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Alanazi N, Fitzgerald M, Hume P, Hellewell S, Horncastle A, Anyaegbu C, Papini MG, Hargreaves N, Halicki M, Entwistle I, Hind K, Chazot P. Concussion-Related Biomarker Variations in Retired Rugby Players and Implications for Neurodegenerative Disease Risk: The UK Rugby Health Study. Int J Mol Sci 2024; 25:7811. [PMID: 39063053 PMCID: PMC11276902 DOI: 10.3390/ijms25147811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/02/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
The health and well-being of retired rugby union and league players, particularly regarding the long-term effects of concussions, are of major concern. Concussion has been identified as a major risk factor for neurodegenerative diseases, such as Alzheimer's and Amyotrophic Lateral Sclerosis (ALS), in athletes engaged in contact sports. This study aimed to assess differences in specific biomarkers between UK-based retired rugby players with a history of concussion and a non-contact sports group, focusing on biomarkers associated with Alzheimer's, ALS, and CTE. We randomly selected a sample of male retired rugby or non-contact sport athletes (n = 56). The mean age was 41.84 ± 6.44, and the mean years since retirement from the sport was 7.76 ± 6.69 for participants with a history of substantial concussions (>5 concussions in their career) (n = 30). The mean age was 45.75 ± 11.52, and the mean years since retirement was 6.75 ± 4.64 for the healthy controls (n = 26). Serum biomarkers (t-tau, RBP-4, SAA, Nf-L, and retinol), plasma cytokines, and biomarkers associated with serum-derived exosomes (Aβ42, p-tau181, p-tau217, and p-tau231) were analyzed using validated commercial ELISA assays. The results of the selected biomarkers were compared between the two groups. Biomarkers including t-tau and p-tau181 were significantly elevated in the history of the substantial concussion group compared to the non-contact sports group (t-tau: p < 0.01; p-tau181: p < 0.05). Although between-group differences in p-tau217, p-tau231, SAA, Nf-L, retinol, and Aβ42 were not significantly different, there was a trend for higher levels of Aβ42, p-tau217, and p-tau231 in the concussed group. Interestingly, the serum-derived exosome sizes were significantly larger (p < 0.01), and serum RBP-4 levels were significantly reduced (p < 0.05) in the highly concussed group. These findings indicate that retired athletes with a history of multiple concussions during their careers have altered serum measurements of exosome size, t-tau, p-tau181, and RBP-4. These biomarkers should be explored further for the prediction of future neurodegenerative outcomes, including ALS, in those with a history of concussion.
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Affiliation(s)
- Norah Alanazi
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Patria Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, AUT Millennium, 17 Antares Place, Mairangi Bay, Private Bag 92006, Auckland 1142, New Zealand;
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Technology and Policy Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Sarah Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Alex Horncastle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Chidozie Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Melissa G. Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (M.F.); (S.H.); (M.G.P.)
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA 6009, Australia
| | - Natasha Hargreaves
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Michal Halicki
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
| | - Ian Entwistle
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Karen Hind
- Wolfson Research Institute for Health and Wellbeing, Durham University, Durham TS17 6BH, UK
| | - Paul Chazot
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK; (N.A.); (A.H.); (N.H.); (M.H.); (I.E.)
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Halicki MJ, Hind K, Chazot PL. Blood-Based Biomarkers in the Diagnosis of Chronic Traumatic Encephalopathy: Research to Date and Future Directions. Int J Mol Sci 2023; 24:12556. [PMID: 37628736 PMCID: PMC10454393 DOI: 10.3390/ijms241612556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease consistently associated with repetitive traumatic brain injuries (TBIs), which makes multiple professions, such as contact sports athletes and the military, especially susceptible to its onset. There are currently no approved biomarkers to diagnose CTE, thus it can only be confirmed through a post-mortem brain autopsy. Several imaging and cerebrospinal fluid biomarkers have shown promise in the diagnosis. However, blood-based biomarkers can be more easily obtained and quantified, increasing their clinical feasibility and potential for prophylactic use. This article aimed to comprehensively review the studies into potential blood-based biomarkers of CTE, discussing common themes and limitations, as well as suggesting future research directions. While the interest in blood-based biomarkers of CTE has recently increased, the research is still in its early stages. The main issue for many proposed biomarkers is their lack of selectivity for CTE. However, several molecules, such as different phosphorylated tau isoforms, were able to discern CTE from different neurodegenerative diseases. Further, the results from studies on exosomal biomarkers suggest that exosomes are a promising source of biomarkers, reflective of the internal environment of the brain. Nonetheless, more longitudinal studies combining imaging, neurobehavioral, and biochemical approaches are warranted to establish robust biomarkers for CTE.
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Affiliation(s)
| | - Karen Hind
- Durham Wolfson Research Institute for Health and Wellbeing, Stockton-on-Tees TS17 6BH, UK;
| | - Paul L. Chazot
- Department of Biosciences, Wolfson Research Institute for Health and Wellbeing, Durham University, Durham DH1 3LE, UK
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Wang KK, Munoz Pareja JC, Mondello S, Diaz-Arrastia R, Wellington C, Kenney K, Puccio AM, Hutchison J, McKinnon N, Okonkwo DO, Yang Z, Kobeissy F, Tyndall JA, Büki A, Czeiter E, Pareja Zabala MC, Gandham N, Berman R. Blood-based traumatic brain injury biomarkers - Clinical utilities and regulatory pathways in the United States, Europe and Canada. Expert Rev Mol Diagn 2021; 21:1303-1321. [PMID: 34783274 DOI: 10.1080/14737159.2021.2005583] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major global health issue, resulting in debilitating consequences to families, communities, and health-care systems. Prior research has found that biomarkers aid in the pathophysiological characterization and diagnosis of TBI. Significantly, the FDA has recently cleared both a bench-top assay and a rapid point-of-care assays of tandem biomarker (UCH-L1/GFAP)-based blood test to aid in the diagnosis mTBI patients. With the global necessity of TBI biomarkers research, several major consortium multicenter observational studies with biosample collection and biomarker analysis have been created in the USA, Europe, and Canada. As each geographical region regulates its data and findings, the International Initiative for Traumatic Brain Injury Research (InTBIR) was formed to facilitate data integration and dissemination across these consortia. AREAS COVERED This paper covers heavily investigated TBI biomarkers and emerging non-protein markers. Finally, we analyze the regulatory pathways for converting promising TBI biomarkers into approved in-vitro diagnostic tests in the United States, European Union, and Canada. EXPERT OPINION TBI biomarker research has significantly advanced in the last decade. The recent approval of an iSTAT point of care test to detect mild TBI has paved the way for future biomarker clearance and appropriate clinical use across the globe.
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Affiliation(s)
- Kevin K Wang
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Jennifer C Munoz Pareja
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cheryl Wellington
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Canada
| | - Kimbra Kenney
- Department of Neurology, Uniformed Service University, Bethesda, Maryland, USA
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jamie Hutchison
- The Hospital for Sick Children, Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole McKinnon
- The Hospital for Sick Children, Department of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - Firas Kobeissy
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Brain Rehabilitation Research Center (BRRC), Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida, USA
| | - J Adrian Tyndall
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Endre Czeiter
- Department of Neurosurgery, Pecs University, Pecs, Hungary
| | | | - Nithya Gandham
- Program for Neurotrauma, Neuroprotoemics & Biomarker Research, Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rebecca Berman
- National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD, USA
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Elevated Tau in Military Personnel Relates to Chronic Symptoms Following Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:66-73. [PMID: 31033745 DOI: 10.1097/htr.0000000000000485] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To understand the relationships between traumatic brain injury (TBI), blood biomarkers, and symptoms of posttraumatic stress disorder (PTSD), depression, and postconcussive syndrome symptoms. DESIGN Cross-sectional cohort study using multivariate analyses. PARTICIPANTS One hundred nine military personnel and veterans, both with and without a history of TBI. MAIN MEASURES PTSD Checklist-Civilian Version (PCL-C); Neurobehavioral Symptom Inventory (NSI); Ohio State University TBI Identification Method; Patient Health Questionnaire-9 (PHQ-9); Simoa-measured concentrations of tau, amyloid-beta (Aβ) 40, Aβ42, and neurofilament light (NFL). RESULTS Controlling for age, sex, time since last injury (TSLI), and antianxiety/depression medication use, NFL was trending toward being significantly elevated in participants who had sustained 3 or more TBIs compared with those who had sustained 1 or 2 TBIs. Within the TBI group, partial correlations that controlled for age, sex, TSLI, and antianxiety/depression medication use showed that tau concentrations were significantly correlated with greater symptom severity, as measured with the NSI, PCL, and PHQ-9. CONCLUSIONS Elevations in tau are associated with symptom severity after TBI, while NFL levels are elevated in those with a history of repetitive TBIs and in military personnel and veterans. This study shows the utility of measuring biomarkers chronically postinjury. Furthermore, there is a critical need for studies of biomarkers longitudinally following TBI.
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Boutté AM, Thangavelu B, Nemes J, LaValle CR, Egnoto M, Carr W, Kamimori GH. Neurotrauma Biomarker Levels and Adverse Symptoms Among Military and Law Enforcement Personnel Exposed to Occupational Overpressure Without Diagnosed Traumatic Brain Injury. JAMA Netw Open 2021; 4:e216445. [PMID: 33861330 PMCID: PMC8052592 DOI: 10.1001/jamanetworkopen.2021.6445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE There is a scientific and operational need to define objective measures of exposure to low-level overpressure (LLOP) and concussion-like symptoms among persons with specialized occupations. OBJECTIVE To evaluate serum levels of neurotrauma biomarkers and their association with concussion-like symptoms reported by LLOP-exposed military and law enforcement personnel who are outwardly healthy and cleared to perform duties. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study, conducted from January 23, 2017, to October 21, 2019, used serum samples and survey data collected from healthy, male, active-duty military and law enforcement personnel assigned to operational training at 4 US Department of Defense and civilian law enforcement training sites. Personnel aged 18 years or older with prior LLOP exposure but no diagnosed traumatic brain injury or with acute blast exposure during sampling participated in the study. Serum samples from 30 control individuals were obtained from a commercial vendor. MAIN OUTCOMES AND MEASURES Serum levels of glial fibrillary acidic protein, ubiquitin carboxyl hydrolase (UCH)-L1, neurofilament light chain, tau, amyloid β (Aβ)-40, and Aβ-42 from a random sample (30 participants) of the LLOP-exposed cohort were compared with those of 30 age-matched controls. Associations between biomarker levels and self-reported symptoms or operational demographics in the remainder of the study cohort (76 participants) were assessed using generalized linear modeling or Spearman correlations with age as a covariate. RESULTS Among the 30 randomly sampled participants (mean [SD] age, 32 [7.75] years), serum levels of UCH-L1 (mean difference, 4.92; 95% CI, 0.71-9.14), tau (mean difference, 0.16; 95% CI, -0.06 to 0.39), Aβ-40 (mean difference, 138.44; 95% CI, 116.32-160.56), and Aβ-42 (mean difference, 4.97; 95% CI, 4.10-5.83) were elevated compared with those in controls. Among the remaining cohort of 76 participants (mean [SD] age, 34 [7.43] years), ear ringing was reported by 44 (58%) and memory or sleep problems were reported by 24 (32%) and 20 (26%), respectively. A total of 26 participants (34%) reported prior concussion. Amyloid β-42 levels were associated with ear ringing (F1,72 = 7.40; P = .008) and memory problems (F1,72 = 9.20; P = .003). CONCLUSIONS AND RELEVANCE The findings suggest that long-term LLOP exposure acquired during occupational training may be associated with serum levels of neurotrauma biomarkers. Assessment of biomarkers and concussion-like symptoms among personnel considered healthy at the time of sampling may be useful for military occupational medicine risk management.
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Affiliation(s)
- Angela M. Boutté
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Bharani Thangavelu
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jeffrey Nemes
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina R. LaValle
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Mike Egnoto
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Walter Carr
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Gary H. Kamimori
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
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Meabon JS, Cook DG, Yagi M, Terry GE, Cross DJ, Muzi M, Pagulayan KF, Logsdon AF, Schindler AG, Ghai V, Wang K, Fallen S, Zhou Y, Kim TK, Lee I, Banks WA, Carlson ES, Mayer C, Hendrickson RC, Raskind MA, Marshall DA, Perl DP, Keene CD, Peskind ER. Chronic elevation of plasma vascular endothelial growth factor-A (VEGF-A) is associated with a history of blast exposure. J Neurol Sci 2020; 417:117049. [PMID: 32758764 PMCID: PMC7492467 DOI: 10.1016/j.jns.2020.117049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/23/2020] [Accepted: 07/15/2020] [Indexed: 02/02/2023]
Abstract
Mounting evidence points to the significance of neurovascular-related dysfunction in veterans with blast-related mTBI, which is also associated with reduced [18F]-fluorodeoxyglucose (FDG) uptake. The goal of this study was to determine whether plasma VEGF-A is altered in veterans with blast-related mTBI and address whether VEGF-A levels correlate with FDG uptake in the cerebellum, a brain region that is vulnerable to blast-related injury 72 veterans with blast-related mTBI (mTBI) and 24 deployed control (DC) veterans with no lifetime history of TBI were studied. Plasma VEGF-A was significantly elevated in mTBIs compared to DCs. Plasma VEGF-A levels in mTBIs were significantly negatively correlated with FDG uptake in cerebellum. In addition, performance on a Stroop color/word interference task was inversely correlated with plasma VEGF-A levels in blast mTBI veterans. Finally, we observed aberrant perivascular VEGF-A immunoreactivity in postmortem cerebellar tissue and not cortical or hippocampal tissues from blast mTBI veterans. These findings add to the limited number of plasma proteins that are chronically elevated in veterans with a history of blast exposure associated with mTBI. It is likely the elevated VEGF-A levels are from peripheral sources. Nonetheless, increasing plasma VEGF-A concentrations correlated with chronically decreased cerebellar glucose metabolism and poorer performance on tasks involving cognitive inhibition and set shifting. These results strengthen an emerging view that cognitive complaints and functional brain deficits caused by blast exposure are associated with chronic blood-brain barrier injury and prolonged recovery in affected regions.
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Affiliation(s)
- James S Meabon
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - David G Cook
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA; Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - Mayumi Yagi
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Garth E Terry
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Radiology, University of Washington, Seattle, WA, USA
| | - Donna J Cross
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Kathleen F Pagulayan
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Aric F Logsdon
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Abigail G Schindler
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Vikas Ghai
- Institute for Systems Biology, Seattle, WA, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Yong Zhou
- Institute for Systems Biology, Seattle, WA, USA
| | | | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA, USA
| | - William A Banks
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA, USA
| | - Erik S Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Cynthia Mayer
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA
| | - Rebecca C Hendrickson
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Murray A Raskind
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Daniel P Perl
- Department of Pathology, Center for Neuroscience and Regenerative Medicine, School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - C Dirk Keene
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Elaine R Peskind
- Veterans Affairs (VA) Northwest Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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Huguenard CJC, Cseresznye A, Evans JE, Oberlin S, Langlois H, Ferguson S, Darcey T, Nkiliza A, Dretsch M, Mullan M, Crawford F, Abdullah L. Plasma Lipidomic Analyses in Cohorts With mTBI and/or PTSD Reveal Lipids Differentially Associated With Diagnosis and APOE ε4 Carrier Status. Front Physiol 2020; 11:12. [PMID: 32082186 PMCID: PMC7005602 DOI: 10.3389/fphys.2020.00012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/13/2020] [Indexed: 01/05/2023] Open
Abstract
The differential diagnosis between mild Traumatic Brain Injury (mTBI) sequelae and Post-Traumatic Stress Disorder (PTSD) is challenging due to their symptomatic overlap and co-morbidity. As such, there is a need to develop biomarkers which can help with differential diagnosis of these two conditions. Studies from our group and others suggest that blood and brain lipids are chronically altered in both mTBI and PTSD. Therefore, examining blood lipids presents a minimally invasive and cost-effective approach to identify promising biomarkers of these conditions. Using liquid chromatography-mass spectrometry (LC-MS) we examined hundreds of lipid species in the blood of healthy active duty soldiers (n = 52) and soldiers with mTBI (n = 21), PTSD (n = 34) as well as co-morbid mTBI and PTSD (n = 13) to test whether lipid levels were differentially altered with each. We also examined if the apolipoprotein E (APOE) ε4 allele can affect the association between diagnosis and peripheral lipid levels in this cohort. We show that several lipid classes are altered with diagnosis and that there is an interaction between diagnosis and the ε4 carrier status on these lipids. Indeed, total lipid levels as well as both the degree of unsaturation and chain lengths are differentially altered with diagnosis and ε4 status, specifically long chain unsaturated triglycerides (TG) and both saturated and mono-unsaturated diglycerides (DG). Additionally, an examination of lipid species reveals distinct profiles in each diagnostic group stratified by ε4 status, mainly in TG, saturated DG species and polyunsaturated phosphatidylserines. In summary, we show that peripheral lipids are promising biomarker candidates to assist with the differential diagnosis of mTBI and PTSD. Further, ε4 carrier status alone and in interaction with diagnosis has a strong influence on peripheral lipid levels. Therefore, examining ε4 status along with peripheral lipid levels could help with differential diagnosis of mTBI and PTSD.
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Affiliation(s)
- Claire J C Huguenard
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Adam Cseresznye
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - James E Evans
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Sarah Oberlin
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Heather Langlois
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Scott Ferguson
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Teresa Darcey
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Aurore Nkiliza
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Michael Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA, United States.,U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, United States
| | - Michael Mullan
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Fiona Crawford
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Laila Abdullah
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
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8
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A Systematic Review and Meta-analysis on PTSD Following TBI Among Military/Veteran and Civilian Populations. J Head Trauma Rehabil 2020; 35:E21-E35. [DOI: 10.1097/htr.0000000000000514] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Boutté AM, Thangavelu B, LaValle CR, Nemes J, Gilsdorf J, Shear DA, Kamimori GH. Brain-related proteins as serum biomarkers of acute, subconcussive blast overpressure exposure: A cohort study of military personnel. PLoS One 2019; 14:e0221036. [PMID: 31408492 PMCID: PMC6692016 DOI: 10.1371/journal.pone.0221036] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022] Open
Abstract
Repeated exposure to blast overpressure remains a major cause of adverse health for military personnel who, as a consequence, are at a higher risk for neurodegenerative disease and suicide. Acute, early tracking of blast related effects holds the promise of rapid health assessment prior to onset of chronic problems. Current techniques used to determine blast-related effects rely upon reporting of symptomology similar to that of concussion and neurocognitive assessment relevant to operational decrement. Here, we describe the results of a cross sectional study with pared observations. The concentration of multiple TBI-related proteins was tested in serum collected within one hour of blast exposure as a quantitative and minimally invasive strategy to augment assessment of blast-exposure effects that are associated with concussion-like symptomology and reaction time decrements. We determined that median simple reaction time (SRT) was slowed in accordance with serum Nf-L, tau, Aβ-40, and Aβ-42 elevation after overpressure exposure. In contrast, median levels of serum GFAP decreased. Individual, inter-subject analysis revealed positive correlations between changes in Nf-L and GFAP, and in Aβ-40 compared to Aβ-42. The change in Nf-L was negatively associated with tau, Aβ-40, and Aβ-42. Participants reported experiencing headaches, dizziness and taking longer to think. Dizziness was associated with reaction time decrements, GFAP or NfL suppression, as well as Aβ peptide elevation. UCH-L1 elevation had a weak association with mTBI/concussion history. Multiplexed serum biomarker quantitation, coupled with reaction time assessment and symptomology determined before and after blast exposure, may serve as a platform for tracking adverse effects in the absence of a head wound or diagnosed concussion. We propose further evaluation of serum biomarkers, which are often associated with TBI, in the context of acute operational blast exposures.
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Affiliation(s)
- Angela M. Boutté
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Bharani Thangavelu
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Christina R. LaValle
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Jeffrey Nemes
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Janice Gilsdorf
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Deborah A. Shear
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Gary H. Kamimori
- Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
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Gill J, Mustapic M, Diaz-Arrastia R, Lange R, Gulyani S, Diehl T, Motamedi V, Osier N, Stern RA, Kapogiannis D. Higher exosomal tau, amyloid-beta 42 and IL-10 are associated with mild TBIs and chronic symptoms in military personnel. Brain Inj 2018; 32:1277-1284. [PMID: 29913077 DOI: 10.1080/02699052.2018.1471738] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Identify biomarkers in peripheral blood that relate to chronic post-concussive and behavioural symptoms following traumatic brain injuries (TBIs) to ultimately improve clinical management. RESEARCH DESIGN We compared military personnel with mild TBIs (mTBIs) (n = 42) to those without TBIs (n = 22) in concentrations of tau, amyloid-beta (Aβ42) and cytokines (tumour necrosis factor alpha (TNFα, interleukin (IL)-6 and -10) in neuronal-derived exosomes from the peripheral blood. We utilized nanosight technology coupled with ultra-sensitivity immunoassay methods. We also examined the impact of post-concussive and behavioural symptoms including depression and post-traumatic stress disorder (PTSD) on these neuronal-derived markers. RESULTS We report that concentrations of exosomal tau (F1, 62 = 10.50), Aβ42 (F1, 61 = 5.32) and IL-10 (F1, 59 = 4.32) were elevated in the mTBI group compared to the controls. Within the mTBI group, regression models show that post-concussive symptoms were most related to exosomal tau elevations, whereas exosomal IL-10 levels were related to PTSD symptoms. CONCLUSIONS These findings suggest that chronic post-concussive symptoms following an mTBI relate to altered exosomal activity, and that greater tau pathology may underlie chronic post-concussive symptoms that develop following mTBIs. It also suggests that central inflammatory activity contributes to PTSD symptoms following an mTBI, providing necessary insights into the role of inflammation in chronic PTSD symptoms.
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Affiliation(s)
- Jessica Gill
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Maja Mustapic
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Ramon Diaz-Arrastia
- c Department of Neurology, School of Medicine , University of Pennsylvania , Philadelphia , PA , United States
| | - Rael Lange
- d Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , United States
| | - Seema Gulyani
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Tom Diehl
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Vida Motamedi
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Nicole Osier
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Robert A Stern
- e Neurosurgery, and Anatomy & Neurobiology , Boston University, Boston University Alzheimer's Disease and CTE Center , Boston , MA , United States
| | - Dimitrios Kapogiannis
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
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11
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Bagnato S, Andriolo M, Boccagni C, Sant'Angelo A, D'Ippolito ME, Galardi G. Dissociation of cerebrospinal fluid amyloid-β and tau levels in patients with prolonged posttraumatic disorders of consciousness. Brain Inj 2018; 32:1056-1060. [PMID: 29792528 DOI: 10.1080/02699052.2018.1479042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major risk factor for Alzheimer's disease (AD). Although the mechanisms that lead to AD after a TBI are unclear, we hypothesize that changes in amyloid-β (Aβ) metabolism and abnormal tau phosphorylation are reasonable candidates. OBJECTIVE To investigate Aβ and tau dynamics in the chronic phase of TBI. METHODS We evaluated Aβ1-42, total tau (t-tau), and phosphorylated tau (p-tau) levels in the cerebrospinal fluid (CSF) of 15 patients who developed a prolonged disorder of consciousness after a severe TBI (mean time from TBI 271.6 ± 176.5 days). RESULTS Reduced Aβ1-42 levels (median 258 pg/ml, range 90-833.6) were observed in 14/15 patients (93.3%) with severe post-TBI disorders of consciousness. These CSF analysis data did not correlate with time since TBI or with the patients' level of consciousness as determined by the Coma Recovery Scale Revised. Normal t-tau levels (median 95.2 pg/ml, range 52-256.9) were found in all patients. Normal p-tau levels (median 22.2 pg/ml, range 14-72) were observed in 14/15 patients, with just a single patient having a slightly increased p-tau level. CONCLUSION The present findings show that Aβ and tau are differently affected in the chronic phase of severe TBI.
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Affiliation(s)
- Sergio Bagnato
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Maria Andriolo
- b Clinical Pathology and Microbiology Laboratory , Giuseppe Giglio Foundation , Cefalù , Italy
| | - Cristina Boccagni
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Antonino Sant'Angelo
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Maria Enza D'Ippolito
- b Clinical Pathology and Microbiology Laboratory , Giuseppe Giglio Foundation , Cefalù , Italy
| | - Giuseppe Galardi
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
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12
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Manivannan S, Makwana M, Ahmed AI, Zaben M. Profiling biomarkers of traumatic axonal injury: From mouse to man. Clin Neurol Neurosurg 2018; 171:6-20. [PMID: 29803093 DOI: 10.1016/j.clineuro.2018.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) poses a major public health problem on a global scale. Its burden results from high mortality and significant morbidity in survivors. This stems, in part, from an ongoing inadequacy in diagnostic and prognostic indicators despite significant technological advances. Traumatic axonal injury (TAI) is a key driver of the ongoing pathological process following TBI, causing chronic neurological deficits and disability. The science underpinning biomarkers of TAI has been a subject of many reviews in recent literature. However, in this review we provide a comprehensive account of biomarkers from animal models to clinical studies, bridging the gap between experimental science and clinical medicine. We have discussed pathogenesis, temporal kinetics, relationships to neuro-imaging, and, most importantly, clinical applicability in order to provide a holistic perspective of how this could improve TBI diagnosis and predict clinical outcome in a real-life setting. We conclude that early and reliable identification of axonal injury post-TBI with the help of body fluid biomarkers could enhance current care of TBI patients by (i) increasing speed and accuracy of diagnosis, (ii) providing invaluable prognostic information, (iii) allow efficient allocation of rehabilitation services, and (iv) provide potential therapeutic targets. The optimal model for assessing TAI is likely to involve multiple components, including several blood biomarkers and neuro-imaging modalities, at different time points.
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Affiliation(s)
- Susruta Manivannan
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Milan Makwana
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom
| | - Aminul Islam Ahmed
- Clinical Neurosciences, University of Southampton, Southampton, SO16 6YD, United Kingdom; Wessex Neurological Centre, University Hospitals Southampton, Southampton, SO16 6YD, United Kingdom
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom; Brain Repair & Intracranial Neurotherapeutics (BRAIN) Unit, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom.
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13
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Osier N, Motamedi V, Edwards K, Puccio A, Diaz-Arrastia R, Kenney K, Gill J. Exosomes in Acquired Neurological Disorders: New Insights into Pathophysiology and Treatment. Mol Neurobiol 2018; 55:9280-9293. [PMID: 29663285 DOI: 10.1007/s12035-018-1054-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/29/2018] [Indexed: 01/08/2023]
Abstract
Exosomes are endogenous nanovesicles that play critical roles in intercellular signaling by conveying functional genetic information and proteins between cells. Exosomes readily cross the blood-brain barrier and have promise as therapeutic delivery vehicles that have the potential to specifically deliver molecules to the central nervous system (CNS). This unique feature also makes exosomes attractive as biomarkers in diagnostics, prognostics, and therapeutics in the context of multiple significant public health conditions, including acquired neurological disorders. The purpose of this review is to summarize the state of the science surrounding the relevance of extracellular vesicles (EVs), particularly exosomes, to acquire neurological disorders, specifically traumatic brain injury (TBI), spinal cord injury (SCI), and ischemic stroke. In total, ten research articles were identified that examined exosomes in the context of TBI, SCI, or stroke; these manuscripts were reviewed and synthesized to further understand the current role of exosomes in the context of acquired neurological disorders. Of the ten published studies, four focused exclusively on TBI, one on both TBI and SCI, and five on ischemic stroke; notably, eight of the ten studies were limited to pre-clinical samples. The present review is the first to discuss the current body of knowledge surrounding the role of exosomes in the pathophysiology, diagnosis, and prognosis, as well as promising therapeutic strategies in TBI, SCI, and stroke research.
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Affiliation(s)
- Nicole Osier
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Ct, Bethesda, MD, 20814, USA. .,University of Texas at Austin, Austin, TX, USA.
| | - Vida Motamedi
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Ct, Bethesda, MD, 20814, USA
| | - Katie Edwards
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Ct, Bethesda, MD, 20814, USA.,Healthcare Genetics Doctoral Program, Clemson University School of Nursing, 508 Edwards, Clemson, SC, 29631, USA
| | - Ava Puccio
- Department of Neurological Surgery, University of Pittsburgh, 200 Lothrop Street, Suite B-400, Pittsburgh, PA, 15213, USA
| | - Ramon Diaz-Arrastia
- University of Pennsylvania School of Medicine, Suite 205 Medical Office Building, 51 N 39TH ST, Philadelphia, PA, 19104, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Building 51, Room 2306, 4860 South Palmer Road, Bethesda, MD, 20889-5649, USA
| | - Jessica Gill
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Ct, Bethesda, MD, 20814, USA
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