ren
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Jun Hou
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Yan Jiang
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Yonghong Tan
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
| | - Weihua Jin
- Department of Pharmacy, Chengdu Military General Hospital, No.270, Rongdu Aveneue, Jinniu District, Chengdu, Sichuan, People's Republic of China
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Di Battista AP, Rhind SG, Hutchison MG, Hassan S, Shiu MY, Inaba K, Topolovec-Vranic J, Neto AC, Rizoli SB, Baker AJ. Inflammatory cytokine and chemokine profiles are associated with patient outcome and the hyperadrenergic state following acute brain injury. J Neuroinflammation 2016; 13:40. [PMID: 26883121 PMCID: PMC4754875 DOI: 10.1186/s12974-016-0500-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/01/2016] [Indexed: 01/25/2023] Open
Abstract
Background Traumatic brain injury (TBI) elicits intense sympathetic nervous system (SNS) activation with profuse catecholamine secretion. The resultant hyperadrenergic state is linked to immunomodulation both within the brain and systemically. Dysregulated inflammation post-TBI exacerbates secondary brain injury and contributes to unfavorable patient outcomes including death. The aim of this study was to characterize the early dynamic profile of circulating inflammatory cytokines/chemokines in patients admitted for moderate-to-severe TBI, to examine interrelationships between these mediators and catecholamines, as well as clinical indices of injury severity and neurological outcome. Methods Blood was sampled from 166 isolated TBI patients (aged 45 ± 20.3 years; 74.7 % male) on admission, 6-, 12-, and 24-h post-injury and from healthy controls (N = 21). Plasma cytokine [interleukin (IL)-1β, -2, -4, -5, -10, -12p70, -13, tumor necrosis factor (TNF)-α, interferon (IFN)-γ] and chemokine [IL-8, eotaxin, eotaxin-3, IFN-γ-induced protein (IP)-10, monocyte chemoattractant protein (MCP)-1, -4, macrophage-derived chemokine (MDC), macrophage inflammatory protein (MIP)-1β, thymus activation regulated chemokine (TARC)] concentrations were analyzed using high-sensitivity electrochemiluminescence multiplex immunoassays. Plasma catecholamines [epinephrine (Epi), norepinephrine (NE)] were measured by immunoassay. Neurological outcome at 6 months was assessed using the extended Glasgow outcome scale (GOSE) dichotomized as good (>4) or poor (≤4) outcomes. Results Patients showed altered levels of IL-10 and all chemokines assayed relative to controls. Significant differences in a number of markers were evident between moderate and severe TBI cohorts. Elevated IL-8, IL-10, and TNF-α, as well as alterations in 8 of 9 chemokines, were associated with poor outcome at 6 months. Notably, a positive association was found between Epi and IL-1β, IL-10, Eotaxin, IL-8, and MCP-1. NE was positively associated with IL-1β, IL-10, TNF-α, eotaxin, IL-8, IP-10, and MCP-1. Conclusions Our results provide further evidence that exaggerated SNS activation acutely after isolated TBI in humans may contribute to harmful peripheral inflammatory cytokine/chemokine dysregulation. These findings are consistent with a potentially beneficial role for therapies aimed at modulating the inflammatory response and hyperadrenergic state acutely post-injury. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0500-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex P Di Battista
- Defence Research & Development Canada, Toronto Research Centre, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Toronto, ON, Canada. .,Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.
| | - Michael G Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, Toronto, ON, Canada.
| | - Syed Hassan
- Defence Research & Development Canada, Toronto Research Centre, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Maria Y Shiu
- Defence Research & Development Canada, Toronto Research Centre, Toronto, ON, Canada. .,Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.
| | - Kenji Inaba
- Division of Trauma & Critical Care, University of Southern California, Los Angeles, CA, USA. .,LA County+ USC Medical Center, Los Angeles, CA, USA.
| | - Jane Topolovec-Vranic
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, Toronto, ON, Canada.
| | | | - Sandro B Rizoli
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, Toronto, ON, Canada. .,Department of Critical Care, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
| | - Andrew J Baker
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hopsital, Toronto, ON, Canada. .,Department of Critical Care, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
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76
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Schober ME, Requena DF, Abdullah OM, Casper TC, Beachy J, Malleske D, Pauly JR. Dietary Docosahexaenoic Acid Improves Cognitive Function, Tissue Sparing, and Magnetic Resonance Imaging Indices of Edema and White Matter Injury in the Immature Rat after Traumatic Brain Injury. J Neurotrauma 2016; 33:390-402. [PMID: 26247583 PMCID: PMC4761828 DOI: 10.1089/neu.2015.3945] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of acquired neurologic disability in children. Specific therapies to treat acute TBI are lacking. Cognitive impairment from TBI may be blunted by decreasing inflammation and oxidative damage after injury. Docosahexaenoic acid (DHA) decreases cognitive impairment, oxidative stress, and white matter injury in adult rats after TBI. Effects of DHA on cognitive outcome, oxidative stress, and white matter injury in the developing rat after experimental TBI are unknown. We hypothesized that DHA would decrease early inflammatory markers and oxidative stress, and improve cognitive, imaging and histologic outcomes in rat pups after controlled cortical impact (CCI). CCI or sham surgery was delivered to 17 d old male rat pups exposed to DHA or standard diet for the duration of the experiments. DHA was introduced into the dam diet the day before CCI to allow timely DHA delivery to the pre-weanling pups. Inflammatory cytokines and nitrates/nitrites were measured in the injured brains at post-injury Day (PID) 1 and PID2. Morris water maze (MWM) testing was performed at PID41-PID47. T2-weighted and diffusion tensor imaging studies were obtained at PID12 and PID28. Tissue sparing was calculated histologically at PID3 and PID50. DHA did not adversely affect rat survival or weight gain. DHA acutely decreased oxidative stress and increased anti-inflammatory interleukin 10 in CCI brains. DHA improved MWM performance and lesion volume late after injury. At PID12, DHA decreased T2-imaging measures of cerebral edema and decreased radial diffusivity, an index of white matter injury. DHA improved short- and long-term neurologic outcomes after CCI in the rat pup. Given its favorable safety profile, DHA is a promising candidate therapy for pediatric TBI. Further studies are needed to explore neuroprotective mechanisms of DHA after developmental TBI.
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Affiliation(s)
- Michelle E Schober
- 1 Department of Pediatrics, Division of Critical Care, University of Utah , Salt Lake City, Utah
| | - Daniela F Requena
- 1 Department of Pediatrics, Division of Critical Care, University of Utah , Salt Lake City, Utah
| | - Osama M Abdullah
- 2 Department of Bioengineering, University of Utah , Salt Lake City, Utah
| | - T Charles Casper
- 1 Department of Pediatrics, Division of Critical Care, University of Utah , Salt Lake City, Utah
| | - Joanna Beachy
- 3 Department of Pediatrics, Division of Neonatology, University of Utah , Salt Lake City, Utah
| | - Daniel Malleske
- 3 Department of Pediatrics, Division of Neonatology, University of Utah , Salt Lake City, Utah
| | - James R Pauly
- 4 College of Pharmacy and Spinal Cord and Brain Injury Research Center, University of Kentucky , Lexington, Kentucky
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77
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Raheja A, Sinha S, Samson N, Bhoi S, Subramanian A, Sharma P, Sharma BS. Serum biomarkers as predictors of long-term outcome in severe traumatic brain injury: analysis from a randomized placebo-controlled Phase II clinical trial. J Neurosurg 2016; 125:631-41. [PMID: 26722854 DOI: 10.3171/2015.6.jns15674] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There has been increased interest in the potential importance of biochemical parameters as predictors of outcome in severe traumatic brain injury (sTBI). METHODS Of 107 patients with sTBI (age 18-65 years with a Glasgow Coma Scale score of 4-8 presenting within 8 hours after injury) who were randomized for a placebo-controlled Phase II trial of progesterone with or without hypothermia, the authors serially analyzed serum biomarkers (S100-B, glial fibrillary acidic protein [GFAP], neuron-specific enolase [NSE], tumor necrosis factor-α, interleukin-6 [IL-6], estrogen [Eg], and progesterone [Pg]). This analysis was performed using the sandwich enzyme-linked immunosorbent assay technique at admission and 7 days later for 86 patients, irrespective of assigned group. The long-term predictive values of serum biomarkers for dichotomized Glasgow Outcome Scale (GOS) score, functional independence measure, and survival status at 6 and 12 months were analyzed using an adjusted binary logistic regression model and receiver operating characteristic curve. RESULTS A favorable GOS score (4-5) at 1 year was predicted by higher admission IL-6 (above 108.36 pg/ml; area under the curve [AUC] 0.69, sensitivity 52%, and specificity 78.6%) and Day 7 Pg levels (above 3.15 ng/ml; AUC 0.79, sensitivity 70%, and specificity 92.9%). An unfavorable GOS score (1-3) at 1 year was predicted by higher Day 7 GFAP levels (above 9.50 ng/ml; AUC 0.82, sensitivity 78.6%, and specificity 82.4%). Survivors at 1 year had significantly higher Day 7 Pg levels (above 3.15 ng/ml; AUC 0.78, sensitivity 66.7%, and specificity 90.9%). Nonsurvivors at 1 year had significantly higher Day 7 GFAP serum levels (above 11.14 ng/ml; AUC 0.81, sensitivity 81.8%, and specificity 88.9%) and Day 7 IL-6 serum levels (above 71.26 pg/ml; AUC 0.87, sensitivity 81.8%, and specificity 87%). In multivariate logistic regression analysis, independent predictors of outcome at 1 year were serum levels of Day 7 Pg (favorable GOS-OR 3.24, CI 1.5-7, p = 0.003; and favorable survival-OR 2, CI 1.2-3.5, p = 0.01); admission IL-6 (favorable GOS-OR 1.04, CI 1.00-1.08, p = 0.04); and Day 7 GFAP (unfavorable GOS-OR 0.79, CI 0.65-0.95, p = 0.01; and unfavorable survival-OR 0.80, CI 0.66-0.96, p = 0.01). CONCLUSIONS Serial Pg, GFAP, and IL-6 monitoring could aid in prognosticating outcomes in patients with acute sTBI. A cause and effect relationship or a mere association of these biomarkers to outcome needs to be further studied for better understanding of the pathophysiology of sTBI and for choosing potential therapeutic targets. Clinical trial registration no.: CTRI/2009/091/000893 ( http://www.ctri.nic.in ).
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Affiliation(s)
| | | | | | | | | | - Pushpa Sharma
- Department of Anaesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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78
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Hazeldine J, Lord JM, Belli A. Traumatic Brain Injury and Peripheral Immune Suppression: Primer and Prospectus. Front Neurol 2015; 6:235. [PMID: 26594196 PMCID: PMC4633482 DOI: 10.3389/fneur.2015.00235] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 10/23/2015] [Indexed: 12/16/2022] Open
Abstract
Nosocomial infections are a common occurrence in patients following traumatic brain injury (TBI) and are associated with an increased risk of mortality, longer length of hospital stay, and poor neurological outcome. Systemic immune suppression arising as a direct result of injury to the central nervous system (CNS) is considered to be primarily responsible for this increased incidence of infection, a view strengthened by recent studies that have reported novel changes in the composition and function of the innate and adaptive arms of the immune system post-TBI. However, our knowledge of the mechanisms that underlie TBI-induced immune suppression is equivocal at best. Here, after summarizing our current understanding of the impact of TBI on peripheral immunity and discussing CNS-mediated regulation of immune function, we propose roles for a series of novel mechanisms in driving the immune suppression that is observed post-TBI. These mechanisms, which have never been considered before in the context of TBI-induced immune paresis, include the CNS-driven emergence into the circulation of myeloid-derived suppressor cells and suppressive neutrophil subsets, and the release from injured tissue of nuclear and mitochondria-derived damage associated molecular patterns. Moreover, in an effort to further our understanding of the mechanisms that underlie TBI-induced changes in immunity, we pose throughout the review a series of questions, which if answered would address a number of key issues, such as establishing whether manipulating peripheral immune function has potential as a future therapeutic strategy by which to treat and/or prevent infections in the hospitalized TBI patient.
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Affiliation(s)
- Jon Hazeldine
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham , Birmingham , UK ; Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
| | - Janet M Lord
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham , Birmingham , UK ; Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
| | - Antonio Belli
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham , Birmingham , UK ; Institute of Inflammation and Ageing, University of Birmingham , Birmingham , UK
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79
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Chenouard A, Chesneau M, Braza F, Dejoie T, Cinotti R, Roquilly A, Brouard S, Asehnoune K. Phenotype and functions of B cells in patients with acute brain injuries. Mol Immunol 2015; 68:350-6. [PMID: 26364142 DOI: 10.1016/j.molimm.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/29/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brain injuries (BI) induce a state of systemic immunosuppression, leading to a high risk of pneumonia. In this pilot study, we investigated the status of B cell compartment in BI patients. METHODS A prospective observational study was performed in 2 intensive care units in a university hospital. Blood samples were collected in 14 patients at day 1 and day 7 after acute BI. The phenotype and the ability of B cells to secrete IL-10 were compared to 11 healthy volunteers (HV). RESULTS Among the circulating lymphocytes, the frequency of B cells was significantly higher in BI patients compared to HV (p<0.001). B cells from BI patients displayed an activated profil on day 7 after BI, reflected by a significantly higher proportion of CD27(+) memory (p=0.01) and CD27(+) IgD(-) switched memory B cells (p=0.02), as well as a significantly higher blood level of IgA (p=0.001) and IgM (p<0.001) as compared to day 1. The frequency of IL-10 secreting B cells (IL-10(+) B cells) on day 1 and day 7 was significantly lower in BI patients compared to HV (p<0.05). Interestingly, we observed that all BI patients with high frequency of IL-10(+) B cells on day 1 displayed an episode of pneumonia, and had a longer duration of mechanical ventilation and ICU stay compared to BI patients with low proportion of IL-10(+) B cells. CONCLUSION This study provides an extensive description of the phenotype and function of B cells in BI patients. Our results suggest that IL-10(+) B cells could play a major role in immunosuppression after BI.
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Affiliation(s)
- Alexis Chenouard
- INSERM, UMR 1064, Nantes F-44093, France; CHU de Nantes, ITUN, Nantes F-44093, France
| | - Mélanie Chesneau
- INSERM, UMR 1064, Nantes F-44093, France; CHU de Nantes, ITUN, Nantes F-44093, France
| | - Faouzi Braza
- INSERM, UMR 1064, Nantes F-44093, France; CHU de Nantes, ITUN, Nantes F-44093, France
| | - Thomas Dejoie
- Biochemistry Laboratory, Nantes University Hospital, Nantes, France
| | - Raphael Cinotti
- Intensive Care Unit, Anesthesia and Critical Care Department, Nantes University Hospital, Nantes, France
| | - Antoine Roquilly
- Intensive Care Unit, Anesthesia and Critical Care Department, Nantes University Hospital, Nantes, France; Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826 Nantes, France
| | - Sophie Brouard
- INSERM, UMR 1064, Nantes F-44093, France; CHU de Nantes, ITUN, Nantes F-44093, France; CIC biothérapie, Nantes F-44035, France
| | - Karim Asehnoune
- Intensive Care Unit, Anesthesia and Critical Care Department, Nantes University Hospital, Nantes, France; Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826 Nantes, France.
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Frieler RA, Nadimpalli S, Boland LK, Xie A, Kooistra LJ, Song J, Chung Y, Cho KW, Lumeng CN, Wang MM, Mortensen RM. Depletion of macrophages in CD11b diphtheria toxin receptor mice induces brain inflammation and enhances inflammatory signaling during traumatic brain injury. Brain Res 2015. [PMID: 26208897 DOI: 10.1016/j.brainres.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Immune cells have important roles during disease and are known to contribute to secondary, inflammation-induced injury after traumatic brain injury. To delineate the functional role of macrophages during traumatic brain injury, we depleted macrophages using transgenic CD11b-DTR mice and subjected them to controlled cortical impact. We found that macrophage depletion had no effect on lesion size assessed by T2-weighted MRI scans 28 days after injury. Macrophage depletion resulted in a robust increase in proinflammatory gene expression in both the ipsilateral and contralateral hemispheres after controlled cortical impact. Interestingly, this sizeable increase in inflammation did not affect lesion development. We also showed that macrophage depletion resulted in increased proinflammatory gene expression in the brain and kidney in the absence of injury. These data demonstrate that depletion of macrophages in CD11b-DTR mice can significantly modulate the inflammatory response during brain injury without affecting lesion formation. These data also reveal a potentially confounding inflammatory effect in CD11b-DTR mice that must be considered when interpreting the effects of macrophage depletion in disease models.
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Affiliation(s)
- Ryan A Frieler
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA; Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sameera Nadimpalli
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Lauren K Boland
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Angela Xie
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Laura J Kooistra
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Jianrui Song
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Yutein Chung
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA
| | - Kae W Cho
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Carey N Lumeng
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA; Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Neurology, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Richard M Mortensen
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1137 E. Catherine St., 7708 Medical Science II, Ann Arbor, MI 48109, USA; Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Di Battista AP, Buonora JE, Rhind SG, Hutchison MG, Baker AJ, Rizoli SB, Diaz-Arrastia R, Mueller GP. Blood Biomarkers in Moderate-To-Severe Traumatic Brain Injury: Potential Utility of a Multi-Marker Approach in Characterizing Outcome. Front Neurol 2015; 6:110. [PMID: 26074866 PMCID: PMC4443732 DOI: 10.3389/fneur.2015.00110] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/04/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Blood biomarkers are valuable tools for elucidating complex cellular and molecular mechanisms underlying traumatic brain injury (TBI). Profiling distinct classes of biomarkers could aid in the identification and characterization of initial injury and secondary pathological processes. This study characterized the prognostic performance of a recently developed multi-marker panel of circulating biomarkers that reflect specific pathogenic mechanisms including neuroinflammation, oxidative damage, and neuroregeneration, in moderate-to-severe TBI patients. MATERIALS AND METHODS Peripheral blood was drawn from 85 isolated TBI patients (n = 60 severe, n = 25 moderate) at hospital admission, 6-, 12-, and 24-h post-injury. Mortality and neurological outcome were assessed using the extended Glasgow Outcome Scale. A multiplex platform was designed on MULTI-SPOT(®) plates to simultaneously analyze human plasma levels of s100 calcium binding protein beta (s100B), glial fibrillary acidic protein (GFAP), neuron specific enolase (NSE), brain-derived neurotrophic factor (BDNF), monocyte chemoattractant protein (MCP)-1, intercellular adhesion molecule (ICAM)-5, and peroxiredoxin (PRDX)-6. Multivariable logistic regression and area under the receiver-operating characteristic curve (AUC) were used to evaluate both individual and combined predictive abilities of these markers for 6-month neurological outcome and mortality after TBI. RESULTS Unfavorable neurological outcome was associated with elevations in s100B, GFAP, and MCP-1. Mortality was related to differences in six of the seven markers analyzed. Combined admission concentrations of s100B, GFAP, and MCP-1 were able to discriminate favorable versus unfavorable outcome (AUC = 0.83), and survival versus death (AUC = 0.87), although not significantly better than s100B alone (AUC = 0.82 and 0.86, respectively). CONCLUSION The multi-marker panel of TBI-related biomarkers performed well in discriminating unfavorable and favorable outcomes in the acute period after moderate-to-severe TBI. However, the combination of these biomarkers did not outperform s100B alone.
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Affiliation(s)
- Alex P Di Battista
- Faculty of Medicine, Institute of Medical Science, University of Toronto , Toronto, ON , Canada ; Defence Research and Development Canada, Toronto Research Centre , Toronto, ON , Canada ; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto, ON , Canada
| | - John E Buonora
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA ; US Army Graduate Program in Anesthesia Nursing , Fort Sam Houston, TX , USA
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre , Toronto, ON , Canada ; Faculty of Kinesiology and Physical Education, David L. MacIntosh Sport Medicine Clinic, University of Toronto , Toronto, ON , Canada
| | - Michael G Hutchison
- Faculty of Kinesiology and Physical Education, David L. MacIntosh Sport Medicine Clinic, University of Toronto , Toronto, ON , Canada
| | - Andrew J Baker
- Faculty of Medicine, Institute of Medical Science, University of Toronto , Toronto, ON , Canada ; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto, ON , Canada ; Department of Anesthesia, University of Toronto , Toronto, ON , Canada ; Department of Surgery and Critical Care Medicine, University of Toronto , Toronto, ON , Canada
| | - Sandro B Rizoli
- Faculty of Medicine, Institute of Medical Science, University of Toronto , Toronto, ON , Canada ; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto, ON , Canada ; Department of Anesthesia, University of Toronto , Toronto, ON , Canada ; Department of Surgery and Critical Care Medicine, University of Toronto , Toronto, ON , Canada
| | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
| | - Gregory P Mueller
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
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Clevenger AC, Kilbaugh T, Margulies SS. Carotid artery blood flow decreases after rapid head rotation in piglets. J Neurotrauma 2014; 32:120-6. [PMID: 25133889 DOI: 10.1089/neu.2014.3570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Modification of cerebral perfusion pressure and cerebral blood flow (CBF) are crucial components of the therapies designed to reduce secondary damage after traumatic brain injury (TBI). Previously we documented a robust decrease in CBF after rapid sagittal head rotation in our well-validated animal model of diffuse TBI. Mechanisms responsible for this immediate (<10 min) and sustained (∼24 h) reduction in CBF have not been explored. Because the carotid arteries are a major source of CBF, we hypothesized that blood flow through the carotid arteries (Q) and vessel diameter (D) would decrease after rapid nonimpact head rotation without cervical spine injury. Four-week-old (toddler) female piglets underwent rapid (<20 msec) sagittal head rotation without impact, previously shown to produce diffuse TBI with reductions in CBF. Ultrasonographic images of the bilateral carotid arteries were recorded at baseline (pre-injury), as well as immediately after head rotation and 15, 30, 45, and 60 min after injury. Diameter (D) and waveform velocity (V) were used to calculate blood flow (Q) through the carotid arteries using the equation Q=(0.25)πD(2)V. D, V, and Q were normalized to the pre-injury baseline values to obtain a relative change after injury in right and left carotid arteries. Three-way analysis of variance and post-hoc Tukey-Kramer analyses were used to assess statistical significance of injury, time, and side. The relative change in carotid artery diameter and flow was significantly decreased in injured animals in comparison with uninjured sham controls (p<0.0001 and p=0.0093, respectively) and did not vary with side (p>0.39). The average carotid blood velocity did not differ between sham and injured animals (p=0.91). These data suggest that a reduction in global CBF after rapid sagittal head rotation may be partially mediated by a reduction in carotid artery flow, via vasoconstriction.
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Affiliation(s)
- Amy C Clevenger
- 1 Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
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Tobin RP, Mukherjee S, Kain JM, Rogers SK, Henderson SK, Motal HL, Rogers MKN, Shapiro LA. Traumatic brain injury causes selective, CD74-dependent peripheral lymphocyte activation that exacerbates neurodegeneration. Acta Neuropathol Commun 2014; 2:143. [PMID: 25329434 PMCID: PMC4203873 DOI: 10.1186/s40478-014-0143-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/11/2014] [Indexed: 12/17/2022] Open
Abstract
Introduction Traumatic brain injury (TBI), a significant cause of death and disability, causes, as in any injury, an acute, innate immune response. A key component in the transition between innate and adaptive immunity is the processing and presentation of antigen by professional antigen presenting cells (APCs). Whether an adaptive immune response to brain injury is beneficial or detrimental is not known. Current efforts to understand the contribution of the immune system after TBI have focused on neuroinflammation and brain-infiltrating immune cells. Here, we characterize and target TBI-induced expansion of peripheral immune cells that may act as potential APCs. Because MHC Class II-associated invariant peptide (CLIP) is important for antigen processing and presentation, we engineered a competitive antagonist (CAP) for CLIP, and tested the hypothesis that peptide competition could reverse or prevent neurodegeneration after TBI. Results We show that after fluid percussion injury (FPI), peripheral splenic lymphocytes, including CD4+ and CD8+ T cells, regulatory T cells (Tregs), and γδ T cells, are increased in number within 24 hours after FPI. These increases were reversed by CAP treatment and this antagonism of CLIP also reduced neuroinflammation and neurodegeneration after TBI. Using a mouse deficient for the precursor of CLIP, CD74, we observed decreased peripheral lymphocyte activation, decreased neurodegeneration, and a significantly smaller lesion size following TBI. Conclusion Taken together, the data support the hypothesis that neurodegeneration following TBI is dependent upon antigen processing and presentation that requires CD74. Electronic supplementary material The online version of this article (doi:10.1186/s40478-014-0143-5) contains supplementary material, which is available to authorized users.
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