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Mortimer DS. Military Traumatic Brain Injury. Phys Med Rehabil Clin N Am 2024; 35:559-571. [PMID: 38945651 DOI: 10.1016/j.pmr.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Traumatic brain injury (TBI) in the military can involve distinct injury mechanisms, diagnostic challenges, treatments, and course of recovery. TBI has played a prominent role in recent conflicts, causing significant morbidity and mortality. Blast-related TBI in combat settings is often accompanied by other physical injuries. Military TBIs of all severities can lead to prolonged recoveries and persistent sequelae. The complex interplay between TBI, pain, and mental health conditions can significantly complicate diagnosis and recovery. Military and veteran health settings and programs provide comprehensive care along the continuum of TBI recovery rehabilitation with the goal of optimizing recovery and function.
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Affiliation(s)
- Diane Schretzman Mortimer
- Department of Physical Medicine, and Rehabilitation, Inpatient Brain Injury/ Polytrauma Rehabilitation Center, Minneapolis VA Health Care System, 1 Veterans Drive, Mail Code 117, Minneapolis, MN 55417, USA; Brain Injury Medicine Fellowship, Department of Rehabilitation Medicine, University of Minnesota.
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2
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O’Brien WT, Spitz G, Xie B, Major BP, Mutimer S, Giesler LP, Bain J, Evans LJ, Duarte Martins B, Piantella S, Alhassan A, Brady S, Cappellari D, Somma V, McColl T, Symons GF, Gore T, Sun M, Kuek T, Horan S, Bei M, Ponsford JL, Willmott C, Reyes J, Ashton NJ, Zetterberg H, Mitra B, O’Brien TJ, Shultz SR, McDonald SJ. Biomarkers of Neurobiologic Recovery in Adults With Sport-Related Concussion. JAMA Netw Open 2024; 7:e2415983. [PMID: 38848061 PMCID: PMC11161851 DOI: 10.1001/jamanetworkopen.2024.15983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024] Open
Abstract
Importance Sport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC. Objective To examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC. Design, Setting, and Participants A cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024. Exposure Sport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms. Main Outcomes and Measures Primary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times. Results Eighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]). Conclusions and Relevance In this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.
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Affiliation(s)
- William T. O’Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Gershon Spitz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Becca Xie
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Brendan P. Major
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Steven Mutimer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Lauren P. Giesler
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jesse Bain
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Lauren J. Evans
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | | | - Stefan Piantella
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Afizu Alhassan
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Shelby Brady
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - David Cappellari
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Vincenzo Somma
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Thomas McColl
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Georgia F. Symons
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Tenae Gore
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Matthew Sun
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Timothy Kuek
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Seamus Horan
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Michael Bei
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catherine Willmott
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Jonathan Reyes
- Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Nicholas J. Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, United Kingdom
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, Hong Kong SAR, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison
| | - Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Terence J. O’Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
- Health Sciences, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - Stuart J. McDonald
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia
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Lange RT, Gill JM, Lippa SM, Hungerford L, Walker T, Kennedy J, Brickell TA, French LM. Elevated Serum Tau and UCHL-1 Concentrations Within 12 Months of Injury Predict Neurobehavioral Functioning 2 or More Years Following Traumatic Brain Injury: A Longitudinal Study. J Head Trauma Rehabil 2024; 39:196-206. [PMID: 37335195 DOI: 10.1097/htr.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Blood-based biomarkers have received considerable attention for their diagnostic and prognostic value in the acute and postacute period following traumatic brain injury (TBI). The purpose of this study was to examine whether blood-based biomarker concentrations within the first 12 months of TBI can predict neurobehavioral outcome in the chronic phase of the recovery trajectory. SETTING Inpatient and outpatient wards from 3 military medical treatment facilities. PARTICIPANTS A total of 161 service members and veterans classified into 3 groups: ( a ) uncomplicated mild TBI (MTBI; n = 37), ( b ) complicated mild, moderate, severe, penetrating TBI combined (STBI; n = 46), and ( c ) controls (CTRL; n = 78). DESIGN Prospective longitudinal. MAIN MEASURES Participants completed 6 scales from the Traumatic Brain Injury Quality of Life (ie, Anger, Anxiety, Depression, Fatigue, Headaches, and Cognitive Concerns) within 12 months (baseline) and at 2 or more years (follow-up) post-injury. Serum concentrations of tau, neurofilament light, glial fibrillary acidic protein, and UCHL-1 at baseline were measured using SIMOA. RESULTS Baseline tau was associated with worse anger, anxiety, and depression in the STBI group at follow-up ( R2 = 0.101-0.127), and worse anxiety in the MTBI group ( R2 = 0.210). Baseline ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) was associated with worse anxiety and depression at follow-up in both the MTBI and STBI groups ( R2 Δ = 0.143-0.207), and worse cognitive concerns in the MTBI group ( R2 Δ = 0.223). CONCLUSIONS A blood-based panel including these biomarkers could be a useful tool for identifying individuals at risk of poor outcome following TBI.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Lange, Hungerford, Kennedy, Brickell, and French and Mr Walker); Walter Reed National Military Medical Center, Bethesda, Maryland (Drs Lange, Lippa, Brickell, and French); National Intrepid Center of Excellence, Bethesda, Maryland (Drs Lange, Lippa, Brickell, and French); General Dynamics Information Technology, Falls Church, Virginia (Drs Lange, Hungerford, Kennedy, and Brickell); Department of Psychiatry, University of British Columbia, Vancouver, Canada (Dr Lange); Department of Physical Medicine and Rehabilitation, University of the Health Sciences, Bethesda, Maryland (Drs Lange, Brickell, and French); Department of Neuroscience, University of the Health Sciences, Bethesda, Maryland (Dr Lippa); San Antonio Military Medical Center, San Antonio, Texas (Dr Kennedy); Naval Medical Center San Diego, San Diego, California (Dr Hungerford and Mr Walker); and Johns Hopkins University, Baltimore, Maryland (Dr Gill)
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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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D'Lauro C, Register-Mihalik JK, Meier TB, Kerr ZY, Knight K, Broglio SP, Leeds D, Lynall RC, Kroshus E, McCrea MA, McAllister TW, Schmidt JD, Master C, McGinty G, Jackson JC, Cameron KL, Buckley T, Kaminski T, Mihalik JP. Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers. Am J Sports Med 2024; 52:801-810. [PMID: 38340366 DOI: 10.1177/03635465231221782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction. PURPOSE/HYPOTHESIS The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles. RESULTS The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed. CONCLUSION Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.
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Affiliation(s)
- Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Zachary Yukio Kerr
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Daniel Leeds
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Emily Kroshus
- University of Washington, Department of Pediatrics & Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jonathan C Jackson
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
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6
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Silvestro S, Raffaele I, Quartarone A, Mazzon E. Innovative Insights into Traumatic Brain Injuries: Biomarkers and New Pharmacological Targets. Int J Mol Sci 2024; 25:2372. [PMID: 38397046 PMCID: PMC10889179 DOI: 10.3390/ijms25042372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
A traumatic brain injury (TBI) is a major health issue affecting many people across the world, causing significant morbidity and mortality. TBIs often have long-lasting effects, disrupting daily life and functionality. They cause two types of damage to the brain: primary and secondary. Secondary damage is particularly critical as it involves complex processes unfolding after the initial injury. These processes can lead to cell damage and death in the brain. Understanding how these processes damage the brain is crucial for finding new treatments. This review examines a wide range of literature from 2021 to 2023, focusing on biomarkers and molecular mechanisms in TBIs to pinpoint therapeutic advancements. Baseline levels of biomarkers, including neurofilament light chain (NF-L), ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), Tau, and glial fibrillary acidic protein (GFAP) in TBI, have demonstrated prognostic value for cognitive outcomes, laying the groundwork for personalized treatment strategies. In terms of pharmacological progress, the most promising approaches currently target neuroinflammation, oxidative stress, and apoptotic mechanisms. Agents that can modulate these pathways offer the potential to reduce a TBI's impact and aid in neurological rehabilitation. Future research is poised to refine these therapeutic approaches, potentially revolutionizing TBI treatment.
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Affiliation(s)
| | | | | | - Emanuela Mazzon
- IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, SS 113, Contrada Casazza, 98124 Messina, Italy; (S.S.); (I.R.); (A.Q.)
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7
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Meier TB, Huber DL, Goeckner BD, Gill JM, Pasquina P, Broglio SP, McAllister TW, Harezlak J, McCrea MA. Association of Blood Biomarkers of Inflammation With Acute Concussion in Collegiate Athletes and Military Service Academy Cadets. Neurology 2024; 102:e207991. [PMID: 38165315 DOI: 10.1212/wnl.0000000000207991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The objective was to characterize the acute effects of concussion (a subset of mild traumatic brain injury) on serum interleukin (IL)-6 and IL-1 receptor antagonist (RA) and 5 additional inflammatory markers in athletes and military service academy members from the Concussion Assessment, Research, and Education Consortium and to determine whether these markers aid in discrimination of concussed participants from controls. METHODS Athletes and cadets with concussion and matched controls provided blood at baseline and postinjury visits between January 2015 and March 2020. Linear models investigated changes in inflammatory markers measured using Meso Scale Discovery assays across time points (baseline and 0-12, 12-36, 36-60 hours). Subanalyses were conducted in participants split by sex and injury population. Logistic regression analyses tested whether acute levels of IL-6 and IL-1RA improved discrimination of concussed participants relative to brain injury markers (glial fibrillary acidic protein, tau, neurofilament light, ubiquitin c-terminal hydrolase-L1) or clinical data (Sport Concussion Assessment Tool-Third Edition, Standardized Assessment of Concussion, Balance Error Scoring System). RESULTS Participants with concussion (total, N = 422) had elevated IL-6 and IL-1RA at 0-12 hours vs controls (n = 345; IL-6: mean difference [MD] (standard error) = 0.701 (0.091), p < 0.0001; IL-1RA: MD = 0.283 (0.042), p < 0.0001) and relative to baseline (IL-6: MD = 0.656 (0.078), p < 0.0001; IL-1RA: MD = 0.242 (0.038), p < 0.0001), 12-36 hours (IL-6: MD = 0.609 (0.086), p < 0.0001; IL-1RA: MD = 0.322 (0.041), p < 0.0001), and 36-60 hours (IL-6: MD = 0.818 (0.084), p < 0.0001; IL-1RA: MD = 0.317 (0.040), p < 0.0001). IL-6 and IL-1RA were elevated in participants with sport (IL-6: MD = 0.748 (0.115), p < 0.0001; IL-1RA: MD = 0.304 (0.055), p < 0.0001) and combative-related concussions (IL-6: MD = 0.583 (0.178), p = 0.001; IL-1RA: MD = 0.312 (0.081), p = 0.0001). IL-6 was elevated in male (MD = 0.734 (0.105), p < 0.0001) and female participants (MD = 0.600 (0.177), p = 0.0008); IL-1RA was only elevated in male participants (MD = 0.356 (0.047), p < 0.0001). Logistic regression showed the inclusion of IL-6 and IL-1RA at 0-12 hours improved the discrimination of participants with concussion from controls relative to brain injury markers (χ2(2) = 17.855, p = 0.0001; area under the receiver operating characteristic curve [AUC] 0.73 [0.66-0.80] to 0.78 [0.71-0.84]), objective clinical measures (balance and cognition; χ2(2) = 40.661, p < 0.0001; AUC 0.81 [0.76-0.86] to 0.87 [0.83-0.91]), and objective and subjective measures combined (χ2(2) = 13.456, p = 0.001; AUC 0.97 [0.95-0.99] to 0.98 [0.96-0.99]), although improvement in AUC was only significantly relative to objective clinical measures. DISCUSSION IL-6 and IL-1RA (male participants only) are elevated in the early-acute window postconcussion and may aid in diagnostic decisions beyond traditional blood markers and common clinical measures. IL-1RA results highlight sex differences in the immune response to concussion which should be considered in future biomarker work.
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Affiliation(s)
- Timothy B Meier
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Daniel L Huber
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Bryna D Goeckner
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Jessica M Gill
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Paul Pasquina
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Steven P Broglio
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Thomas W McAllister
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Jaroslaw Harezlak
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
| | - Michael A McCrea
- From the Departments of Neurosurgery (T.B.M., D.L.H., M.A.M.), Biomedical Engineering (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), Biophysics (B.D.G.), and Neurology (M.A.M.), Medical College of Wisconsin, Milwaukee; National Institute of Nursing Research (J.M.G.), NIH, Bethesda; Johns Hopkins School of Nursing and Medicine (J.M.G.), Baltimore, MD; Department of Physical Medicine and Rehabilitation (P.P.), Uniformed Services University of the Health Sciences, Bethesda, MD; Michigan Concussion Center (S.P.B.), University of Michigan, Ann Arbor; Department of Psychiatry (T.W.M.), Indiana University School of Medicine, Indianapolis; Department of Epidemiology and Biostatistics (J.H.), School of Public Health-Bloomington, Indiana University
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8
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Mayer AR, Meier TB, Ling JM, Dodd AB, Brett BL, Robertson-Benta CR, Huber DL, Van der Horn HJ, Broglio SP, McCrea MA, McAllister T. Increased brain age and relationships with blood-based biomarkers following concussion in younger populations. J Neurol 2023; 270:5835-5848. [PMID: 37594499 PMCID: PMC10632216 DOI: 10.1007/s00415-023-11931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/19/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Brain age is increasingly being applied to the spectrum of brain injury to define neuropathological changes in conjunction with blood-based biomarkers. However, data from the acute/sub-acute stages of concussion are lacking, especially among younger cohorts. METHODS Predicted brain age differences were independently calculated in large, prospectively recruited cohorts of pediatric concussion and matched healthy controls (total N = 446), as well as collegiate athletes with sport-related concussion and matched non-contact sport controls (total N = 184). Effects of repetitive head injury (i.e., exposure) were examined in a separate cohort of contact sport athletes (N = 82), as well as by quantifying concussion history through semi-structured interviews and years of contact sport participation. RESULTS Findings of increased brain age during acute and sub-acute concussion were independently replicated across both cohorts, with stronger evidence of recovery for pediatric (4 months) relative to concussed athletes (6 months). Mixed evidence existed for effects of repetitive head injury, as brain age was increased in contact sport athletes, but was not associated with concussion history or years of contact sport exposure. There was no difference in brain age between concussed and contact sport athletes. Total tau decreased immediately (~ 1.5 days) post-concussion relative to the non-contact group, whereas pro-inflammatory markers were increased in both concussed and contact sport athletes. Anti-inflammatory markers were inversely related to brain age, whereas markers of axonal injury (neurofilament light) exhibited a trend positive association. CONCLUSION Current and previous findings collectively suggest that the chronicity of brain age differences may be mediated by age at injury (adults > children), with preliminary findings suggesting that exposure to contact sports may also increase brain age.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA.
- Neurology and Psychiatry Departments, University of New Mexico School of Medicine, Albuquerque, NM, USA.
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA.
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Josef M Ling
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Daniel L Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Harm J Van der Horn
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd. NE, Albuquerque, NM, 87106, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Bloomington, IN, USA
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9
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Devoto C, Vorn R, Mithani S, Meier TB, Lai C, Broglio SP, McAllister T, Giza CC, Huber D, Harezlak J, Cameron KL, McGinty G, Jackson J, Guskiewicz K, Mihalik JP, Brooks A, Duma S, Rowson S, Nelson LD, Pasquina P, Turtzo C, Latour L, McCrea MA, Gill JM. Plasma phosphorylated tau181 as a biomarker of mild traumatic brain injury: findings from THINC and NCAA-DoD CARE Consortium prospective cohorts. Front Neurol 2023; 14:1202967. [PMID: 37662031 PMCID: PMC10470112 DOI: 10.3389/fneur.2023.1202967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/18/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The aim of this study was to investigate phosphorylated tau (p-tau181) protein in plasma in a cohort of mild traumatic brain injury (mTBI) patients and a cohort of concussed athletes. Methods This pilot study comprised two independent cohorts. The first cohort-part of a Traumatic Head Injury Neuroimaging Classification (THINC) study-with a mean age of 46 years was composed of uninjured controls (UIC, n = 30) and mTBI patients (n = 288) recruited from the emergency department with clinical computed tomography (CT) and research magnetic resonance imaging (MRI) findings. The second cohort-with a mean age of 19 years-comprised 133 collegiate athletes with (n = 112) and without (n = 21) concussions. The participants enrolled in the second cohort were a part of a multicenter, prospective, case-control study conducted by the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium at six CARE Advanced Research Core (ARC) sites between 2015 and 2019. Blood was collected within 48 h of injury for both cohorts. Plasma concentration (pg/ml) of p-tau181 was measured using the Single Molecule Array ultrasensitive assay. Results Concentrations of plasma p-tau181 in both cohorts were significantly elevated compared to controls within 48 h of injury, with the highest concentrations of p-tau181 within 18 h of injury, with an area under the curve (AUC) of 0.690-0.748, respectively, in distinguishing mTBI patients and concussed athletes from controls. Among the mTBI patients, the levels of plasma p-tau181 were significantly higher in patients with positive neuroimaging (either CT+/MRI+, n = 74 or CT-/MRI+, n = 89) compared to mTBI patients with negative neuroimaging (CT-/MRI-, n = 111) findings and UIC (P-values < 0.05). Conclusion These findings indicate that plasma p-tau181 concentrations likely relate to brain injury, with the highest levels in patients with neuroimaging evidence of injury. Future research is needed to replicate and validate this protein assay's performance as a possible early diagnostic biomarker for mTBI/concussions.
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Affiliation(s)
- Christina Devoto
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Rany Vorn
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Sara Mithani
- School of Nursing, University of Texas Health at San Antonio, San Antonio, TX, United States
| | - Timothy B. Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Chen Lai
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Steven P. Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, United States
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Christopher C. Giza
- Departments of Pediatrics and Neurosurgery, UCLA Steve Tisch BrainSPORT Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Kenneth L. Cameron
- John A. Feagin Sports Medicine Fellowship, Keller Army Hospital, West Point, NY, United States
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Jonathan Jackson
- United States Air Force Academy, Colorado Springs, CO, United States
| | - Kevin Guskiewicz
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason P. Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison Brooks
- Department of Orthopedics and Sports Medicine, University of Wisconsin, Madison, WI, United States
| | - Stefan Duma
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Steven Rowson
- Department of Biomedical Engineering, Virginia Tech, Blacksburg, VA, United States
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Paul Pasquina
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University and Health Science, Bethesda, MD, United States
| | - Christine Turtzo
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Lawrence Latour
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jessica M. Gill
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
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10
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Vorn R, Devoto C, Meier TB, Lai C, Yun S, Broglio SP, Mithani S, McAllister TW, Giza CC, Kim HS, Huber D, Harezlak J, Cameron KL, McGinty G, Jackson J, Guskiewicz KM, Mihalik JP, Brooks A, Duma S, Rowson S, Nelson LD, Pasquina P, McCrea MA, Gill JM. Are EPB41 and alpha-synuclein diagnostic biomarkers of sport-related concussion? Findings from the NCAA and Department of Defense CARE Consortium. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:379-387. [PMID: 36403906 DOI: 10.1016/j.jshs.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/15/2022] [Accepted: 10/08/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Current protein biomarkers are only moderately predictive at identifying individuals with mild traumatic brain injury or concussion. Therefore, more accurate diagnostic markers are needed for sport-related concussion. METHODS This was a multicenter, prospective, case-control study of athletes who provided blood samples and were diagnosed with a concussion or were a matched non-concussed control within the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium conducted between 2015 and 2019. The blood was collected within 48 h of injury to identify protein abnormalities at the acute and subacute timepoints. Athletes with concussion were divided into 6 h post-injury (0-6 h post-injury) and after 6 h post-injury (7-48 h post-injury) groups. We applied a highly multiplexed proteomic technique that used a DNA aptamers assay to target 1305 proteins in plasma samples from athletes with and without sport-related concussion. RESULTS A total of 140 athletes with concussion (79.3% males; aged 18.71 ± 1.10 years, mean ± SD) and 21 non-concussed athletes (76.2% males; 19.14 ± 1.10 years) were included in this study. We identified 338 plasma proteins that significantly differed in abundance (319 upregulated and 19 downregulated) in concussed athletes compared to non-concussed athletes. The top 20 most differentially abundant proteins discriminated concussed athletes from non-concussed athletes with an area under the curve (AUC) of 0.954 (95% confidence interval: 0.922‒0.986). Specifically, after 6 h of injury, the individual AUC of plasma erythrocyte membrane protein band 4.1 (EPB41) and alpha-synuclein (SNCA) were 0.956 and 0.875, respectively. The combination of EPB41 and SNCA provided the best AUC (1.000), which suggests this combination of candidate plasma biomarkers is the best for diagnosing concussion in athletes after 6 h of injury. CONCLUSION Our data suggest that proteomic profiling may provide novel diagnostic protein markers and that a combination of EPB41 and SNCA is the most predictive biomarker of concussion after 6 h of injury.
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Affiliation(s)
- Rany Vorn
- Johns Hopkins School of Nursing and Medicine, Baltimore, MD 21205, USA; National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Chen Lai
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Sijung Yun
- Predictiv Care, Inc., Mountain View, CA 94086, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sara Mithani
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Christopher C Giza
- Departments of Pediatrics and Neurosurgery, University of California at Los Angeles (UCLA), Los Angeles, CA 90024, USA
| | - Hyung-Suk Kim
- National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel Huber
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics School of Public Health - Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Kenneth L Cameron
- John A. Feagin Sports Medicine Fellowship, Keller Army Community Hospital, West Point, NY 10996, USA
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, CO 80840, USA
| | - Jonathan Jackson
- United States Air Force Academy, Colorado Springs, CO 80840, USA
| | - Kevin M Guskiewicz
- Mathew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Jason P Mihalik
- Mathew Gfeller Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Alison Brooks
- Department of Orthopedics, Division of Sports Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA
| | - Stefan Duma
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Paul Pasquina
- Center for Neuroscience & Regenerative Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Jessica M Gill
- Johns Hopkins School of Nursing and Medicine, Baltimore, MD 21205, USA.
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11
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Hicks SD, Onks C, Kim RY, Zhen KJ, Loeffert J, Loeffert AC, Olympia RP, Fedorchak G, DeVita S, Gagnon Z, McLoughlin C, Madeira MM, Zuckerman SL, Lee T, Heller M, Monteith C, Campbell TR, Neville C, Fengler E, Dretsch MN. Refinement of saliva microRNA biomarkers for sports-related concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:369-378. [PMID: 34461327 DOI: 10.1016/j.jshs.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/29/2021] [Accepted: 07/13/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS Two miRNAs (miR-532-5p and miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p and miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (area under curve > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.
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Affiliation(s)
- Steven D Hicks
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA.
| | - Cayce Onks
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Raymond Y Kim
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Kevin J Zhen
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Jayson Loeffert
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Andrea C Loeffert
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Robert P Olympia
- Department of Emergency Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Gregory Fedorchak
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Samantha DeVita
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Zofia Gagnon
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | | | - Miguel M Madeira
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | - Scott L Zuckerman
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Timothy Lee
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Matthew Heller
- Department of Family Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA
| | - Chuck Monteith
- Department of Athletic Training, Colgate University, Hamilton, NY 13346, USA
| | - Thomas R Campbell
- Department of Rehabilitation Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Christopher Neville
- Department of Physical Therapy Education, Orthopedics, and Neuroscience, College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Elise Fengler
- Department of Exercise Science, Syracuse University, Syracuse, NY 13210, USA
| | - Michael N Dretsch
- Department of Medical Research-West, Walter Reed Army Institute of Research, US Army Joint Base Lewis-McChord, Hillhurst, WA 98433, USA
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12
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Lange RT, Lippa S, Brickell TA, Gill J, French LM. Serum Tau, Neurofilament Light Chain, Glial Fibrillary Acidic Protein, and Ubiquitin Carboxyl-Terminal Hydrolase L1 Are Associated with the Chronic Deterioration of Neurobehavioral Symptoms after Traumatic Brain Injury. J Neurotrauma 2023; 40:482-492. [PMID: 36170576 DOI: 10.1089/neu.2022.0249] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to examine the association of serum tau, neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase L1 (UCHL-1) concentrations evaluated within the first 12 months after a military-related TBI, with longitudinal changes in neurobehavioral functioning extending two or more years post-injury. Participants were 84 United States service members and veterans (SMVs) prospectively enrolled in the Defense and Veterans Brain Injury Center of Excellence/Traumatic Brain Injury Center 15-Year Longitudinal TBI Study, separated into three discreet groups: (a) uncomplicated mild TBI (MTBI; n = 28), (b) complicated mild, moderate, severe, and penetrating TBI combined (STBI; n = 29], and (c) non-injured controls (NIC, n = 27). Participants completed a battery of self-report neurobehavioral symptom measures (e.g., depression, post-traumatic stress disorder [PTSD], post-concussion, anxiety, somatic, cognitive, and neurological symptoms) within 12 months of injury (baseline), and then again at two or more years post-injury (follow-up). At baseline, participants also completed a blood draw to determine serum concentrations of tau, NFL, GFAP, and UCHL-1 using an ultra-sensitivity assay method. In the MTBI and STBI groups (using hierarchical regression analyses), (1) baseline tau concentrations predicted the deterioration of neurobehavioral symptoms from baseline to follow-up on measures of anxiety, PTSD, depression, post-concussion, somatic, and neurological symptoms (accounting for 10-28% of the variance); (2) NFL predicted the deterioration of depression, post-concussion, somatic, cognitive, and neurological symptoms (10-32% variance); (3) GFAP predicted the deterioration of post-concussion, PTSD, depression, anxiety, somatic, neurological, and cognitive symptoms (11-43% variance); and (4) UCHL-1 predicted the deterioration of anxiety, somatic, and neurological symptoms (10-16% variance). In the NIC group, no meaningful associations were found between baseline biomarker concentrations and the deterioration of neurobehavioral symptoms on the majority of measures. This study reports that elevated tau, NFL, GFAP, and UCHL-1 concentrations within the first 12 months of injury are associated with the deterioration of neurobehavioral symptoms that extends to the chronic phase of recovery after a TBI. These findings suggest that a blood-based panel including these biomarkers could be a useful prognostic tool to identifying those individuals at risk of poor future outcome after TBI.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Bethesda, Maryland, USA.,Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA.,University of British Columbia, Vancouver, Briish Columbia, Canada.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sara Lippa
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Bethesda, Maryland, USA.,Contractor, General Dynamics Information Technology, Silver Spring, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica Gill
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,National Intrepid Center of Excellence, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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McDonald SJ, Piantella S, O'Brien WT, Hale MW, O'Halloran P, Kinsella G, Horan B, O'Brien TJ, Maruff P, Shultz SR, Wright BJ. Clinical and Blood Biomarker Trajectories after Concussion: New Insights from a Longitudinal Pilot Study of Professional Flat-Track Jockeys. J Neurotrauma 2023; 40:52-62. [PMID: 35734899 DOI: 10.1089/neu.2022.0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
There is a recognized need for objective tools for detecting and tracking clinical and neuropathological recovery after sports-related concussion (SRC). Although computerized neurocognitive testing has been shown to be sensitive to cognitive deficits after SRC, and some blood biomarkers have shown promise as indicators of axonal and glial damage, the potential utility of these measures in isolation and combination for assisting SRC diagnosis and tracking recovery is not well understood. To provide new insights, we conducted a prospective study of 64 male and female professional flat-track jockeys (49 non-SRC, 15 SRC), with each jockey undergoing symptom evaluation, cognitive testing using the CogSport battery, and serum biomarker quantification of glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) using a Simoa HD-X Analyzer. Measures were performed at baseline (i.e., pre-injury), and 2 and 7 days and 1 and 12 months after SRC. Symptoms were most pronounced at 2 days and had largely resolved by either 7 days or 1 month. CogSport testing at 2 days revealed cognitive impairments relative to both non-concussed peers and their own pre-injury baselines, with SRC classification utility found at 2 days, and to a slightly lesser extent, at 7 days. Relatively prolonged changes in serum NfL were observed, with elevated levels and classification utility persisting beyond the resolution of SRC symptoms and cognitive deficits. Finally, SRC classification performance throughout the 1st month after SRC was optimized through the combination of cognitive testing and serum biomarkers. Considered together, these findings provide further evidence for a role of computerized cognitive testing and fluid biomarkers of neuropathology as objective measures to assist in the identification of SRC and the monitoring of clinical and neuropathological recovery.
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Affiliation(s)
- Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Stefan Piantella
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Matthew W Hale
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Paul O'Halloran
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Glynda Kinsella
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ben Horan
- School of Engineering, Deakin University, Geelong, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Bradley J Wright
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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14
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Alvarez BE, McGrew CA, Bossart C. When Is Air Travel Safe after Mild Traumatic Brain Injury/Sports-Related Concussion? Curr Sports Med Rep 2023; 22:15-18. [PMID: 36606631 DOI: 10.1249/jsr.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT While the literature regarding return to play and recovery protocols from mild traumatic brain injury (mTBI) and sports-related concussions (SRC) is growing, there continues to be a paucity of data regarding when air travel is safe for athletes after sustaining certain brain injuries, such as mTBI and SRC. Although it is known hypoxia can negatively affect severe TBI patients, it is unclear whether mild hypoxia, which may be experienced during commercial air travel, is clinically significant for athletes who have recently sustained mTBI injuries. Further research is required to provide more standardized recommendations on when air travel is safe. With the current available literature, clinicians still need to weigh the evidence, consider how it applies to each individual patient, and engage in shared decision making to ultimately decide what is best for the patient.
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15
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Goutnik M, Goeckeritz J, Sabetta Z, Curry T, Willman M, Willman J, Thomas TC, Lucke-Wold B. Neurotrauma Prevention Review: Improving Helmet Design and Implementation. BIOMECHANICS (BASEL, SWITZERLAND) 2022; 2:500-512. [PMID: 36185779 PMCID: PMC9521172 DOI: 10.3390/biomechanics2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Neurotrauma continues to contribute to significant mortality and disability. The need for better protective equipment is apparent. This review focuses on improved helmet design and the necessity for continued research. We start by highlighting current innovations in helmet design for sport and subsequent utilization in the lay community for construction. The current standards by sport and organization are summarized. We then address current standards within the military environment. The pathophysiology is discussed with emphasis on how helmets provide protection. As innovative designs emerge, protection against secondary injury becomes apparent. Much research is needed, but this focused paper is intended to serve as a catalyst for improvement in helmet design and implementation to provide more efficient and reliable neuroprotection across broad arenas.
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Affiliation(s)
- Michael Goutnik
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Joel Goeckeritz
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Zackary Sabetta
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Tala Curry
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- College of Graduate Studies, Midwestern University, Downers Grove, IL 60515, USA
| | - Matthew Willman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Jonathan Willman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
| | - Theresa Currier Thomas
- College of Medicine-Phoenix, University of Arizona, Child Health, Phoenix, AZ 85721, USA
- BARROW Neurological Institute at Phoenix Children’s Hospital, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
- Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32601, USA
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16
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Kulbe JR, Jain S, Nelson LD, Korley FK, Mukherjee P, Sun X, Okonkwo DO, Giacino JT, Vassar MJ, Robertson CS, McCrea MA, Wang KKW, Temkin N, Mac Donald CL, Taylor SR, Ferguson AR, Markowitz AJ, Diaz-Arrastia R, Manley GT, Stein MB. Association of day-of-injury plasma glial fibrillary acidic protein concentration and six-month posttraumatic stress disorder in patients with mild traumatic brain injury. Neuropsychopharmacology 2022; 47:2300-2308. [PMID: 35717463 PMCID: PMC9630517 DOI: 10.1038/s41386-022-01359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
Several proteins have proven useful as blood-based biomarkers to assist in evaluation and management of traumatic brain injury (TBI). The objective of this study was to determine whether two day-of-injury blood-based biomarkers are predictive of posttraumatic stress disorder (PTSD). We used data from 1143 individuals with mild TBI (mTBI; defined as admission Glasgow Coma Scale [GCS] score 13-15) enrolled in TRACK-TBI, a prospective longitudinal study of level 1 trauma center patients. Plasma glial fibrillary acidic protein (GFAP) and serum high sensitivity C-reactive protein (hsCRP) were measured from blood collected within 24 h of injury. Two hundred and twenty-seven (19.9% of) patients had probable PTSD (PCL-5 score ≥ 33) at 6 months post-injury. GFAP levels were positively associated (Spearman's rho = 0.35, p < 0.001) with duration of posttraumatic amnesia (PTA). There was an inverse association between PTSD and (log)GFAP (adjusted OR = 0.85, 95% CI 0.77-0.95 per log unit increase) levels, but no significant association with (log)hsCRP (adjusted OR = 1.11, 95% CI 0.98-1.25 per log unit increase) levels. Elevated day-of-injury plasma GFAP, a biomarker of glial reactivity, is associated with reduced risk of PTSD after mTBI. This finding merits replication and additional studies to determine a possible neurocognitive basis for this relationship.
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Affiliation(s)
- Jacqueline R. Kulbe
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
| | - Sonia Jain
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Lindsay D. Nelson
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Frederick K. Korley
- grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA
| | - Pratik Mukherjee
- grid.266102.10000 0001 2297 6811Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Bioengineering & Therapeutic Sciences, UCSF, San Francisco, CA USA
| | - Xiaoying Sun
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - David O. Okonkwo
- grid.412689.00000 0001 0650 7433Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Joseph T. Giacino
- grid.38142.3c000000041936754XDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA ,grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Mary J. Vassar
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Claudia S. Robertson
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Michael A. McCrea
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Kevin K. W. Wang
- grid.15276.370000 0004 1936 8091Department of Emergency Medicine, University of Florida, Gainesville, FL USA
| | - Nancy Temkin
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Christine L. Mac Donald
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Sabrina R. Taylor
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Adam R. Ferguson
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Amy J. Markowitz
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Ramon Diaz-Arrastia
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Geoffrey T. Manley
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Murray B. Stein
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242School of Public Health, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VA San Diego Healthcare System, San Diego, CA USA
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17
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Morgan JE, Gaynor-Metzinger SA, Beck SD, Scobercea IC, Austin IJ, Blankenship HE, Baker JS, Knox A, Serrador JM, Rogatzki MJ. Serum Amyloid Beta Precursor Protein, Neurofilament Light, and Visinin-like Protein-1 in Rugby Players: An Exploratory Study. Sports (Basel) 2022; 10:sports10120194. [PMID: 36548491 PMCID: PMC9782676 DOI: 10.3390/sports10120194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022] Open
Abstract
Concussion diagnosis is difficult and may be improved with the addition of a blood-based biomarker that indicates concussion. The purpose of this research was to investigate the capability of serum amyloid beta precursor protein (APP), neurofilament light (NfL), and visinin-like protein-1 (VILIP-1) to distinguish athletes who were diagnosed with a concussion pitch-side. An observational cross-sectional study design was used to replicate sideline concussion diagnosis. Subjects included mutually exclusive pre-match (n = 9), post-match (n = 15), and SRC (n = 7) groups. Six paired pre-and post-match subjects were analyzed for APP. APP increased significantly from pre-match (mean = 57.98 pg·mL−1, SD = 63.21 pg·mL−1) to post-match (mean = 111.37 pg·mL−1, SD = 106.89 pg·mL−1, p = 0.048) in the paired subjects. NfL was lower in the SRC group (median = 8.71 pg·mL−1, IQR = 6.09 pg·mL−1) compared to the post-match group (median = 29.60 pg·mL−1, IQR = 57.45 pg·mL−1, p < 0.001). VILIP-1 was higher in the post-match group (median = 212.18 pg·mL−1, IQR = 345.00 pg·mL−1) compared to both the pre-match (median = 32.63 pg·mL−1, IQR = 52.24 pg·mL−1), p = 0.001) and SRC (median = 30.21 pg·mL−1, IQR = 47.20 pg·mL−1), p = 0.003) groups. APP, NfL, and VILIP-1 were all able to distinguish between pre-match and post-match groups (AUROC > 0.700) but not from the SRC group (AUROC < 0.660). Our results show that APP, NfL, and VILIP-1 were not helpful in differentiating concussed from non-concussed athletes pitch-side in this study.
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Affiliation(s)
- Jessica E. Morgan
- Department of Public Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
| | | | - Steven D. Beck
- Cardio-Renal Physiology Laboratory, Department of Biology, Appalachian State University, North Carolina Research Campus, Kannapolis, NC 28081, USA
| | - Iustin C. Scobercea
- College of Osteopathic Medicine, Liberty University, Lynchburg, VA 24515, USA
| | - India J. Austin
- Department of Public Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
| | - Hannah E. Blankenship
- Department of Public Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Allan Knox
- Exercise Science Department, California Lutheran University, Thousand Oaks, CA 91360, USA
| | - Jorge M. Serrador
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW 2751, Australia
- Rehabilitation and Movement Sciences, School of Health Professions, Department of Pharmacology, Physiology and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ 07102, USA
| | - Matthew J. Rogatzki
- Department of Public Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
- Correspondence:
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18
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Muacevic A, Adler JR, Powers JE. The Potential Role of Neurofilament Light in Mild Traumatic Brain Injury Diagnosis: A Systematic Review. Cureus 2022; 14:e31301. [PMID: 36514599 PMCID: PMC9733779 DOI: 10.7759/cureus.31301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is an insult to the CNS often overlooked at the time of presentation due to variable symptomatology and undetectable nature on CT/MRI. Increased exposure to repetitive head injuries results in a high prevalence of mTBI among athletes and military personnel. While most patients fully recover with rest, some are at risk for long-lasting neurocognitive dysfunction, leading to a high morbidity and cost burden on the healthcare system. Currently, there are no unified symptom-based criteria or gold standard objective measurement for mTBI. Neurofilament light (Nf-L) is a highly sensitive biomarker for axonal injury with the potential to serve as an objective serum measurement for mTBI. This systematic review investigates the ability of Nf-L to accurately diagnose acute mTBI in athletes and military personnel. A comprehensive literature search of PubMed, Scopus, and Google Scholar from 2010 to 2021 using keywords neurofilament light chain, mTBI, concussion, athletes, and military identified 239 articles for eligibility screening. Ten articles met the inclusion criteria for qualitative analysis, with extracted data including Nf-L levels, recovery characteristics, and neuroimaging results. Of the 10 studies meeting inclusion criteria, one was military-related, five were sports-related, and four were mixed-focus. Six studies investigated the association between mTBI and Nf-L levels within 24 hours of injury. Four of these studies involved athletes, with three showing evidence of acute Nf-L elevations. No evidence of acute Nf-L elevations was reported among military personnel or emergency department patients. Nf-L elevations were recorded at various time points greater than 24 hours post-injury in athletes (two studies) and emergency department patients (one study). Positive associations were found between Nf-L levels and loss of consciousness/post-traumatic amnesia (one study), positive neuroimaging findings (three studies), and prolonged recovery times (three studies). We are unable to conclude whether Nf-L has the capacity for acute diagnosis of mTBI or the optimal time for serum measurement. Nf-L does, however, shows promise as a prognostic factor for mTBI complications, neuroimaging findings, and recovery. Additional studies are warranted, as the use of Nf-L in early diagnosis of mTBI in the future would improve clinical management while decreasing complications and healthcare costs.
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19
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Papa L, Walter AE, Wilkes JR, Clonts HS, Johnson B, Slobounov SM. Effect of Player Position on Serum Biomarkers during Participation in a Season of Collegiate Football. J Neurotrauma 2022; 39:1339-1348. [PMID: 35615873 PMCID: PMC9529311 DOI: 10.1089/neu.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This prospective cohort study examined the relationship between a panel of four serum proteomic biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], total Tau, and neurofilament light chain polypeptide [NF-L]) in 52 players from two different cohorts of male collegiate student football athletes from two different competitive seasons of Division I National Collegiate Athletic Association Football Bowl Subdivision. This study evaluated changes in biomarker concentrations (as indicators of brain injury) over the course of the playing season (pre- and post-season) and also assessed biomarker concentrations by player position using two different published classification systems. Player positions were divided into: 1) speed (quarterbacks, running backs, halfbacks, fullbacks, wide receivers, tight ends, defensive backs, safety, and linebackers) versus non-speed (offensive and defensive linemen), and 2) "Profile 1" (low frequency/high strain magnitudes positions including quarterbacks, wide receivers, and defensive backs), "Profile 2" (mid-range impact frequency and strain positions including linebackers, running backs, and tight ends), and "Profile 3" (high frequency/low strains positions including defensive and offensive linemen). There were significant increases in GFAP 39.3 to 45.6 pg/mL and NF-L 3.5 to 5.4 pg/mL over the course of the season (p < 0.001) despite only five players being diagnosed with concussion. UCH-L1 decreased significantly, and Tau was not significantly different. In both the pre- and post-season blood samples Tau and NF-L concentrations were significantly higher in speed versus non-speed positions. Concentrations of GFAP, Tau, and NF-L increased incrementally from "Profile 3," to "Profile 2" to "Profile 1" in the post-season. UCH-L1 did not. GFAP increased (by Profiles 3, 2, 1) from 42.4 to 49.6 to 78.2, respectively (p = 0.051). Tau increased from 0.37 to 0.61 to 0.67, respectively (p = 0.024). NF-L increased from 3.5 to 4.9 to 8.2, respectively (p < 0.001). Although GFAP and Tau showed similar patterns of elevations by profile in the pre-season samples they were not statistically significant. Only NF-L showed significant differences between profiles 2.7 to 3.1 to 4.2 in the pre-season (p = 0.042). GFAP, Tau, and NF-L concentrations were significantly associated with different playing positions with the highest concentrations in speed and "Profile 1" positions and the lowest concentrations were in non-speed and "Profile 3" positions. Blood-based biomarkers (GFAP, Tau, NF-L) provide an additional layer of injury quantification that could contribute to a better understanding of the risks of playing different positions.
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Affiliation(s)
- Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alexa E. Walter
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James R. Wilkes
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Hunter S. Clonts
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
| | - Brian Johnson
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Semyon M. Slobounov
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
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20
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Tybirk L, Hviid CVB, Knudsen CS, Parkner T. Serum GFAP - reference interval and preanalytical properties in Danish adults. Clin Chem Lab Med 2022; 60:1830-1838. [PMID: 36067832 DOI: 10.1515/cclm-2022-0646] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) is a promising biomarker that could potentially contribute to diagnosis and prognosis in neurological diseases. The biomarker is approaching clinical use but the reference interval for serum GFAP remains to be established, and knowledge about the effect of preanalytical factors is also limited. METHODS Serum samples from 371 apparently healthy reference subjects, 21-90 years of age, were measured by a single-molecule array (Simoa) assay. Continuous reference intervals were modelled using non-parametric quantile regression and compared with traditional age-partitioned non-parametric reference intervals established according to the Clinical and Laboratory Standards Institute (CLSI) guideline C28-A3. The following preanalytical conditions were also examined: stability in whole blood at room temperature (RT), stability in serum at RT and -20 °C, repeated freeze-thaw cycles, and haemolysis. RESULTS The continuous reference interval showed good overall agreement with the traditional age-partitioned reference intervals of 25-136 ng/L, 34-242 ng/L, and 5-438 ng/L for the age groups 20-39, 40-64, and 65-90 years, respectively. Both types of reference intervals showed increasing levels and variability of serum GFAP with age. In the preanalytical tests, the mean changes from baseline were 2.3% (95% CI: -2.4%, 6.9%) in whole blood after 9 h at RT, 3.1% (95% CI: -4.5%, 10.7%) in serum after 7 days at RT, 10.4% (95% CI: -6.0%, 26.8%) in serum after 133 days at -20 °C, and 10.4% (95% CI: 9.5%, 11.4%) after three freeze-thaw cycles. CONCLUSIONS The study establishes age-dependent reference ranges for serum GFAP in adults and demonstrates overall good stability of the biomarker.
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Affiliation(s)
- Lea Tybirk
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Tina Parkner
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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21
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Vorn R, Naunheim R, Lai C, Wagner C, Gill JM. Elevated Axonal Protein Markers Following Repetitive Blast Exposure in Military Personnel. Front Neurosci 2022; 16:853616. [PMID: 35573288 PMCID: PMC9099432 DOI: 10.3389/fnins.2022.853616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Blast exposures that occur during training are common in military personnel; however, the biomarkers that relate to these subtle injuries is not well understood. Therefore, the purpose of this study is to identify the acute biomarkers related to blast injury in a cohort of military personnel exposure to blast-related training. Thirty-four military personnel who participated in the training program were included in this study. Blood samples were collected before and after repetitive blast-related training on days 2 (n = 19) and days 7 (n = 15). Serum concentration (pg/mL) of tau, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau181 (p-tau181) were measured using an ultrasensitive immunoassay platform. We observed that serum p-tau181 concentrations were elevated after exposed to repetitive blast on days 2 (z = −2.983, p = 0.003) and days 7 (z = −2.158, p = 0.031). Serum tau (z = −2.272, p = 0.023) and NfL (z = −2.158, p = 0.031) levels were significantly elevated after exposure to repetitive blasts on days 7. Our findings indicate that blast exposure affects serum biomarkers indicating axonal injury.
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Affiliation(s)
- Rany Vorn
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Rany Vorn,
| | - Rosanne Naunheim
- Department of Emergency Medicine, Washington University Barnes Jewish Medical Center, St. Louis, MO, United States
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Chelsea Wagner
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Jessica M. Gill
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, United States
- School of Nursing and Medicine, Johns Hopkins University, Baltimore, MD, United States
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22
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Posti JP, Tenovuo O. Blood-based biomarkers and traumatic brain injury-A clinical perspective. Acta Neurol Scand 2022; 146:389-399. [PMID: 35383879 DOI: 10.1111/ane.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 12/19/2022]
Abstract
Blood-based biomarkers are promising tools to complement clinical variables and imaging findings in the diagnosis, monitoring and outcome prediction of traumatic brain injury (TBI). Several promising biomarker candidates have been found for various clinical questions, but the translation of TBI biomarkers into clinical applications has been negligible. Measured biomarker levels are influenced by patient-related variables such as age, blood-brain barrier integrity and renal and liver function. It is not yet fully understood how biomarkers enter the bloodstream from the interstitial fluid of the brain. In addition, the diagnostic performance of TBI biomarkers is affected by sampling timing and analytical methods. In this focused review, the clinical aspects of glial fibrillary acidic protein, neurofilament light, S100 calcium-binding protein B, tau and ubiquitin C-terminal hydrolase-L1 are examined. Current findings and clinical caveats are addressed.
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Affiliation(s)
- Jussi P. Posti
- Neurocenter Department of Neurosurgery and Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Olli Tenovuo
- Neurocenter Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
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23
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Shahim P, Zetterberg H. Neurochemical Markers of Traumatic Brain Injury: Relevance to Acute Diagnostics, Disease Monitoring, and Neuropsychiatric Outcome Prediction. Biol Psychiatry 2022; 91:405-412. [PMID: 34857362 DOI: 10.1016/j.biopsych.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022]
Abstract
Considerable advancements have been made in the quantification of biofluid-based biomarkers for traumatic brain injury (TBI), which provide a clinically accessible window to investigate disease mechanisms and progression. Methods with improved analytical sensitivity compared with standard immunoassays are increasingly used, and blood tests are being used in the diagnosis, monitoring, and outcome prediction of TBI. Most work to date has focused on acute TBI diagnostics, while the literature on biomarkers for long-term sequelae is relatively scarce. In this review, we give an update on the latest developments in biofluid-based biomarker research in TBI and discuss how acute and prolonged biomarker changes can be used to detect and quantify brain injury and predict clinical outcome and neuropsychiatric sequelae.
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Affiliation(s)
- Pashtun Shahim
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at University College London, London, United Kingdom; Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China.
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24
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Sarkis GA, Zhu T, Yang Z, Li X, Shi Y, Rubenstein R, Yost RA, Manley GT, Wang KK. Characterization and standardization of multiassay platforms for four commonly studied traumatic brain injury protein biomarkers: a TBI Endpoints Development Study. Biomark Med 2021; 15:1721-1732. [PMID: 34674546 PMCID: PMC8739397 DOI: 10.2217/bmm-2021-0284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/28/2021] [Indexed: 12/21/2022] Open
Abstract
Aim: There is a critical need to validate biofluid-based biomarkers as diagnostic and drug development tools for traumatic brain injury (TBI). As part of the TBI Endpoints Development Initiative, we identified four potentially predictive and pharmacodynamic biomarkers for TBI: astroglial markers GFAP and S100B and the neuronal markers UCH-L1 and Tau. Materials & methods: Several commonly used platforms for these four biomarkers were identified and compared on analytic performance and ability to detect gold standard recombinant protein antigens and to pool control versus TBI cerebrospinal fluid (CSF). Results: For each marker, only some assay formats could differentiate TBI CSF from the control CSF. Also, different assays for the same biomarker reported divergent biomarker values for the same biosamples. Conclusion: Due to the variability of TBI marker assay in performance and reported values, standardization strategies are recommended when comparing reported biomarker levels across assay platforms.
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Affiliation(s)
- George Anis Sarkis
- Department of Chemistry, University of Florida, Gainesville, FL 32611, USA
| | - Tian Zhu
- Department of Emergency Medicine, University of Florida, 1149 Newell Drive, L4-100, Gainesville, FL 32611, USA
- Department of Pediatrics, Daping Hospital, Chongqing, Third Military Medical University, Chongqing, China
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Zhihui Yang
- Department of Emergency Medicine, University of Florida, 1149 Newell Drive, L4-100, Gainesville, FL 32611, USA
| | - Xue Li
- Department of Emergency Medicine, University of Florida, 1149 Newell Drive, L4-100, Gainesville, FL 32611, USA
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Shi
- Department of Pediatrics, Daping Hospital, Chongqing, Third Military Medical University, Chongqing, China
- Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Richard Rubenstein
- Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA
| | - Richard A Yost
- Department of Chemistry, University of Florida, Gainesville, FL 32611, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kevin K Wang
- Department of Emergency Medicine, University of Florida, 1149 Newell Drive, L4-100, Gainesville, FL 32611, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Road, Gainesville, FL 32608, USA
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25
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McDonald SJ, Shultz SR, Agoston DV. The Known Unknowns: An Overview of the State of Blood-Based Protein Biomarkers of Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2652-2666. [PMID: 33906422 DOI: 10.1089/neu.2021.0011] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Blood-based protein biomarkers have revolutionized several fields of medicine by enabling molecular level diagnosis, as well as monitoring disease progression and treatment efficacy. Traumatic brain injury (TBI) so far has benefitted only moderately from using protein biomarkers to improve injury outcome. Because of its complexity and dynamic nature, TBI, especially its most prevalent mild form (mild TBI; mTBI), presents unique challenges toward protein biomarker discovery and validation given that blood is frequently obtained and processed outside of the clinical laboratory (e.g., athletic fields, battlefield) under variable conditions. As it stands, the field of mTBI blood biomarkers faces a number of outstanding questions. Do elevated blood levels of currently used biomarkers-ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light chain, and tau/p-tau-truly mirror the extent of parenchymal damage? Do these different proteins represent distinct injury mechanisms? Is the blood-brain barrier a "brick wall"? What is the relationship between intra- versus extracranial values? Does prolonged elevation of blood levels reflect de novo release or extended protein half-lives? Does biological sex affect the pathobiological responses after mTBI and thus blood levels of protein biomarkers? At the practical level, it is unknown how pre-analytical variables-sample collection, preparation, handling, and stability-affect the quality and reliability of biomarker data. The ever-increasing sensitivity of assay systems and lack of quality control of samples, combined with the almost complete reliance on antibody-based assay platforms, represent important unsolved issues given that false-negative results can lead to false clinical decision making and adverse outcomes. This article serves as a commentary on the state of mTBI biomarkers and the landscape of significant challenges. We highlight and discusses several biological and methodological "known unknowns" and close with some practical recommendations.
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Affiliation(s)
- Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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26
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Hier DB, Obafemi-Ajayi T, Thimgan MS, Olbricht GR, Azizi S, Allen B, Hadi BA, Wunsch DC. Blood biomarkers for mild traumatic brain injury: a selective review of unresolved issues. Biomark Res 2021; 9:70. [PMID: 34530937 PMCID: PMC8447604 DOI: 10.1186/s40364-021-00325-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background The use of blood biomarkers after mild traumatic brain injury (mTBI) has been widely studied. We have identified eight unresolved issues related to the use of five commonly investigated blood biomarkers: neurofilament light chain, ubiquitin carboxy-terminal hydrolase-L1, tau, S100B, and glial acidic fibrillary protein. We conducted a focused literature review of unresolved issues in three areas: mode of entry into and exit from the blood, kinetics of blood biomarkers in the blood, and predictive capacity of the blood biomarkers after mTBI. Findings Although a disruption of the blood brain barrier has been demonstrated in mild and severe traumatic brain injury, biomarkers can enter the blood through pathways that do not require a breach in this barrier. A definitive accounting for the pathways that biomarkers follow from the brain to the blood after mTBI has not been performed. Although preliminary investigations of blood biomarkers kinetics after TBI are available, our current knowledge is incomplete and definitive studies are needed. Optimal sampling times for biomarkers after mTBI have not been established. Kinetic models of blood biomarkers can be informative, but more precise estimates of kinetic parameters are needed. Confounding factors for blood biomarker levels have been identified, but corrections for these factors are not routinely made. Little evidence has emerged to date to suggest that blood biomarker levels correlate with clinical measures of mTBI severity. The significance of elevated biomarker levels thirty or more days following mTBI is uncertain. Blood biomarkers have shown a modest but not definitive ability to distinguish concussed from non-concussed subjects, to detect sub-concussive hits to the head, and to predict recovery from mTBI. Blood biomarkers have performed best at distinguishing CT scan positive from CT scan negative subjects after mTBI.
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Affiliation(s)
- Daniel B Hier
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO 65401, USA.
| | - Tayo Obafemi-Ajayi
- Cooperative Engineering Program, Missouri State University, Springfield, MO 65897, United States
| | - Matthew S Thimgan
- Department of Biological Sciences, Missouri University of Science and Technology, Rolla, MO 65409, United States
| | - Gayla R Olbricht
- Department of Mathematics and Statistics, Missouri University of Science and Technology, Rolla, MO 65409, United States
| | - Sima Azizi
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO 65401, USA
| | - Blaine Allen
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO 65401, USA
| | - Bassam A Hadi
- Department of Surgery, Mercy Hospital, St. Louis MO, Missouri, MO 63141, United States
| | - Donald C Wunsch
- Department of Electrical and Computer Engineering, Missouri University of Science and Technology, Rolla, MO 65401, USA.,National Science Foundation, ECCS Division, Virginia, 22314, USA
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