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Wongsripuemtet P, Ohnuma T, Temkin N, Barber J, Komisarow J, Manley GT, Hatfield J, Treggiari M, Colton K, Sasannejad C, Chaikittisilpa N, Ivins-O'Keefe K, Grandhi R, Laskowitz D, Mathew JP, Hernandez A, James ML, Raghunathan K, Miller J, Vavilala M, Krishnamoorthy V. Association of early dexmedetomidine exposure with brain injury biomarker levels following moderate - Severe traumatic brain injury: A TRACK-TBI study. J Clin Neurosci 2024; 126:338-347. [PMID: 39029302 DOI: 10.1016/j.jocn.2024.07.003] [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: 03/27/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) triggers autonomic dysfunction and inflammatory response that can result in secondary brain injuries. Dexmedetomidine is an alpha-2 agonist that may modulate autonomic function and inflammation and has been increasingly used as a sedative agent for critically ill TBI patients. We aimed to investigate the association between early dexmedetomidine exposure and blood-based biomarker levels in moderate-to-severe TBI (msTBI). METHODS We conducted a retrospective cohort study using data from the Transforming Clinical Research and Knowledge in Traumatic Brain Injury Study (TRACK-TBI), which enrolled acute TBI patients prospectively across 18 United States Level 1 trauma centers between 2014-2018. Our study population focused on adults with msTBI defined by Glasgow Coma Scale score 3-12 after resuscitation, who required mechanical ventilation and sedation within the first 48 h of ICU admission. The study's exposure was early dexmedetomidine utilization (within the first 48 h of admission). Primary outcome included brain injury biomarker levels measured from circulating blood on day 3 following injury, including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), neuron-specific enolase (NSE), S100 calcium-binding protein B (S100B) and the inflammatory biomarker C-reactive protein (CRP). Secondary outcomes assessed biomarker levels on days 5 and 14. Linear mixed-effects regression modelling of the log-transformed response variable was used to analyze the association of early dexmedetomidine exposure with brain injury biomarker levels. RESULTS Among the 352 TRACK-TBI subjects that met inclusion criteria, 50 (14.2 %) were exposed to early dexmedetomidine, predominantly male (78 %), white (81 %), and non-Hispanic (81 %), with mean age of 39.8 years. Motor vehicle collisions (27 %) and falls (22 %) were common causes of injury. No significant associations were found between early dexmedetomidine exposure with day 3 brain injury biomarker levels (GFAP, ratio = 1.46, 95 % confidence interval [0.90, 2.34], P = 0.12; UCH-L1; ratio = 1.17 [0.89, 1.53], P = 0.26; NSE, ratio = 1.19 [0.92, 1.53], P = 0.19; S100B, ratio = 1.01 [0.95, 1.06], P = 0.82; hs-CRP, ratio = 1.29 [0.91, 1.83], P = 0.15). The hs-CRP level at day 14 in the dexmedetomidine group was higher than that of the non-exposure group (ratio = 1.62 [1.12, 2.35], P = 0.012). CONCLUSIONS There were no significant associations between early dexmedetomidine exposure and day 3 brain injury biomarkers in msTBI. Our findings suggest that early dexmedetomidine use is not correlated with either decrease or increase in brain injury biomarkers following msTBI. Further research is necessary to confirm these findings.
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Affiliation(s)
- Pattrapun Wongsripuemtet
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Tetsu Ohnuma
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Nancy Temkin
- Department of Biostatistics, University of Washington, Seattle, WA, United States; Department of Neurosurgery, University of Washington, Seattle, WA, United States
| | - Jason Barber
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Jordan Komisarow
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, United States
| | - Jordan Hatfield
- Department of Neurosurgery, Duke University, Durham, NC, United States; Duke University School of Medicine, Durham, NC, United States
| | - Miriam Treggiari
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Katharine Colton
- Department of Neurology, Duke University, Durham, NC, United States
| | - Cina Sasannejad
- Department of Neurology, Duke University, Durham, NC, United States
| | - Nophanan Chaikittisilpa
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kelly Ivins-O'Keefe
- Department of Anesthesiology, Duke University, Durham, NC, United States; Duke University School of Medicine, Durham, NC, United States
| | - Ramesh Grandhi
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States
| | - Daniel Laskowitz
- Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Neurosurgery, Duke University, Durham, NC, United States; Department of Neurology, Duke University, Durham, NC, United States
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Adrian Hernandez
- Department of Medicine, Duke University, Durham, NC, United States
| | - Michael L James
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Neurology, Duke University, Durham, NC, United States
| | - Karthik Raghunathan
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Joseph Miller
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Monica Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Vijay Krishnamoorthy
- Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Anesthesiology, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States
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Abdul Baki S, Zakeri Z, Chari G, Fenton A, Omurtag A. Relaxed Alert Electroencephalography Screening for Mild Traumatic Brain Injury in Athletes. Int J Sports Med 2023; 44:896-905. [PMID: 37164326 DOI: 10.1055/a-2091-4860] [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: 05/12/2023]
Abstract
Due to the mildness of initial injury, many athletes with recurrent mild traumatic brain injury (mTBI) are misdiagnosed with other neuropsychiatric illnesses. This study was designed as a proof-of-principle feasibility trial for athletic trainers at a sports facility to generate electroencephalograms (EEGs) from student athletes for discriminating (mTBI) associated EEGs from uninjured ones. A total of 47 EEGs were generated, with 30 athletes recruited at baseline (BL) pre-season, after a concussive injury (IN), and post-season (PS). Outcomes included: 1) visual analyses of EEGs by a neurologist; 2) support vector machine (SVM) classification for inferences about whether particular groups belonged to the three subgroups of BL, IN, or PS; and 3) analyses of EEG synchronies including phase locking value (PLV) computed between pairs of distinct electrodes. All EEGs were visually interpreted as normal. SVM classification showed that BL and IN could be discriminated with 81% accuracy using features of EEG synchronies combined. Frontal inter-hemispheric phase synchronization measured by PLV was significantly lower in the IN group. It is feasible for athletic trainers to record high quality EEGs from student athletes. Also, spatially localized metrics of EEG synchrony can discriminate mTBI associated EEGs from control EEGs.
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Affiliation(s)
- Samah Abdul Baki
- Clinical BioSignal Group Corp., Acton, Massachusetts, United States
| | - Zohreh Zakeri
- Department of Engineering, Nottingham Trent University School of Science and Technology, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Geetha Chari
- Pediatric Neurology, SUNY Downstate Medical Center, New York City, United States
| | - André Fenton
- Center for Neural Science, NYU, New York, United States
| | - Ahmet Omurtag
- Department of Engineering, Nottingham Trent University School of Science and Technology, Nottingham, United Kingdom of Great Britain and Northern Ireland
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Itälinna V, Kaltiainen H, Forss N, Liljeström M, Parkkonen L. Using normative modeling and machine learning for detecting mild traumatic brain injury from magnetoencephalography data. PLoS Comput Biol 2023; 19:e1011613. [PMID: 37943963 PMCID: PMC10662745 DOI: 10.1371/journal.pcbi.1011613] [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: 03/23/2023] [Revised: 11/21/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
New biomarkers are urgently needed for many brain disorders; for example, the diagnosis of mild traumatic brain injury (mTBI) is challenging as the clinical symptoms are diverse and nonspecific. EEG and MEG studies have demonstrated several population-level indicators of mTBI that could serve as objective markers of brain injury. However, deriving clinically useful biomarkers for mTBI and other brain disorders from EEG/MEG signals is hampered by the large inter-individual variability even across healthy people. Here, we used a multivariate machine-learning approach to detect mTBI from resting-state MEG measurements. To address the heterogeneity of the condition, we employed a normative modeling approach and modeled MEG signal features of individual mTBI patients as deviations with respect to the normal variation. To this end, a normative dataset comprising 621 healthy participants was used to determine the variation in power spectra across the cortex. In addition, we constructed normative datasets based on age-matched subsets of the full normative data. To discriminate patients from healthy control subjects, we trained support-vector-machine classifiers on the quantitative deviation maps for 25 mTBI patients and 20 controls not included in the normative dataset. The best performing classifier made use of the full normative data across the entire age and frequency ranges. This classifier was able to distinguish patients from controls with an accuracy of 79%. Inspection of the trained model revealed that low-frequency activity in the theta frequency band (4-8 Hz) is a significant indicator of mTBI, consistent with earlier studies. The results demonstrate the feasibility of using normative modeling of MEG data combined with machine learning to advance diagnosis of mTBI and identify patients that would benefit from treatment and rehabilitation. The current approach could be applied to a wide range of brain disorders, thus providing a basis for deriving MEG/EEG-based biomarkers.
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Affiliation(s)
- Veera Itälinna
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
| | - Hanna Kaltiainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Nina Forss
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki, Helsinki, Finland
| | - Mia Liljeström
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Lauri Parkkonen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Aalto, Finland
- Aalto NeuroImaging, Aalto University School of Science, Aalto, Finland
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Dong X, Dong JF, Zhang J. Roles and therapeutic potential of different extracellular vesicle subtypes on traumatic brain injury. Cell Commun Signal 2023; 21:211. [PMID: 37596642 PMCID: PMC10436659 DOI: 10.1186/s12964-023-01165-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/13/2023] [Indexed: 08/20/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of injury-related disability and death around the world, but the clinical stratification, diagnosis, and treatment of complex TBI are limited. Due to their unique properties, extracellular vesicles (EVs) are emerging candidates for being biomarkers of traumatic brain injury as well as serving as potential therapeutic targets. However, the effects of different extracellular vesicle subtypes on the pathophysiology of traumatic brain injury are very different, or potentially even opposite. Before extracellular vesicles can be used as targets for TBI therapy, it is necessary to classify different extracellular vesicle subtypes according to their functions to clarify different strategies for EV-based TBI therapy. The purpose of this review is to discuss contradictory effects of different EV subtypes on TBI, and to propose treatment ideas based on different EV subtypes to maximize their benefits for the recovery of TBI patients. Video Abstract.
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Affiliation(s)
- Xinlong Dong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, Nansihuan West Road, Fengtai District, Beijing, China.
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Jing-Fei Dong
- Bloodworks Research Institute, Seattle, WA, USA
- Division of Hematology, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
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Wong ET, Kapadia A, Krishnamurthy V, Mikulis DJ. Cerebrovascular Reactivity and Concussion. Neuroimaging Clin N Am 2023; 33:335-342. [PMID: 36965950 DOI: 10.1016/j.nic.2023.01.008] [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: 02/27/2023]
Abstract
Cerebrovascular reactivity (CVR) reflects the change in cerebral blood flow in response to vasodilatory stimuli enabling assessment of the health of the cerebral vasculature. Recent advances in the quantitative delivery of CO2 stimuli with computer-controlled sequential gas delivery have enabled mapping of the speed and magnitude of response to flow stimuli. These CVR advances when applied to patients with acute concussion have unexpectedly shown faster speed and greater magnitude of responses unseen in other diseases that typically show the opposite effects. The strength of the CVR alterations have diagnostic potential in single subjects with AUC values in the 0.90-0.94 range.
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Affiliation(s)
- Erin T Wong
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Anish Kapadia
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Venkatagiri Krishnamurthy
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University, Atlanta, GA, USA; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center (VAMC), 1670 Clairmont Road, Suite # 12C 141, Decatur, GA 30033, USA; Department of Neurology, Emory University, Atlanta, GA, USA
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Department of Medical Imaging, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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Burns JM, Kalinosky BT, Sloan MA, Cerna CZ, Fines DA, Valdez CM, Voorhees WB. Dilation of the superior sagittal sinus detected in rat model of mild traumatic brain injury using 1 T magnetic resonance imaging. Front Neurol 2023; 14:1045695. [PMID: 37181576 PMCID: PMC10169716 DOI: 10.3389/fneur.2023.1045695] [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: 09/15/2022] [Accepted: 03/23/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Mild traumatic brain injury (mTBI) is a common injury that can lead to temporary and, in some cases, life-long disability. Magnetic resonance imaging (MRI) is widely used to diagnose and study brain injuries and diseases, yet mTBI remains notoriously difficult to detect in structural MRI. mTBI is thought to be caused by microstructural or physiological changes in the function of the brain that cannot be adequately captured in structural imaging of the gray and white matter. However, structural MRIs may be useful in detecting significant changes in the cerebral vascular system (e.g., the blood-brain barrier (BBB), major blood vessels, and sinuses) and the ventricular system, and these changes may even be detectable in images taken by low magnetic field strength MRI scanners (<1.5T). Methods In this study, we induced a model of mTBI in the anesthetized rat animal model using a commonly used linear acceleration drop-weight technique. Using a 1T MRI scanner, the brain of the rat was imaged, without and with contrast, before and after mTBI on post-injury days 1, 2, 7, and 14 (i.e., P1, P2, P7, and P14). Results Voxel-based analyses of MRIs showed time-dependent, statistically significant T2-weighted signal hypointensities in the superior sagittal sinus (SSS) and hyperintensities of the gadolinium-enhanced T1-weighted signal in the superior subarachnoid space (SA) and blood vessels near the dorsal third ventricle. These results showed a widening, or vasodilation, of the SSS on P1 and of the SA on P1-2 on the dorsal surface of the cortex near the site of the drop-weight impact. The results also showed vasodilation of vasculature near the dorsal third ventricle and basal forebrain on P1-7. Discussion Vasodilation of the SSS and SA near the site of impact could be explained by the direct mechanical injury resulting in local changes in tissue function, oxygenation, inflammation, and blood flow dynamics. Our results agreed with literature and show that the 1T MRI scanner performs at a level comparable to higher field strength scanners for this type of research.
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Affiliation(s)
- Jennie M. Burns
- General Dynamics Information Technology, Defense Division, JBSA Fort SamHouston, TX, United States
| | - Benjamin T. Kalinosky
- General Dynamics Information Technology, Defense Division, JBSA Fort SamHouston, TX, United States
| | - Mark A. Sloan
- General Dynamics Information Technology, Defense Division, JBSA Fort SamHouston, TX, United States
| | - Cesario Z. Cerna
- General Dynamics Information Technology, Defense Division, JBSA Fort SamHouston, TX, United States
| | - David A. Fines
- General Dynamics Information Technology, Defense Division, JBSA Fort SamHouston, TX, United States
| | - Christopher M. Valdez
- Radio Frequency Bioeffects Branch, Bioeffects Division, Airman Systems Directorate, 711th Human Performance Wing, Air Force Research Laboratory, JBSA FortSam Houston, TX, United States
| | - William B. Voorhees
- Radio Frequency Bioeffects Branch, Bioeffects Division, Airman Systems Directorate, 711th Human Performance Wing, Air Force Research Laboratory, JBSA FortSam Houston, TX, United States
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Vutakuri N. Detection of emotional and behavioural changes after traumatic brain injury: A comprehensive survey. COGNITIVE COMPUTATION AND SYSTEMS 2023. [DOI: 10.1049/ccs2.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
- Neha Vutakuri
- Department of Psychology & Neuroscience Duke University Durham North Carolina USA
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Harris G, Rickard JJS, Butt G, Kelleher L, Blanch RJ, Cooper J, Oppenheimer PG. Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury. IEEE Rev Biomed Eng 2023; 16:530-559. [PMID: 35320105 PMCID: PMC9888755 DOI: 10.1109/rbme.2022.3161352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/06/2022]
Abstract
The study of ocular manifestations of neurodegenerative disorders, Oculomics, is a growing field of investigation for early diagnostics, enabling structural and chemical biomarkers to be monitored overtime to predict prognosis. Traumatic brain injury (TBI) triggers a cascade of events harmful to the brain, which can lead to neurodegeneration. TBI, termed the "silent epidemic" is becoming a leading cause of death and disability worldwide. There is currently no effective diagnostic tool for TBI, and yet, early-intervention is known to considerably shorten hospital stays, improve outcomes, fasten neurological recovery and lower mortality rates, highlighting the unmet need for techniques capable of rapid and accurate point-of-care diagnostics, implemented in the earliest stages. This review focuses on the latest advances in the main neuropathophysiological responses and the achievements and shortfalls of TBI diagnostic methods. Validated and emerging TBI-indicative biomarkers are outlined and linked to ocular neuro-disorders. Methods detecting structural and chemical ocular responses to TBI are categorised along with prospective chemical and physical sensing techniques. Particular attention is drawn to the potential of Raman spectroscopy as a non-invasive sensing of neurological molecular signatures in the ocular projections of the brain, laying the platform for the first tangible path towards alternative point-of-care diagnostic technologies for TBI.
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Affiliation(s)
- Georgia Harris
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
| | - Jonathan James Stanley Rickard
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
- Department of Physics, Cavendish LaboratoryUniversity of CambridgeCB3 0HECambridgeU.K.
| | - Gibran Butt
- Ophthalmology DepartmentUniversity Hospitals Birmingham NHS Foundation TrustB15 2THBirminghamU.K.
| | - Liam Kelleher
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
| | - Richard James Blanch
- Department of Military Surgery and TraumaRoyal Centre for Defence MedicineB15 2THBirminghamU.K.
- Neuroscience and Ophthalmology, Department of Ophthalmology, University Hospitals Birmingham NHS Foundation TrustcBirminghamU.K.
| | - Jonathan Cooper
- School of Biomedical EngineeringUniversity of GlasgowG12 8LTGlasgowU.K.
| | - Pola Goldberg Oppenheimer
- School of Chemical Engineering, Advanced Nanomaterials Structures and Applications Laboratories, College of Engineering and Physical SciencesUniversity of BirminghamB15 2TTBirminghamU.K.
- Healthcare Technologies Institute, Institute of Translational MedicineB15 2THBirminghamU.K.
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Abstract
OBJECTIVE Depression is among the most pervasive and debilitating neuropsychiatric sequelae experienced by patients following a traumatic brain injury (TBI). While the individual mechanisms underlying depression and TBI have been widely studied, the neurobiological bases of depression after TBI remain largely unknown. This article highlights the potential mechanisms of action implicated in depression after TBI. RESULTS We review putative mechanisms of action including neuroinflammation, neuroendocrine dysregulation, metabolic abnormalities, and neurotransmitter and circuitry dysfunction. We also identify the current limitations in the field and propose directions for future research. CONCLUSION An improved understanding of the underlying mechanisms will aid the development of precision-guided and personalized treatments for patients suffering from depression after TBI.
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Affiliation(s)
- Aava Bushra Jahan
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, US
| | - Kaloyan Tanev
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
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Khan NA, Asim M, El-Menyar A, Biswas KH, Rizoli S, Al-Thani H. The evolving role of extracellular vesicles (exosomes) as biomarkers in traumatic brain injury: Clinical perspectives and therapeutic implications. Front Aging Neurosci 2022; 14:933434. [PMID: 36275010 PMCID: PMC9584168 DOI: 10.3389/fnagi.2022.933434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Developing effective disease-modifying therapies for neurodegenerative diseases (NDs) requires reliable diagnostic, disease activity, and progression indicators. While desirable, identifying biomarkers for NDs can be difficult because of the complex cytoarchitecture of the brain and the distinct cell subsets seen in different parts of the central nervous system (CNS). Extracellular vesicles (EVs) are heterogeneous, cell-derived, membrane-bound vesicles involved in the intercellular communication and transport of cell-specific cargos, such as proteins, Ribonucleic acid (RNA), and lipids. The types of EVs include exosomes, microvesicles, and apoptotic bodies based on their size and origin of biogenesis. A growing body of evidence suggests that intercellular communication mediated through EVs is responsible for disseminating important proteins implicated in the progression of traumatic brain injury (TBI) and other NDs. Some studies showed that TBI is a risk factor for different NDs. In terms of therapeutic potential, EVs outperform the alternative synthetic drug delivery methods because they can transverse the blood–brain barrier (BBB) without inducing immunogenicity, impacting neuroinflammation, immunological responses, and prolonged bio-distribution. Furthermore, EV production varies across different cell types and represents intracellular processes. Moreover, proteomic markers, which can represent a variety of pathological processes, such as cellular damage or neuroinflammation, have been frequently studied in neurotrauma research. However, proteomic blood-based biomarkers have short half-lives as they are easily susceptible to degradation. EV-based biomarkers for TBI may represent the complex genetic and neurometabolic abnormalities that occur post-TBI. These biomarkers are not caught by proteomics, less susceptible to degradation and hence more reflective of these modifications (cellular damage and neuroinflammation). In the current narrative and comprehensive review, we sought to discuss the contemporary knowledge and better understanding the EV-based research in TBI, and thus its applications in modern medicine. These applications include the utilization of circulating EVs as biomarkers for diagnosis, developments of EV-based therapies, and managing their associated challenges and opportunities.
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Affiliation(s)
- Naushad Ahmad Khan
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- *Correspondence: Ayman El-Menyar
| | - Kabir H. Biswas
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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Abstract
Research into TBI biomarkers has accelerated rapidly in the past decade owing to the heterogeneous nature of TBI pathologies and management, which pose challenges to TBI evaluation, management, and prognosis. TBI biomarker proteins resulting from axonal, neuronal, or glial cell injuries are widely used and have been extensively studied. However, they might not pass the blood-brain barrier with sufficient amounts to be detected in peripheral blood specimens, and further might not be detectable in the cerebrospinal fluid owing to flow limitations triggered by the injury itself. Despite the advances in TBI research, there is an unmet clinical need to develop and identify novel TBI biomarkers that entirely correlate with TBI pathologies on the molecular level, including mild TBI, and further enable physicians to predict patient outcomes and allow researchers to test neuroprotective agents to limit the extents of injury. Although the extracellular vesicles have been identified and studied long ago, they have recently been revisited and repurposed as potential TBI biomarkers that overcome the many limitations of the traditional blood and CSF assays. Animal and human experiments demonstrated the accuracy of several types of exosomes and miRNAs in detecting mild, moderate, and severe TBI. In this paper, we provide a comprehensive review of the traditional TBI biomarkers that are helpful in clinical practice. Also, we highlight the emerging roles of exosomes and miRNA being the promising candidates under investigation of current research.
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Vaughn MN, Winston CN, Levin N, Rissman RA, Risbrough VB. Developing Biomarkers of Mild Traumatic Brain Injury: Promise and Progress of CNS-Derived Exosomes. Front Neurol 2022; 12:698206. [PMID: 35222223 PMCID: PMC8866179 DOI: 10.3389/fneur.2021.698206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/30/2021] [Indexed: 01/18/2023] Open
Abstract
Mild traumatic brain injuries (mTBI) are common injuries across civilian and military populations. Although most individuals recover after mTBI, some individuals continue to show long-term symptoms as well as increased risk for neurodegenerative and neuropsychiatric disorders. Currently, diagnosing TBI severity relies primarily on self-report and subjective symptoms, with limited tools for diagnosis or prognosis. Brain-derived exosomes, a form of extracellular vesicle, may offer a solution for interpreting injury states by aiding in diagnosis as well as outcome prediction with relatively low patient burden. Exosomes, which are released into circulation, contain both protein and RNA cargo that can be isolated and quantified, providing a molecular window into molecular status of the exosome source. Here we examined the current literature studying the utility of exosomes, in particular neuronal- and astrocyte-derived exosomes, to identify protein and miRNA biomarkers of injury severity, trajectory, and functional outcome. Current evidence supports the potential for these emerging new tools to capture an accessible molecular window into the brain as it responds to a traumatic injury, however a number of limitations must be addressed in future studies. Most current studies are relatively small and cross sectional; prospective, longitudinal studies across injury severity, and populations are needed to track exosome cargo changes after injury. Standardized exosome isolation as well as advancement in identifying/isolating exosomes from CNS-specific tissue sources will improve mechanistic understanding of cargo changes as well as reliability of findings. Exosomes are also just beginning to be used in model systems to understand functional effects of TBI-associated cargo such as toxicity. Finally linking exosome cargo changes to objective markers of neuronal pathology and cognitive changes will be critical in validating these tools to provide insights into injury and recovery states after TBI.
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Affiliation(s)
- Melonie N. Vaughn
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Charisse N. Winston
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Natalie Levin
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
- Veterans Affairs San Diego Health System, University of California, San Diego, San Diego, CA, United States
| | - Victoria B. Risbrough
- Veterans Affairs San Diego Health System, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- VA Center of Excellence for Stress and Mental Health, La Jolla, CA, United States
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Li MJ, Yeh FC, Huang SH, Huang CX, Zhang H, Liu J. Differential Tractography and Correlation Tractography Findings on Patients With Mild Traumatic Brain Injury: A Pilot Study. Front Hum Neurosci 2022; 16:751902. [PMID: 35126076 PMCID: PMC8811572 DOI: 10.3389/fnhum.2022.751902] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Differential tractography and correlation tractography are new tractography modalities to study neuronal changes in brain diseases, but their performances in detecting neuronal injuries are yet to be investigated in patients with mild traumatic brain injury (mTBI). Here we investigated the white matter injury in mTBI patients using differential and correlation tractography. The diffusion MRI was acquired at 33 mTBI patients and 31 health controls. 7 of the mTBI patients had one-year follow-up scans, and differential tractography was used to evaluate injured fiber bundles on these 7 patients. All subjects were evaluated using digital symbol substitution test (DSST) and trail making test A (TMT-A), and the correlation tractography was performed to explore the exact pathways related to the cognitive performance. Our results showed that differential tractography revealed neuronal changes in the corpus callosum in all 7 follow-up mTBI patients with FDR between 0.007 and 0.17. Further, the correlation tractography showed that the splenium of the corpus callosum, combined with the right superior longitudinal fasciculus and right cingulum, were correlated with DSST (FDR = 0.001669) in the acute mTBI patients. The cognitive impairment findings in the acute stage and the longitudinal findings in the corpus callosum in the chronic stage of mTBI patients suggest that differential tractography and correlation tractography are valuable tools in the diagnostic and prognostic evaluation of neuronal injuries in mTBI patients.
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Affiliation(s)
- Meng-Jun Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Si-Hong Huang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chu-Xin Huang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthcare Ltd., Wuhan, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Jun Liu,
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Long-term effects of concussion on relevancy-based modulation of somatosensory-evoked potentials. Clin Neurophysiol 2021; 132:2431-2439. [PMID: 34454270 DOI: 10.1016/j.clinph.2021.06.027] [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: 03/17/2021] [Revised: 05/15/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this investigation was to better understand the effects of concussions on the ability to selectively up or down-regulate incoming somatosensory information based on relevance. METHODS Median nerve somatosensory-evoked potentials (SEPs) were elicited from electrical stimulation and recorded from scalp electrodes while participants completed tasks that altered the relevance of specific somatosensory information being conveyed along the stimulated nerve. RESULTS Within the control group, SEP amplitudes for task-relevant somatosensory information were significantly greater than for non-relevant somatosensory information at the earliest cortical processing potentials (N20-P27). Alternatively, the concussion history group showed similar SEP amplitudes for all conditions at early processing potentials, however a pattern similar to controls emerged later in the processing stream (P100) where both movement-related gating and facilitation of task-relevant information were present. CONCLUSIONS Previously concussed participants demonstrated impairments in the ability to up-regulate relevant somatosensory information at early processing stages. These effects appear to be chronic, as this pattern was observed on average several years after participants' most recent concussion. SIGNIFICANCE Given the role of the prefrontal cortex in relevancy-based facilitation during movement-related gating, these findings lend support to the notion that this brain area may be particularly vulnerable to concussive forces.
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Khanmohammadi S, Laurido-Soto O, Eisenman LN, Kummer TT, Ching S. Localizing focal brain injury via EEG spectral variance. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Altered glucose metabolism of the olfactory-related cortices in anosmia patients with traumatic brain injury. Eur Arch Otorhinolaryngol 2021; 278:4813-4821. [PMID: 33744988 DOI: 10.1007/s00405-021-06754-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Impaired brain cortices contribute significantly to the pathophysiological mechanisms of post-traumatic olfactory dysfunction (PTOD). This study aimed to use 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to measure cerebral cortices' metabolism activity and then to explore their associations with olfaction in patients with PTOD. METHODS Ethics committee-approved prospective studies included 15 patients with post-traumatic anosmia and 11 healthy volunteers. Olfactory function was assessed using the Sniffin' Sticks. Participants underwent 18F-FDG PET/CT scan and the image data were collected for the voxel-based whole brain analysis. Furthermore, the standardized uptake value ratio (SUVR) of the whole brain regions was measured and correlated with olfactory function. RESULTS Patients with post-traumatic anosmia showed significantly reduced glucose metabolism in bilateral rectus, bilateral superior and medial orbitofrontal cortex (OFC), bilateral thalamus, left hippocampus and parahippocampus and left superior temporal pole (all p < 0.001). In contrast, patients with post-traumatic anosmia had significantly increased glucose metabolism in the bilateral insula (all p < 0.001). SUVR values among a total of 17 cerebral cortices including frontal, limbic, and temporal regions were significantly and positively correlated with olfactory function. The cerebral cortices with the top three correlations were the right middle frontal OFC (r = 0.765, p = 0.001), right caudate (r = 0.652, p = 0.010) and right putamen (r = 0.623, p = 0.002). CONCLUSION Patients with post-traumatic anosmia presented with distinct patterns of brain metabolism and key cortices that highly associated with the retained olfactory function were identified. The preliminary results further support the potential use of PET imaging for precisely assessing brain metabolism in patients with PTOD.
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Plasma miR-9-3p and miR-136-3p as Potential Novel Diagnostic Biomarkers for Experimental and Human Mild Traumatic Brain Injury. Int J Mol Sci 2021; 22:ijms22041563. [PMID: 33557217 PMCID: PMC7913923 DOI: 10.3390/ijms22041563] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Noninvasive, affordable circulating biomarkers for difficult-to-diagnose mild traumatic brain injury (mTBI) are an unmet medical need. Although blood microRNA (miRNA) levels are reportedly altered after traumatic brain injury (TBI), their diagnostic potential for mTBI remains inconclusive. We hypothesized that acutely altered plasma miRNAs could serve as diagnostic biomarkers both in the lateral fluid percussion injury (FPI) model and clinical mTBI. We performed plasma small RNA-sequencing from adult male Sprague-Dawley rats (n = 31) at 2 days post-TBI, followed by polymerase chain reaction (PCR)-based validation of selected candidates. miR-9a-3p, miR-136-3p, and miR-434-3p were identified as the most promising candidates at 2 days after lateral FPI. Digital droplet PCR (ddPCR) revealed 4.2-, 2.8-, and 4.6-fold elevations in miR-9a-3p, miR-136-3p, and miR-434-3p levels (p < 0.01 for all), respectively, distinguishing rats with mTBI from naïve rats with 100% sensitivity and specificity. DdPCR further identified a subpopulation of mTBI patients with plasma miR-9-3p (n = 7/15) and miR-136-3p (n = 5/15) levels higher than one standard deviation above the control mean at <2 days postinjury. In sTBI patients, plasma miR-9-3p levels were 6.5- and 9.2-fold in comparison to the mTBI and control groups, respectively. Thus, plasma miR-9-3p and miR-136-3p were identified as promising biomarker candidates for mTBI requiring further evaluation in a larger patient population.
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Winston CN, Romero HK, Ellisman M, Nauss S, Julovich DA, Conger T, Hall JR, Campana W, O’Bryant SE, Nievergelt CM, Baker DG, Risbrough VB, Rissman RA. Assessing Neuronal and Astrocyte Derived Exosomes From Individuals With Mild Traumatic Brain Injury for Markers of Neurodegeneration and Cytotoxic Activity. Front Neurosci 2019; 13:1005. [PMID: 31680797 PMCID: PMC6797846 DOI: 10.3389/fnins.2019.01005] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022] Open
Abstract
Mild traumatic brain injury (mTBI) disproportionately affects military service members and is very difficult to diagnose. To-date, there is currently no blood-based, diagnostic biomarker for mTBI cases with persistent post concussive symptoms. To examine the potential of neuronally-derived (NDE) and astrocytic-derived (ADE) exosome cargo proteins as biomarkers of chronic mTBI in younger adults, we examined plasma exosomes from a prospective longitudinal study of combat-related risk and resilience, marine resiliency study II (MRSII). After return from a combat-deployment participants were interviewed to assess TBI exposure while on deployment. Plasma exosomes from military service members with mTBI (mean age, 21.7 years, n = 19, avg. days since injury 151), and age-matched, controls (deployed service members who did not endorse a deployment-related TBI or a pre-deployment history of TBI; mean age, 21.95 years, n = 20) were precipitated and enriched against a neuronal adhesion protein, L1-CAM, and an astrocyte marker, glutamine aspartate transporter (GLAST) using magnetic beads to immunocapture the proteins and subsequently selected by fluorescent activated cell sorting (FACS). Extracted protein cargo from NDE and ADE preparations were quantified for protein levels implicated in TBI neuropathology by standard ELISAs and on the ultra-sensitive single molecule assay (Simoa) platform. Plasma NDE and ADE levels of Aβ42 were significantly higher while plasma NDE and ADE levels of the postsynaptic protein, neurogranin (NRGN) were significantly lower in participants endorsing mTBI exposure compared to controls with no TBI history. Plasma NDE and ADE levels of Aβ40, total tau, and neurofilament light (NFL), P-T181-tau, P-S396-tau were either undetectable or not significantly different between the two groups. In an effort to understand the pathogenetic potential of NDE and ADE cargo proteins, neuron-like cultures were treated with NDE and ADE preparations from TBI and non-TBI groups. Lastly, we determined that plasma NDE but not ADE cargo proteins from mTBI samples were found to be toxic to neuron-like recipient cells in vitro. These data support the presence of markers of neurodegeneration in NDEs of mTBI and suggest that these NDEs can be used as tools to identify pathogenic mechanisms of TBI.
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Affiliation(s)
- Charisse N. Winston
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Haylie K. Romero
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, United States
| | - Maya Ellisman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Sophie Nauss
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - David A. Julovich
- Department of Pharmacology and Neuroscience, Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Tori Conger
- Department of Pharmacology and Neuroscience, Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - James R. Hall
- Department of Pharmacology and Neuroscience, Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Wendy Campana
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
| | - Sid E. O’Bryant
- Department of Pharmacology and Neuroscience, Institute for Translational Research, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Caroline M. Nievergelt
- Center of Excellence for Stress and Mental Health, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Dewleen G. Baker
- Center of Excellence for Stress and Mental Health, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Victoria B. Risbrough
- Center of Excellence for Stress and Mental Health, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Robert A. Rissman
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
- VA San Diego Healthcare System, La Jolla, CA, United States
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Yan J, Bu X, Li Z, Wu J, Wang C, Li D, Song J, Wang J. Screening the expression of several miRNAs from TaqMan Low Density Array in traumatic brain injury: miR-219a-5p regulates neuronal apoptosis by modulating CCNA2 and CACUL1. J Neurochem 2019; 150:202-217. [PMID: 31077370 DOI: 10.1111/jnc.14717] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 12/19/2022]
Abstract
Circulating microRNAs (miRNAs) have emerged as diagnostic and prognostic biomarkers for traumatic brain injury (TBI). However, a comprehensive characterization of the serum miRNA profile in patients with TBI and the roles of these potential markers in neuronal regulation have rarely been reported. In this study, the levels of 754 serum miRNAs were initially determined in two pooled samples of 15 severe traumatic brain injury (sTBI) patients and 15 healthy controls using a TaqMan Low Density Array. The markedly upregulated miRNAs in sTBI patients were subsequently validated individually by quantitative reverse-transcription PCR (RT-qPCR) in another larger cohort consisting of 81 sTBI patients, 81 mild traumatic brain injury (mTBI) patients and 82 age/sex-matched healthy controls. Seven miRNAs, including miR-103a-3p, miR-219a-5p, miR-302d-3p, miR-422a, miR-518f-3p, miR-520d-3p and miR-627, were significantly upregulated in both sTBI and mTBI patients compared with their expression in controls. Among these miRNAs, miR-219a-5p not only discriminated sTBI and mTBI patients from controls but also discriminated between sTBI and mTBI patients. We further show here that in the neuronal cell injury model, upregulated miR-219a-5p inhibits the expression of CCNA2 and CACUL1 and further regulates akt/Foxo3a and p53/Bcl-2 signaling pathways, causing a notable change in the expression of cleaved caspase-3, thereby inducing neuronal apoptosis. These results indicate that these seven selected miRNAs could serve as novel biomarkers for TBI. In particular, miR-219a-5p is a potentially valuable indicator of the diagnosis, prognosis of TBI and appears to regulate neuronal apoptosis and death.
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Affiliation(s)
- Jing Yan
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,Jinling Clinical Medical College of Nanjing Medical University, Nanjing, China
| | - Xiaomin Bu
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhuoling Li
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jia Wu
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Cheng Wang
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dandan Li
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiaxi Song
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Junjun Wang
- Department of Clinical Laboratory, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Mild, moderate and severe: terminology implications for clinical and experimental traumatic brain injury. Curr Opin Neurol 2019; 31:672-680. [PMID: 30379702 DOI: 10.1097/wco.0000000000000624] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW When describing clinical or experimental traumatic brain injury (TBI), the adjectives 'mild,' 'moderate' and 'severe' are misleading. 'Mild' clinical TBI frequently results in long-term disability. 'Severe' rodent TBI actually resembles mild or complicated mild clinical TBI. RECENT FINDINGS Many mild TBI patients appear to have recovered completely but have postconcussive symptoms, deficits in cognitive and executive function and reduced cerebral blood flow. After moderate TBI, 31.8% of patients died or were discharged to skilled nursing or hospice. Among survivors of moderate and severe TBI, 44% were unable to return to work. On MRI, 88% of mild TBI patients have evidence of white matter damage, based on measurements of fractional anisotropy and mean diffusivity/apparent diffusion coefficient. After sports concussion, clinically recovered patients have abnormalities in functional connectivity on functional MRI. Methylphenidate improved fatigue and cognitive impairment and, combined with cognitive rehabilitation, improved memory and executive functioning. In comparison to clinical TB, because the entire spectrum of experimental rodent TBI, although defined as moderate or severe, more closely resembles mild or complicated mild clinical TBI. SUMMARY Many patients after mild or moderate TBI suffer long-term sequelae and should be considered a major target for translational research. Treatments that improve outcome in rodent TBI, even when the experimental injuries are defined as severe, might be most applicable to mild or moderate TBI.
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Abstract
The underlying mechanisms that result in neurophysiological changes and cognitive sequelae in the context of repetitive mild traumatic brain injury (rmTBI) remain poorly understood. Animal models provide a unique opportunity to examine cellular and molecular responses using histological assessment, which can give important insights on the neurophysiological changes associated with the evolution of brain injury. To better understand the potential cumulative effects of multiple concussions, the focus of animal models is shifting from single to repetitive head impacts. With a growing body of literature on this subject, a review and discussion of current findings is valuable to better understand the neuropathology associated with rmTBI, to evaluate the current state of the field, and to guide future research efforts. Despite variability in experimental settings, existing animal models of rmTBI have contributed to our understanding of the underlying mechanisms following repeat concussion. However, how to reconcile the various impact methods remains one of the major challenges in the field today.
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Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Departments of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
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Kaufman NK, Bush SS, Aguilar MR. What Attorneys and Factfinders Need to Know About Mild Traumatic Brain Injuries. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09355-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lu L, Li F, Ma Y, Chen H, Wang P, Peng M, Chen YC, Yin X. Functional connectivity disruption of the substantia nigra associated with cognitive impairment in acute mild traumatic brain injury. Eur J Radiol 2019; 114:69-75. [PMID: 31005180 DOI: 10.1016/j.ejrad.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Mild traumatic brain injury is known to have frequent cognitive impairment. Accumulating evidence is pointing to the malfunctioning of the substantia nigra (SN) as an important factor for head trauma. However, it remains unknown whether changes in the SN-based resting state functional connectivity following mTBI at acute stage and its relationship with cognitive function. MATERIALS AND METHODS 58 patients with mTBI and 30 age-, gender-, and years of education-matched healthy controls were enrolled in the current study. All of participants received resting state functional magnetic resonance imaging as well as neuropsychological assessment. The resting state functional MR imaging data were analyzed by using a standard seed-based whole-brain correlation method to characterize SN resting state networks. Student t tests were used to perform comparisons. The association between SN resting state networks and performance on neuropsychological measures was also investigated in patients with mTBI by using Pearson rank correlation. RESULTS Patients with mTBI at acute stage exhibited reduced left SN-based functional connectivity with right insula and caudate and increased left SN-based functional connectivity with left precuneus and left middle occipital gyrus, and reduced right SN-based functional connectivity with left insula. Increased functional connectivity of left precuneus was negatively associated with neurocognitive functions as well (r = -0.266; P = 0.049). CONCLUSION The present study indicated that patients with acute mTBI suffer from disruption in their SN resting state networks. Moreover, abnormal functional connectivity significantly correlated with cognitive function. Taking together, these results may better improve our understanding of the neuropathological mechanism underlying the neurocognitive symptoms associated with acute mTBI.
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Affiliation(s)
- Liyan Lu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Fengfang Li
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yuehu Ma
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Mingyang Peng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
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Introduction to contrast-enhanced ultrasound of the brain in neonates and infants: current understanding and future potential. Pediatr Radiol 2019; 49:254-262. [PMID: 30353273 PMCID: PMC6604800 DOI: 10.1007/s00247-018-4270-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 10/28/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) is a valuable bedside imaging technique that enables both qualitative and quantitative assessment of cerebral perfusion. In neonates and infants whose fontanelles remain open, the technique is particularly useful as it delineates cerebral pathology with high soft-tissue contrast. The technique has the potential to be a valuable alternative to computed tomography (CT) or magnetic resonance imaging (MRI) in critically ill neonates and infants in need of bedside imaging. While further studies are needed to validate the technique, preliminary data in this regard appear promising. This review introduces the current understanding and future potential of brain CEUS.
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Proton Magnetic Resonance Spectroscopy (H1-MRS) Study of the Ketogenic Diet on Repetitive Mild Traumatic Brain Injury in Adolescent Rats and Its Effect on Neurodegeneration. World Neurosurg 2018; 120:e1193-e1202. [DOI: 10.1016/j.wneu.2018.09.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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Stephens JA, Salorio CF, Barber AD, Risen SR, Mostofsky SH, Suskauer SJ. Preliminary findings of altered functional connectivity of the default mode network linked to functional outcomes one year after pediatric traumatic brain injury. Dev Neurorehabil 2018; 21:423-430. [PMID: 28692408 PMCID: PMC5843556 DOI: 10.1080/17518423.2017.1338777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE AND METHOD This study examined functional connectivity of the default mode network (DMN) and examined brain-behavior relationships in a pilot cohort of children with chronic mild to moderate traumatic brain injury (TBI). RESULTS Compared to uninjured peers, children with TBI demonstrated less anti-correlated functional connectivity between DMN and right Brodmann Area 40 (BA 40). In children with TBI, more anomalous less anti-correlated) connectivity between DMN and right BA 40 was linked to poorer performance on response inhibition tasks. CONCLUSION Collectively, these preliminary findings suggest that functional connectivity between DMN and BA 40 may relate to longterm functional outcomes in chronic pediatric TBI.
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Affiliation(s)
- Jaclyn A. Stephens
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Cynthia F. Salorio
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anita D. Barber
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sarah R. Risen
- Department of Pediatric Neurology, Baylor College of Medicine, Texas Children’s Hospital, Houston TX, USA
| | - Stewart H. Mostofsky
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stacy J. Suskauer
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Impaired brain response to odors in patients with varied severity of olfactory loss after traumatic brain injury. J Neurol 2018; 265:2322-2332. [DOI: 10.1007/s00415-018-9003-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
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28
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Raji CA, Henderson TA. PET and Single-Photon Emission Computed Tomography in Brain Concussion. Neuroimaging Clin N Am 2018; 28:67-82. [PMID: 29157854 DOI: 10.1016/j.nic.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article offers an overview of the application of PET and single photon emission computed tomography brain imaging to concussion, a type of mild traumatic brain injury and traumatic brain injury, in general. The article reviews the application of these neuronuclear imaging modalities in cross-sectional and longitudinal studies. Additionally, this article frames the current literature with an overview of the basic physics and radiation exposure risks of each modality.
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Affiliation(s)
- Cyrus A Raji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, UCSF China Basin, 185 Berry Street, Suite 350, San Francisco, CA 94158, USA
| | - Theodore A Henderson
- The Synaptic Space Inc, Neuro-Laser Foundation, Neuro-Luminance Brain Health Centers Inc, Dr. Theodore Henderson Inc, 3979 East Arapahoe Road, Suite 200, Centennial, CO 80122, USA.
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29
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Evanson NK, Guilhaume-Correa F, Herman JP, Goodman MD. Optic tract injury after closed head traumatic brain injury in mice: A model of indirect traumatic optic neuropathy. PLoS One 2018; 13:e0197346. [PMID: 29746557 PMCID: PMC5944994 DOI: 10.1371/journal.pone.0197346] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Abstract
Adult male C57BL/6J mice have previously been reported to have motor and memory deficits after experimental closed head traumatic brain injury (TBI), without associated gross pathologic damage or neuroimaging changes detectable by magnetic resonance imaging or diffusion tensor imaging protocols. The presence of neurologic deficits, however, suggests neural damage or dysfunction in these animals. Accordingly, we undertook a histologic analysis of mice after TBI. Gross pathology and histologic analysis using Nissl stain and NeuN immunohistochemistry demonstrated no obvious tissue damage or neuron loss. However, Luxol Fast Blue stain revealed myelin injury in the optic tract, while Fluoro Jade B and silver degeneration staining revealed evidence of axonal neurodegeneration in the optic tract as well as the lateral geniculate nucleus of the thalamus and superior colliculus (detectable at 7 days, but not 24 hours, after injury). Fluoro Jade B staining was not detectable in other white matter tracts, brain regions or in cell somata. In addition, there was increased GFAP staining in these optic tract, lateral geniculate, and superior colliculus 7 days post-injury, and morphologic changes in optic tract microglia that were detectable 24 hours after injury but were more prominent 7 days post-injury. Interestingly, there were no findings of degeneration or gliosis in the suprachiasmatic nucleus, which is also heavily innervated by the optic tract. Using micro-computed tomography imaging, we also found that the optic canal appears to decrease in diameter with a dorsal-ventral load on the skull, which suggests that the optic canal may be the site of injury. These results suggest that there is axonal degeneration in the optic tract and a subset of directly innervated areas, with associated neuroinflammation and astrocytosis, which develop within 7 days of injury, and also suggest that this weight drop injury may be a model for studying indirect traumatic optic neuropathy.
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Affiliation(s)
- Nathan K. Evanson
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Fernanda Guilhaume-Correa
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - James P. Herman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Michael D. Goodman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, United States of America
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30
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Scared or scarred: Could ‘dissociogenic’ lesions predispose to nonepileptic seizures after head trauma? Seizure 2018; 58:127-132. [DOI: 10.1016/j.seizure.2018.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 01/08/2023] Open
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31
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Chong CD, Schwedt TJ. Research Imaging of Brain Structure and Function After Concussion. Headache 2018; 58:827-835. [DOI: 10.1111/head.13269] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
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32
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Kirov II, Whitlow CT, Zamora C. Susceptibility-Weighted Imaging and Magnetic Resonance Spectroscopy in Concussion. Neuroimaging Clin N Am 2018; 28:91-105. [DOI: 10.1016/j.nic.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Najem D, Rennie K, Ribecco-Lutkiewicz M, Ly D, Haukenfrers J, Liu Q, Nzau M, Fraser DD, Bani-Yaghoub M. Traumatic brain injury: classification, models, and markers. Biochem Cell Biol 2018; 96:391-406. [PMID: 29370536 DOI: 10.1139/bcb-2016-0160] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Due to its high incidence rate and often long-term sequelae, TBI contributes significantly to increasing costs of health care expenditures annually. Unfortunately, advances in the field have been stifled by patient and injury heterogeneity that pose a major challenge in TBI prevention, diagnosis, and treatment. In this review, we briefly discuss the causes of TBI, followed by its prevalence, classification, and pathophysiology. The current imaging detection methods and animal models used to study brain injury are examined. We discuss the potential use of molecular markers in detecting and monitoring the progression of TBI, with particular emphasis on microRNAs as a novel class of molecular modulators of injury and its repair in the neural tissue.
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Affiliation(s)
- Dema Najem
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Kerry Rennie
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Maria Ribecco-Lutkiewicz
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Dao Ly
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Julie Haukenfrers
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Qing Liu
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada.,b Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Munyao Nzau
- c Paediatric Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Douglas D Fraser
- d Children's Health Research Institute, London, ON N6C 2V5, Canada.,e Departments of Pediatrics and Clinical Neurological Sciences, Western University, London, ON N6A 3K7, Canada
| | - Mahmud Bani-Yaghoub
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada.,f Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Manning KY, Schranz A, Bartha R, Dekaban GA, Barreira C, Brown A, Fischer L, Asem K, Doherty TJ, Fraser DD, Holmes J, Menon RS. Multiparametric MRI changes persist beyond recovery in concussed adolescent hockey players. Neurology 2017; 89:2157-2166. [PMID: 29070666 PMCID: PMC5696642 DOI: 10.1212/wnl.0000000000004669] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/06/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To determine whether multiparametric MRI data can provide insight into the acute and long-lasting neuronal sequelae after a concussion in adolescent athletes. METHODS Players were recruited from Bantam hockey leagues in which body checking is first introduced (male, age 11-14 years). Clinical measures, diffusion metrics, resting-state network and region-to-region functional connectivity patterns, and magnetic resonance spectroscopy absolute metabolite concentrations were analyzed from an independent, age-matched control group of hockey players (n = 26) and longitudinally in concussed athletes within 24 to 72 hours (n = 17) and 3 months (n = 14) after a diagnosed concussion. RESULTS There were diffusion abnormalities within multiple white matter tracts, functional hyperconnectivity, and decreases in choline 3 months after concussion. Tract-specific spatial statistics revealed a large region along the superior longitudinal fasciculus with the largest decreases in diffusivity measures, which significantly correlated with clinical deficits. This region also spatially intersected with probabilistic tracts connecting cortical regions where we found acute functional connectivity changes. Hyperconnectivity patterns at 3 months after concussion were present only in players with relatively less severe clinical outcomes, higher choline concentrations, and diffusivity indicative of relatively less axonal disruption. CONCLUSIONS Changes persisted well after players' clinical scores had returned to normal and they had been cleared to return to play. Ongoing white matter maturation may make adolescent athletes particularly vulnerable to brain injury, and they may require extended recovery periods. The consequences of early brain injury for ongoing brain development and risk of more serious conditions such as second impact syndrome or neural degenerative processes need to be elucidated.
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Affiliation(s)
- Kathryn Y Manning
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Amy Schranz
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Robert Bartha
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Gregory A Dekaban
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Christy Barreira
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Arthur Brown
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Fischer
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Asem
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Timothy J Doherty
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Douglas D Fraser
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Jeff Holmes
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada
| | - Ravi S Menon
- From the Department of Medical Biophysics (K.Y.M., A.S., R.B., R.S.M.), Department of Microbiology and Immunology (G.A.D., C.B.), Department of Anatomy and Cell Biology (A.B), Department of Physical Medicine and Rehabilitation (T.J.D.), and School of Occupational Therapy (J.H.), University of Western Ontario; Centre for Functional and Metabolic Mapping (K.Y.M., R.B., R.S.M.) and Molecular Medicine (G.A.D., C.B., A.B.), Robarts Research Institute; Primary Care Sport Medicine (L.F., K.A.), Family Medicine, Fowler Kennedy Sport Medicine; and Paediatrics Critical Care Medicine (D.D.F.), London Health Sciences Centre, London, Ontario, Canada.
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Kenzie ES, Parks EL, Bigler ED, Lim MM, Chesnutt JC, Wakeland W. Concussion As a Multi-Scale Complex System: An Interdisciplinary Synthesis of Current Knowledge. Front Neurol 2017; 8:513. [PMID: 29033888 PMCID: PMC5626937 DOI: 10.3389/fneur.2017.00513] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been called "the most complicated disease of the most complex organ of the body" and is an increasingly high-profile public health issue. Many patients report long-term impairments following even "mild" injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual's recovery trajectory. Many of the obstacles faced in research and clinical practice related to TBI and concussion, including observed heterogeneity, arguably stem from the complexity of the condition itself. To improve understanding of this complexity, we review the current state of research through the lens provided by the interdisciplinary field of systems science, which has been increasingly applied to biomedical issues. The review was conducted iteratively, through multiple phases of literature review, expert interviews, and systems diagramming and represents the first phase in an effort to develop systems models of concussion. The primary focus of this work was to examine concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI. Results are presented in the form of a multi-scale conceptual framework intended to synthesize knowledge across disciplines, improve research design, and provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.
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Affiliation(s)
- Erin S. Kenzie
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Elle L. Parks
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Miranda M. Lim
- Sleep Disorders Clinic, Division of Hospital and Specialty Medicine, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Departments of Neurology, Medicine, and Behavioral Neuroscience, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - James C. Chesnutt
- TBI/Concussion Program, Orthopedics & Rehabilitation and Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, OR, United States
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36
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Abstract
Mild traumatic brain injury (mTBI) frequently challenges the integrity of sleep function by affecting multiple brain areas implicated in controlling the switch between wakefulness and sleep and those involved in circadian and homeostatic processes; the malfunction of each causes a variety of disorders. In this review, we discuss recent data on the dynamics between disorders of sleep and mental/psychiatric disorders in persons with mTBI. This analysis sets the stage for understanding how a variety of physiological, emotional and environmental influences affect sleep and mental activities after injury to the brain. Consideration of the intricate links between sleep and mental functions in future research can increase understanding on the underlying mechanisms of sleep-related and psychiatric comorbidity in mTBI.
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37
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van der Naalt J, Timmerman ME, de Koning ME, van der Horn HJ, Scheenen ME, Jacobs B, Hageman G, Yilmaz T, Roks G, Spikman JM. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol 2017; 16:532-540. [DOI: 10.1016/s1474-4422(17)30117-5] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/07/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
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