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Cheng KY, Robinson N, Ploner A, Kuja-Halkola R, Molero Y, Lichtenstein P, Bergen SE. Impact of traumatic brain injury on risk for schizophrenia and bipolar disorder. Psychiatry Res 2024; 339:115990. [PMID: 38896929 DOI: 10.1016/j.psychres.2024.115990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
The impact of traumatic brain injury (TBI) on subsequent risk of schizophrenia (SCZ) or bipolar disorder (BD) remains contested. Possible genetic and environmental confounding effects have also been understudied. Therefore, we aim to investigate the impact of TBI on the risk of SCZ and BD and whether the effect varies by injury severity, age at injury, and sex. We identified 4,184 SCZ and 18,681 BD cases born between 1973 and 1998 in the Swedish National Registers. Case-control samples matched (1:5) on birth year, sex, and birthplace were created along with a family design study, with cases matched to non-case full siblings. TBI was associated with higher risk of SCZ and BD (IRR=1.33 for SCZ, IRR=1.78 for BD). The association remained significant in the sibling comparison study. Moderate or severe TBI was associated with higher risk for both SCZ and BD compared to mild TBI. Older age at injury was associated with higher risk of SCZ and BD, and the effect of TBI was stronger in women than men. Findings indicate that TBI is a risk factor for both SCZ and BD with differential impact by age, severity and sex and that this association cannot be explained by familial confounding alone.
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Affiliation(s)
- Kai-Yuan Cheng
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Natassia Robinson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Yasmina Molero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden; Centre for Psychiatric Research, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-17177 Stockholm, Sweden.
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Basilio AV, Zeng D, Pichay LA, Maas SA, Sundaresh SN, Finan JD, Elkin BS, McKhann GM, Ateshian GA, Morrison B. Region-Dependent Mechanical Properties of Human Brain Tissue Under Large Deformations Using Inverse Finite Element Modeling. Ann Biomed Eng 2024; 52:600-610. [PMID: 37993751 DOI: 10.1007/s10439-023-03407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
This study aims to facilitate intracranial simulation of traumatic events by determining the mechanical properties of different anatomical structures of the brain. Our experimental indentation paradigm used fresh, post-operative human tissue, which is highly advantageous in determining mechanical properties without being affected by postmortem time. This study employed an inverse finite element approach coupled with experimental indentation data to characterize mechanical properties of the human hippocampus (CA1, CA3, dentate gyrus), cortex white matter, and cortex grey matter. We determined that an uncoupled viscoelastic Ogden constitutive formulation was most appropriate to represent the mechanical behavior of these different regions of brain. Anatomical regions were significantly different in their mechanical properties. The cortex white matter was stiffer than cortex grey matter, and the CA1 and dentate gyrus were both stiffer than cortex grey matter. Although no sex dependency was observed, there were trends indicating that male brain regions were generally stiffer than corresponding female regions. In addition, there were no statistically significant age dependent differences. This study provides a structure-specific description of fresh human brain tissue mechanical properties, which will be an important step toward explicitly modeling the heterogeneity of brain tissue deformation during TBI through finite element modeling.
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Affiliation(s)
- Andrew V Basilio
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Delin Zeng
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Leanne A Pichay
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Steve A Maas
- Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, SMBB 3100, Salt Lake City, UT, 84112, USA
| | - Sowmya N Sundaresh
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - John D Finan
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
| | - Benjamin S Elkin
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
- MEA Forensic Engineers & Scientists, 22 Voyager Court South, Toronto, ON, M9W 5M7, Canada
| | - Guy M McKhann
- Department of Neurological Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 710 West 168th St, New York, NY, 10032, USA
| | - Gerard A Ateshian
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA
- Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, New York, NY, 10027, USA
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace MC 8904, 1210 Amsterdam Avenue, New York, NY, 10027, USA.
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Anderson C, Carmichael J, Hicks AJ, Burke R, Ponsford J. Interaction between APOE ɛ4 and Age Is Associated with Emotional Distress One Year after Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2023; 40:326-336. [PMID: 35996348 DOI: 10.1089/neu.2022.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Emotional distress is common following moderate-severe traumatic brain injury (TBI) and is associated with poorer post-injury outcomes. Previously investigated sociodemographic, psychological, and injury-related factors account for only a small proportion of variance in post-TBI emotional distress, highlighting a need to consider other factors such as genetic factors. The apolipoprotein E gene (APOE) has been commonly studied in the TBI literature, with the ɛ4 allele linked to worse neuronal repair and recovery. Few studies have investigated the potential relationship between APOE ɛ4 and emotional distress after moderate-severe TBI, and results have been varied. We examined whether APOE ɛ4 was associated with emotional distress 1 year following moderate-severe TBI, and whether this relationship was moderated by age, sex, and TBI severity (as indexed by the duration of post-traumatic amnesia [PTA]). Moderate-severe TBI survivors provided saliva samples following inpatient admission to a TBI rehabilitation hospital. They completed a self-report measure of emotional distress, the Hospital Anxiety and Depression Scale (HADS), at a follow-up interview ∼1 year post-injury. Complete genetic and follow-up data were available for 441 moderate-severe TBI survivors (mean age = 39.42 years; 75% male). We constructed a linear regression model that included APOE ɛ4 carriage status (carrier vs. non-carrier) and interactions with age, sex, and TBI severity (APOE × age, APOE × sex, APOE × age × sex, and APOE × PTA duration) to predict total score on the HADS, while covarying for the main effects of age, sex, PTA duration, and previous head injury. There was a significant main effect of APOE ɛ4, whereby ɛ4 carriers reported less emotional distress than non-carriers (p = 0.04). However, we also found a significant interaction with age such that APOE ɛ4 carriers reported increasingly greater emotional distress with older age compared with non-carriers (p = 0.01). A sensitivity analysis (n = 306) suggested that the APOE × age interaction, and main effects of age and previous head injury, were not unique to individuals with pre-injury mental health problems (n = 136). However, the main effect of APOE ɛ4 was no longer significant when individuals with pre-injury mental health problems were removed. Our findings highlight the importance of considering moderation of genetic associations, suggesting that APOE ɛ4 may be a risk factor for emotional distress specifically among older survivors of moderate-severe TBI. If these findings can be independently replicated, APOE ɛ4 carriage status, interpreted in the context of age, could be incorporated into risk prediction models of emotional distress after moderate-severe TBI, enhancing targeted early detection and intervention efforts.
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Affiliation(s)
- Chloe Anderson
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Richard Burke
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institutes for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Svingos AM, Robicsek SA, Hayes RL, Wang KK, Robertson CS, Brophy GM, Papa L, Gabrielli A, Hannay HJ, Bauer RM, Heaton SC. Predicting Clinical Outcomes 7-10 Years after Severe Traumatic Brain Injury: Exploring the Prognostic Utility of the IMPACT Lab Model and Cerebrospinal Fluid UCH-L1 and MAP-2. Neurocrit Care 2022; 37:172-183. [PMID: 35229233 DOI: 10.1007/s12028-022-01461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a major contributor to disability and mortality in the industrialized world. Outcomes of severe TBI are profoundly heterogeneous, complicating outcome prognostication. Several prognostic models have been validated for acute prediction of 6-month global outcomes following TBI (e.g., morbidity/mortality). In this preliminary observational prognostic study, we assess the utility of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) Lab model in predicting longer term global and cognitive outcomes (7-10 years post injury) and the extent to which cerebrospinal fluid (CSF) biomarkers enhance outcome prediction. METHODS Very long-term global outcome was assessed in a total of 59 participants (41 of whom did not survive their injuries) using the Glasgow Outcome Scale-Extended and Disability Rating Scale. More detailed outcome information regarding cognitive functioning in daily life was collected from 18 participants surviving to 7-10 years post injury using the Cognitive Subscale of the Functional Independence Measure. A subset (n = 10) of these participants also completed performance-based cognitive testing (Digit Span Test) by telephone. The IMPACT lab model was applied to determine its prognostic value in relation to very long-term outcomes as well as the additive effects of acute CSF ubiquitin C-terminal hydrolase-L1 (UCH-L1) and microtubule associated protein 2 (MAP-2) concentrations. RESULTS The IMPACT lab model discriminated favorable versus unfavorable 7- to 10-year outcome with an area under the receiver operating characteristic curve of 0.80. Higher IMPACT lab model risk scores predicted greater extent of very long-term morbidity (β = 0.488 p = 0.000) as well as reduced cognitive independence (β = - 0.515, p = 0.034). Acute elevations in UCH-L1 levels were also predictive of lesser independence in cognitive activities in daily life at very long-term follow-up (β = 0.286, p = 0.048). Addition of two CSF biomarkers significantly improved prediction of very long-term neuropsychological performance among survivors, with the overall model (including IMPACT lab score, UCH-L1, and MAP-2) explaining 89.6% of variance in cognitive performance 7-10 years post injury (p = 0.008). Higher acute UCH-L1 concentrations were predictive of poorer cognitive performance (β = - 0.496, p = 0.029), whereas higher acute MAP-2 concentrations demonstrated a strong cognitive protective effect (β = 0.679, p = 0.010). CONCLUSIONS Although preliminary, results suggest that existing prognostic models, including models with incorporation of CSF markers, may be applied to predict outcome of severe TBI years after injury. Continued research is needed examining early predictors of longer-term outcomes following TBI to identify potential targets for clinical trials that could impact long-ranging functional and cognitive outcomes.
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Affiliation(s)
- Adrian M Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven A Robicsek
- Departments of Anesthesiology, Neurosurgery, and Neuroscience, University of Florida, Gainesville, FL, USA
| | | | - Kevin K Wang
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
| | | | - Gretchen M Brophy
- Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, VA, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Health Orlando Regional Medical Center, Orlando, FL, USA
| | - Andrea Gabrielli
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Russell M Bauer
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C Heaton
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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5
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Hellstrøm T, Andelic N, Holthe ØØ, Helseth E, Server A, Eiklid K, Sigurdardottir S. APOE-ε4 Is Associated With Reduced Verbal Memory Performance and Higher Emotional, Cognitive, and Everyday Executive Function Symptoms Two Months After Mild Traumatic Brain Injury. Front Neurol 2022; 13:735206. [PMID: 35250800 PMCID: PMC8888909 DOI: 10.3389/fneur.2022.735206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Substantial variance exists in outcomes after mild traumatic brain injury (MTBI), and these differences are not fully explained by injury characteristics or severity. Genetic factors are likely to play a role in this variance. Objectives The aim of this study was to examine associations between the apolipoprotein (APOE)-ε4 allele and memory measures at two months post-MTBI and to evaluate whether subjective cognitive and affective symptoms were associated with APOE-ε4 status. Based on previous research, it was hypothesized that APOE-ε4 carriers would show poorer verbal memory performance compared to APOE-ε4 non-carriers. Methods Neuropsychological data at two months post-injury and blood samples that could be used to assess APOE genotype were available for 134 patients with MTBI (mean age 39.2 years, 62% males, 37% APOE-ε4 carriers). All patients underwent computed tomography at hospital admission and magnetic resonance imaging four weeks post-injury. Results The APOE-ε4 + status was associated with decreased immediate memory recall (p = 0.036; β = −0.10, 95% CI [−0.19, −0.01]). Emotional, cognitive, and everyday executive function symptoms at two months post-injury were significantly higher in APOE-ε4 carriers compared to non-carriers. Conclusion The APOE-ε4+ allele has a negative effect on verbal memory and symptom burden two months after MTBI.
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Affiliation(s)
- Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- *Correspondence: Torgeir Hellstrøm
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Research Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvor Øistensen Holthe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Andres Server
- Section of Neuroradiology, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Eiklid
- Department of Medical Genetic, Oslo University Hospital, Oslo, Norway
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Yang B, Liang X, Wu Z, Sun X, Shi Q, Zhan Y, Dan W, Zheng D, Xia Y, Deng B, Xie Y, Jiang L. APOE gene polymorphism alters cerebral oxygen saturation and quantitative EEG in early-stage traumatic brain injury. Clin Neurophysiol 2022; 136:182-190. [DOI: 10.1016/j.clinph.2022.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 11/03/2022]
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Kristinsson S, Fridriksson J. Genetics in aphasia recovery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:283-296. [PMID: 35078606 DOI: 10.1016/b978-0-12-823384-9.00015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Considerable research efforts have been exerted toward understanding the mechanisms underlying recovery in aphasia. However, predictive models of spontaneous and treatment-induced recovery remain imprecise. Some of the hitherto unexplained variability in recovery may be accounted for with genetic data. A few studies have examined the effects of the BDNF val66met polymorphism on aphasia recovery, yielding mixed results. Advances in the study of stroke genetics and genetics of stroke recovery, including identification of several susceptibility genes through candidate-gene or genome-wide association studies, may have implications for the recovery of language function. The current chapter discusses both the direct and indirect evidence for a genetic basis of aphasia recovery, the implications of recent findings within the field, and potential future directions to advance understanding of the genetics-recovery associations.
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Affiliation(s)
- Sigfus Kristinsson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States.
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Acera A, Gómez-Esteban JC, Murueta-Goyena A, Galdos M, Azkargorta M, Elortza F, Ruzafa N, Ibarrondo O, Pereiro X, Vecino E. Potential Tear Biomarkers for the Diagnosis of Parkinson’s Disease—A Pilot Study. Proteomes 2022; 10:proteomes10010004. [PMID: 35076620 PMCID: PMC8788479 DOI: 10.3390/proteomes10010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease. In this study, the tear proteome profile of patients with idiopathic PD (iPD, n = 24), carriers of the E46K-SNCA mutation (n = 3) and healthy control (CT, n = 27) subjects was analyzed to identify candidate biomarkers for the diagnosis of PD. An observational, prospective and case-control pilot study was carried out, analyzing the participants tear samples by nano-liquid chromatography–mass spectrometry (nLC–MS/MS) and assessing their neurological impairment. The proteomic data obtained are available at ProteomeXchange with identifier 10.6019/PXD028811. These analyses led to the identification of 560 tear proteins, some of which were deregulated in PD patients and that have been implicated in immune responses, inflammation, apoptosis, collagen degradation, protein synthesis, defense, lipid transport and altered lysosomal function. Of these proteins, six were related to neurodegenerative processes and showed a good capacity to classify patients and controls. These findings revealed that certain proteins were upregulated in the tears of PD patients, mainly proteins involved in lysosomal function. Thus, in this study, tear proteins were identified that are implicated in neurodegeneration and that may be related to an aggressive disease phenotype in PD patients.
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Affiliation(s)
- Arantxa Acera
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (A.A.); (N.R.); (X.P.)
- Department of Neuroscience, Biodonostia Health Research Institute, 20014 Donostia-San Sebastian, Spain
| | - Juan Carlos Gómez-Esteban
- Department of Neurology, Cruces University Hospital, 48903 Barakaldo, Spain;
- Neurodegenerative Diseases Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Ane Murueta-Goyena
- Neurodegenerative Diseases Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
- Department of Neurosciences, Faculty of Medicine and Nursery, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Marta Galdos
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
| | - Mikel Azkargorta
- Department of Proteomics, Center for Cooperative Research in Biosciences, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Felix Elortza
- Department of Proteomics, Center for Cooperative Research in Biosciences, 48160 Derio, Spain; (M.A.); (F.E.)
| | - Noelia Ruzafa
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (A.A.); (N.R.); (X.P.)
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
| | | | - Xandra Pereiro
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (A.A.); (N.R.); (X.P.)
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
| | - Elena Vecino
- Experimental Ophthalmo-Biology Group, Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain; (A.A.); (N.R.); (X.P.)
- Begiker-Ophthalmology Research Group, BioCruces Health Research Institute, 48903 Barakaldo, Spain;
- Correspondence: ; Tel.: +34-94-601-2820
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9
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Blaya MO, Raval AP, Bramlett HM. Traumatic brain injury in women across lifespan. Neurobiol Dis 2022; 164:105613. [PMID: 34995753 DOI: 10.1016/j.nbd.2022.105613] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability and a global public health challenge. Every year more than 50 million people suffer a TBI, and it is estimated that 50% of the global population will experience at least one TBI in their lifetime. TBI affects both men and women of all ages, however there is a male bias in TBI research as women have frequently been left out of the literature despite irrefutable evidence of male and female dimorphism in several posttraumatic measures. Women uniquely experience distinct life stages marked by levels of endogenous circulating sex hormones, as well as by physiological changes that are nonexistent in men. In addition to generalized sex-specific differences, a woman's susceptibility, neurological outcomes, and treatment success may vary considerably depending upon when in her lifespan she incurred a traumatic insult. How women impacted by TBI might differ from other women as a factor of age and physiology is not well understood. Furthermore, there is a gap in the knowledge of what happens when TBI occurs in the presence of certain sex-specific and sex-nonspecific variables, such as during pregnancy, with oral contraceptive use, in athletics, in cases of addiction and nicotine consumption, during perimenopause, postmenopause, in frailty, among others. Parsing out how hormone-dependent and hormone-independent lifespan variables may influence physiological, neurodegenerative, and functional outcomes will greatly contribute to future investigative studies and direct therapeutic strategies. The goal of this review is to aggregate the knowledge of prevalence, prognosis, comorbid risk, and response of women incurring TBI at differing phases of lifespan. We strive to illuminate commonalities and disparities among female populations, and to pose important questions to highlight gaps in the field in order to further the endeavor of targeted treatment interventions in a patient-specific manner.
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Affiliation(s)
- Meghan O Blaya
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA; The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ami P Raval
- Peritz Scheinberg Cerebral Vascular Disease Research Laboratory, Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Helen M Bramlett
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA; The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA; Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA.
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10
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Javaid S, Farooq T, Rehman Z, Afzal A, Ashraf W, Rasool MF, Alqahtani F, Alsanea S, Alasmari F, Alanazi MM, Alharbi M, Imran I. Dynamics of Choline-Containing Phospholipids in Traumatic Brain Injury and Associated Comorbidities. Int J Mol Sci 2021; 22:ijms222111313. [PMID: 34768742 PMCID: PMC8583393 DOI: 10.3390/ijms222111313] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/01/2023] Open
Abstract
The incidences of traumatic brain injuries (TBIs) are increasing globally because of expanding population and increased dependencies on motorized vehicles and machines. This has resulted in increased socio-economic burden on the healthcare system, as TBIs are often associated with mental and physical morbidities with lifelong dependencies, and have severely limited therapeutic options. There is an emerging need to identify the molecular mechanisms orchestrating these injuries to life-long neurodegenerative disease and a therapeutic strategy to counter them. This review highlights the dynamics and role of choline-containing phospholipids during TBIs and how they can be used to evaluate the severity of injuries and later targeted to mitigate neuro-degradation, based on clinical and preclinical studies. Choline-based phospholipids are involved in maintaining the structural integrity of the neuronal/glial cell membranes and are simultaneously the essential component of various biochemical pathways, such as cholinergic neuronal transmission in the brain. Choline or its metabolite levels increase during acute and chronic phases of TBI because of excitotoxicity, ischemia and oxidative stress; this can serve as useful biomarker to predict the severity and prognosis of TBIs. Moreover, the effect of choline-replenishing agents as a post-TBI management strategy has been reviewed in clinical and preclinical studies. Overall, this review determines the theranostic potential of choline phospholipids and provides new insights in the management of TBI.
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Affiliation(s)
- Sana Javaid
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
- Department of Pharmacy, The Women University, Multan 60000, Pakistan
| | - Talha Farooq
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Zohabia Rehman
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Ammara Afzal
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Waseem Ashraf
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan;
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
- Correspondence: ; Tel.: +966-114697749
| | - Sary Alsanea
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Mohammed Mufadhe Alanazi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Metab Alharbi
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (S.A.); (F.A.); (M.M.A.); (M.A.)
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (S.J.); (T.F.); (Z.R.); (A.A.); (W.A.); (I.I.)
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11
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Mikolic A, Groeniger JO, Zeldovich M, Wilson L, van Lennep JR, van Klaveren D, Polinder S. Explaining Outcome Differences between Men and Women following Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:3315-3331. [PMID: 34617454 DOI: 10.1089/neu.2021.0116] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Men and women differ in outcomes following mild traumatic brain injury (TBI). In the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we previously found that women had worse 6-month functional outcome (Glasgow Outcome Score Extended [GOSE]), health-related quality of life (HRQoL), and mental health following mild TBI. The aim of this study was to investigate whether those differences were mediated by psychiatric history, gender-related sociodemographic variables, or by care pathways. We analyzed sex/gender differences in 6-month GOSE, generic and TBI-specific HRQoL, and post-concussion and mental health symptoms using three sets of mediators: psychiatric history, sociodemographic variables (living alone, living with children, education and employment status/job category), and care-pathways (referral to study hospital and discharge destination after emergency department); while controlling for a substantial number of potential confounders (pre-injury health and injury-related characteristics). We included 1842 men and 1022 women (16+) with a Glasgow Coma Score 13-15, among whom 83% had GOSE available and about 60% other 6-month outcomes. We used natural effects models to decompose the total effect of sex/gender on the outcomes into indirect effects that passed through the specified mediators and the remaining direct effects. In our study population, women had worse outcomes and these were only partly explained by psychiatric history, and not considerably explained by sociodemographic variables nor by care pathways. Factors other than differences in specified variables seem to underlie observed differences between men and women in outcomes after mild TBI. Future studies should explore more aspects of gender roles and identity and biological factors underpinning sex and gender differences in TBI outcomes.
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Affiliation(s)
- Ana Mikolic
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.,Department of Public Administration and Sociology, Erasmus University, Rotterdam, the Netherlands
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | | | - David van Klaveren
- Department of Public Administration and Sociology, Erasmus University, Rotterdam, the Netherlands.,Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies/Tufts Medical Center, Boston, Massachusetts, USA
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
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12
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Simmons KE, Healey KL, Li Q, Moore SD, Klein RC. Effects of sex and genotype in human APOE-targeted replacement mice on alcohol self-administration measured with the automated IntelliCage system before and after repeated mild traumatic brain injury. Alcohol Clin Exp Res 2021; 45:2231-2245. [PMID: 34585391 DOI: 10.1111/acer.14717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined the association between APOE genotype and alcohol use. Although some of these studies have reported outcomes associated with a history of drinking, none have examined alcohol-seeking behavior. In addition, no preclinical studies have examined alcohol use as a function of APOE genotype with or without traumatic brain injury. METHODS Male and female human APOE3- and APOE4-targeted replacement (TR) mice were used to assess voluntary alcohol seeking longitudinally using a 2-bottle choice paradigm conducted within the automated IntelliCage system prior to and following repeated mild TBI (rmTBI). Following an acquisition phase in which the concentration of ethanol (EtOH) was increased to 12%, a variety of drinking paradigms that included extended alcohol access (EAA1 and EAA2), alcohol deprivation effect (ADE), limited access drinking in the dark (DID), and progressive ratio (PR) were used to assess alcohol-seeking behavior. Additional behavioral tasks were performed to measure cognitive function and anxiety-like behavior. RESULTS All groups readily consumed increasing concentrations of EtOH (4-12%) during the acquisition phase. During the EAA1 period (12% EtOH), there was a significant genotype effect in both males and females for EtOH preference. Following a 3-week abstinence period, mice received sham or rmTBI resulting in a genotype- and sex-independent main effect of rmTBI on the recovery of righting reflex and a main effect of rmTBI on spontaneous home-cage activity in females only. Reintroduction of 12% EtOH (EAA2) resulted in a significant effect genotype for alcohol preference in males with APOE4 mice displaying increased preference and motivation for alcohol compared with APOE3 mice independent of TBI while in females, there was a significant genotype × TBI interaction under the ADE and DID paradigms. Finally, there was a main effect of rmTBI on increased risk-seeking behavior in both sexes, but no effect on spatial learning or cognitive flexibility. CONCLUSION These results suggest that sex and APOE genotype play a significant role in alcohol consumption and may subsequently influence long-term recovery following traumatic brain insults.
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Affiliation(s)
- Kathryn E Simmons
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina, USA
| | - Kati L Healey
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Qiang Li
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott D Moore
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Rebecca C Klein
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA.,Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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13
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Carmichael J, Hicks AJ, Spitz G, Gould KR, Ponsford J. Moderators of gene-outcome associations following traumatic brain injury. Neurosci Biobehav Rev 2021; 130:107-124. [PMID: 34411558 DOI: 10.1016/j.neubiorev.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/04/2021] [Accepted: 08/13/2021] [Indexed: 12/14/2022]
Abstract
The field of genomics is the principal avenue in the ongoing development of precision/personalised medicine for a variety of health conditions. However, relating genes to outcomes is notoriously complex, especially when considering that other variables can change, or moderate, gene-outcome associations. Here, we comprehensively discuss moderation of gene-outcome associations in the context of traumatic brain injury (TBI), a common, chronically debilitating, and costly neurological condition that is under complex polygenic influence. We focus our narrative review on single nucleotide polymorphisms (SNPs) of three of the most studied genes (apolipoprotein E, brain-derived neurotrophic factor, and catechol-O-methyltransferase) and on three demographic variables believed to moderate associations between these SNPs and TBI outcomes (age, biological sex, and ethnicity). We speculate on the mechanisms which may underlie these moderating effects, drawing widely from biomolecular and behavioural research (n = 175 scientific reports) within the TBI population (n = 72) and other neurological, healthy, ageing, and psychiatric populations (n = 103). We conclude with methodological recommendations for improved exploration of moderators in future genetics research in TBI and other populations.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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14
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Johansson B. Mental Fatigue after Mild Traumatic Brain Injury in Relation to Cognitive Tests and Brain Imaging Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115955. [PMID: 34199339 PMCID: PMC8199529 DOI: 10.3390/ijerph18115955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 01/09/2023]
Abstract
Most people recover within months after a mild traumatic brain injury (TBI) or concussion, but some will suffer from long-term fatigue with a reduced quality of life and the inability to maintain their employment status or education. For many people, mental fatigue is one of the most distressing and long-lasting symptoms following an mTBI. No efficient treatment options can be offered. The best method for measuring fatigue today is with fatigue self-assessment scales, there being no objective clinical tests available for mental fatigue. The aim here is to provide a narrative review and identify fatigue in relation to cognitive tests and brain imaging methods. Suggestions for future research are presented.
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Affiliation(s)
- Birgitta Johansson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 413 45 Göteborg, Sweden
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15
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McFadyen CA, Zeiler FA, Newcombe V, Synnot A, Steyerberg E, Gruen RL, Rosand J, Palotie A, Maas AI, Menon DK. Apolipoprotein E4 Polymorphism and Outcomes from Traumatic Brain Injury: A Living Systematic Review and Meta-Analysis. J Neurotrauma 2021; 38:1124-1136. [PMID: 30848161 PMCID: PMC8054520 DOI: 10.1089/neu.2018.6052] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The mortality of traumatic brain injury (TBI) has been largely static despite advances in monitoring and imaging techniques. Substantial variance exists in outcome, not fully accounted for by baseline characteristics or injury severity, and genetic factors likely play a role in this variance. The aims of this systematic review were to examine the evidence for a link between the apolipoprotein E4 (APOE4) polymorphism and TBI outcomes and where possible, to quantify the effect size via meta-analysis. We searched EMBASE, MEDLINE, CINAHL, and gray literature in December 2017. We included studies of APOE genotype in relation to functional adult TBI outcomes. Methodological quality was assessed using the Quality in Prognostic Studies Risk of Bias Assessment Instrument and the prognostic studies adaptation of the Grading of Recommendations Assessment, Development and Evaluation tool. In addition, we contacted investigators and included an additional 160 patients whose data had not been made available for previous analyses, giving a total sample size of 2593 patients. Meta-analysis demonstrated higher odds of a favorable outcome following TBI in those not possessing an ApoE ɛ4 allele compared with ɛ4 carriers and homozygotes (odds ratio 1.39, 95% confidence interval 1.05 to 1.84; p = 0.02). The influence of APOE4 on neuropsychological functioning following TBI remained uncertain, with multiple conflicting studies. We conclude that the ApoE ɛ4 allele confers a small risk of poor outcome following TBI, with analysis by TBI severity not possible based on the currently available published data. Further research into the long-term neuropsychological impact and risk of dementia is warranted.
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Affiliation(s)
| | - Frederick A. Zeiler
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virginia Newcombe
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Anneliese Synnot
- Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, Monash University, Alfred Hospital, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Russel L. Gruen
- NTU Institute for Health Technologies and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jonathan Rosand
- Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aarno Palotie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K. Menon
- Division of Anesthesia, University of Cambridge, Cambridge, United Kingdom
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16
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Esopenko C, Meyer J, Wilde EA, Marshall AD, Tate DF, Lin AP, Koerte IK, Werner KB, Dennis EL, Ware AL, de Souza NL, Menefee DS, Dams-O'Connor K, Stein DJ, Bigler ED, Shenton ME, Chiou KS, Postmus JL, Monahan K, Eagan-Johnson B, van Donkelaar P, Merkley TL, Velez C, Hodges CB, Lindsey HM, Johnson P, Irimia A, Spruiell M, Bennett ER, Bridwell A, Zieman G, Hillary FG. A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group. Brain Imaging Behav 2021; 15:475-503. [PMID: 33405096 PMCID: PMC8785101 DOI: 10.1007/s11682-020-00417-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
- Department of Health Informatics, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, 07107, USA.
| | - Jessica Meyer
- Department of Psychiatry, Summa Health System, Akron, OH, 44304, USA
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Amy D Marshall
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
| | - David F Tate
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Alexander P Lin
- Department of Clinical Spectroscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität, 80336, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kimberly B Werner
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
| | - Emily L Dennis
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Ashley L Ware
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers, The State University of New Jersey, Newark, NJ, 07103, USA
| | | | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, 7501, South Africa
| | - Erin D Bigler
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Martha E Shenton
- College of Nursing, University of Missouri, St. Louis, MO, 63121, USA
- Departments of Psychiatry and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Veterans Affairs, Boston Healthcare System, Boston, MA, 02130, USA
| | - Kathy S Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Judy L Postmus
- School of Social Work, University of Maryland, Baltimore, USA
| | - Kathleen Monahan
- School of Social Welfare, Stony Brook University, Stony Brook, NY, 11794-8231, USA
| | | | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Carmen Velez
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
| | - Cooper B Hodges
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Department of Psychology, Brigham Young University, Provo, UT, 84602, USA
| | - Paula Johnson
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, 84132, USA
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
- Neuroscience Center, Brigham Young University, Provo, UT, 84602, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
- Denney Research Center Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, 90089, USA
| | - Matthew Spruiell
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Esther R Bennett
- Rutgers University School of Social Work, New Brunswick, NJ, 08901, USA
| | - Ashley Bridwell
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Glynnis Zieman
- Barrow Concussion and Brain Injury Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, PA, 16802, USA
- Social Life and Engineering Sciences Imaging Center, University Park, PA, 16802, USA
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17
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Coffman CA, Harrison AT, Kay JJM, Holloway JP, LaFountaine MF, Moore RD. The Influence of Family History of Neurodegenerative Disease on Adolescent Concussion Outcomes. J Clin Med 2021; 10:528. [PMID: 33540525 PMCID: PMC7867167 DOI: 10.3390/jcm10030528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 12/04/2022] Open
Abstract
Evidence suggests that factors associated with a family history of neurodegenerative disease (fhNDD) may influence outcomes following a concussion. However, the relevance of these findings in adolescent populations has not been fully explored. Therefore, the present study sought to evaluate the relationship between fhNDD and neurological outcomes following an adolescent concussion. Data from a local pediatric concussion clinic were used to compare adolescents with (n = 22) and without (n = 44) an fhNDD. Clinical symptom burden, emotional health, cardio-autonomic function, and cognitive performance were assessed at initial (~2 weeks) and follow-up (~5 weeks) post-injury evaluations. Cardio-autonomic function was assessed at rest and during isometric handgrip contraction (IHGC). Results indicated no significant group differences in emotional health or cognitive performance. Across evaluations, those with an fhNDD exhibited greater somatic symptom severity, alterations in HRV at rest, and early blunted cardio-autonomic reactivity during IHGC compared to those without an fhNDD. These findings suggest that positive fhNDD is negatively associated with clinical symptomology and cardio-autonomic functioning following an adolescent concussion. Further, these findings encourage clinicians to utilize a comprehensive neurological evaluation to monitor concussion recovery. Future studies should look into exploring the role of specific neurodegenerative processes and conditions on concussion outcomes in adolescents.
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Affiliation(s)
- Colt A. Coffman
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Adam T. Harrison
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jacob J. M. Kay
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
| | - Jeffrey P. Holloway
- Department of Pediatrics—School of Medicine, University of South Carolina, Columbia, SC 29209, USA;
| | - Michael F. LaFountaine
- Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ 07110, USA;
- Departments of Medical Sciences and Neurology, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Robert Davis Moore
- Concussion Health and Neuroscience Lab, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.T.H.); (J.J.M.K.)
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18
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Cortes D, Pera MF. The genetic basis of inter-individual variation in recovery from traumatic brain injury. NPJ Regen Med 2021; 6:5. [PMID: 33479258 PMCID: PMC7820607 DOI: 10.1038/s41536-020-00114-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death among young people, and is increasingly prevalent in the aging population. Survivors of TBI face a spectrum of outcomes from short-term non-incapacitating injuries to long-lasting serious and deteriorating sequelae. TBI is a highly complex condition to treat; many variables can account for the observed heterogeneity in patient outcome. The limited success of neuroprotection strategies in the clinic has led to a new emphasis on neurorestorative approaches. In TBI, it is well recognized clinically that patients with similar lesions, age, and health status often display differences in recovery of function after injury. Despite this heterogeneity of outcomes in TBI, restorative treatment has remained generic. There is now a new emphasis on developing a personalized medicine approach in TBI, and this will require an improved understanding of how genetics impacts on long-term outcomes. Studies in animal model systems indicate clearly that the genetic background plays a role in determining the extent of recovery following an insult. A candidate gene approach in human studies has led to the identification of factors that can influence recovery. Here we review studies of the genetic basis for individual differences in functional recovery in the CNS in animals and man. The application of in vitro modeling with human cells and organoid cultures, along with whole-organism studies, will help to identify genes and networks that account for individual variation in recovery from brain injury, and will point the way towards the development of new therapeutic approaches.
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19
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Harrison AT, McAllister T, McCrea M, Broglio SP, Moore RD. Recovery Profiles after Concussion among Male Student-Athletes and Service Cadets with a Family History of Neurodegenerative Disease: Data from the NCAA-DoD CARE Consortium. J Neurotrauma 2020; 38:485-492. [PMID: 33280495 DOI: 10.1089/neu.2020.7386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Preliminary evidence indicates that genetic factors associated with having a family history of neurodegenerative disease (fhNDD) may predispose an individual to persistent symptoms and poorer cognitive performance after concussion. No previous study, however, longitudinally examined athletes with (+) and without (-) a fhNDD. Therefore, we aimed to compare clinical symptoms and cognitive performance of fhNDD+ and fhNDD- athletes at baseline and at multiple time points after concussion. Questionnaire data from the Concussion Assessment, Research and Education (CARE) Consortium were used to identify male athletes and cadets with (n = 51) and without (n = 102) a fhNDD (Alzheimer disease, Parkinson disease, mild cognitive impairment, and non-Alzheimer dementia). All athletes completed the SCAT3 symptom checklist and ImPACT test before their sport season and again within 24-48 h of injury, at the unrestricted return-to-play, and at six months post-concussion. Compared with fhNDD-, fhNDD+ individuals demonstrated greater decrements in visual memory (relative to baseline) 24-48 h post-injury (p < 0.05, d = 0.18). In addition, a main effect of group was observed for impulse control. Compared with fhNDD- athletes, fhNDD+ individuals demonstrated greater decrements in impulse control, 24-48 h post-injury, at the return to play, and at six-month assessments (p < 0.01, d = 0.23). These findings suggest that male athletes with a fhNDD may exhibit greater decrements in cognitive performance after concussion. Small, subtle deficits in cognitive performance may still significantly hinder day-to-day function in student-athletes.
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Affiliation(s)
- Adam T Harrison
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Thomas McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert D Moore
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
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20
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Johnson LW, Lundgren K, Henrich V, Phillips S. Factors influencing recovery from mild traumatic brain injury. Brain Inj 2020; 34:1202-1212. [PMID: 32705914 DOI: 10.1080/02699052.2020.1795719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE This study determined whether initial GCS score, head CT results, cognitive performance on IMPACT testing, or APOE genotype most effectively predicted 1-month functional outcome after mild traumatic brain injury (mTBI). This study tested the hypotheses that participants with poor performance on initial cognitive testing and those with an APOEe4 genotype would exhibit a poorer 1-month recovery after mTBI. RESEARCH DESIGN Regression analysis determined which independent variables were most effective in predicting 1-month GOS-E or DRS score. Independent t-test procedures determined whether cognitive recovery varied across APOEe4 carriers. METHODS AND PROCEDURES 49 participants admitted to the hospital with mTBI received cognitive evaluation within 48 hours after injury and again one month later. DNA analysis provided participant APOE genotype. MAIN OUTCOMES AND RESULTS Results showed that no study variables significantly predicted GOS-E or DRS scores, however, differences were identified when APOE groups were compared. Participants who were noncarriers of APOEe4 had significantly slower reaction times compared to APOEe4 carriers. Participants who were homozygous APOEe4 carriers had significantly lower instances of impulsivity than noncarriers. CONCLUSIONS Further research is needed to understand how APOE allele status and performance on initial cognitive testing may influence short-term recovery after mTBI.
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Affiliation(s)
- Leslie Weaver Johnson
- Communications Disorders Program, North Carolina Central University , Durham, North Carolina, USA
| | - Kristine Lundgren
- Department of Communication and Sciences Disorders, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
| | - Vincent Henrich
- Department of Biology, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
| | - Susan Phillips
- Department of Communication and Sciences Disorders, University of North Carolina - Greensboro , Greensboro, North Carolina, USA
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21
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Shchepareva ME, Zakharova MN. Functional Role of Aquaporins in the Nervous System under Normal and Pathological Conditions. NEUROCHEM J+ 2020. [DOI: 10.1134/s1819712420010171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Bathini P, Brai E, Auber LA. Olfactory dysfunction in the pathophysiological continuum of dementia. Ageing Res Rev 2019; 55:100956. [PMID: 31479764 DOI: 10.1016/j.arr.2019.100956] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/29/2019] [Accepted: 08/26/2019] [Indexed: 12/21/2022]
Abstract
Sensory capacities like smell, taste, hearing, vision decline with aging, but increasing evidence show that sensory dysfunctions are one of the early signs diagnosing the conversion from physiological to pathological brain state. Smell loss represents the best characterized sense in clinical practice and is considered as one of the first preclinical signs of Alzheimer's and Parkinson's disease, occurring a decade or more before the onset of cognitive and motor symptoms. Despite the numerous scientific reports and the adoption in clinical practice, the etiology of sensory damage as prodromal of dementia remains largely unexplored and more studies are needed to resolve the mechanisms underlying sensory network dysfunction. Although both cognitive and sensory domains are progressively affected, loss of sensory experience in early stages plays a major role in reducing the autonomy of demented people in their daily tasks or even possibly contributing to their cognitive decline. Interestingly, the chemosensory circuitry is devoid of a blood brain barrier, representing a vulnerable port of entry for neurotoxic species that can spread to the brain. Furthermore, the exposure of the olfactory system to the external environment make it more susceptible to mechanical injury and trauma, which can cause degenerative neuroinflammation. In this review, we will summarize several findings about chemosensory impairment signing the conversion from healthy to pathological brain aging and we will try to connect those observations to the promising research linking environmental influences to sporadic dementia. The scientific body of knowledge will support the use of chemosensory diagnostics in the presymptomatic stages of AD and other biomarkers with the scope of finding treatment strategies before the onset of the disease.
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Affiliation(s)
- Praveen Bathini
- Department of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Emanuele Brai
- VIB-KU Leuven Center for Brain & Disease Research, Laboratory for the Research of Neurodegenerative Diseases, Leuven, Belgium
| | - Lavinia Alberi Auber
- Department of Medicine, University of Fribourg, Fribourg, Switzerland; Swiss Integrative Center of Human Health, Fribourg, Switzerland.
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23
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Bryden DW, Tilghman JI, Hinds SR. Blast-Related Traumatic Brain Injury: Current Concepts and Research Considerations. J Exp Neurosci 2019; 13:1179069519872213. [PMID: 31548796 PMCID: PMC6743194 DOI: 10.1177/1179069519872213] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Traumatic brain injury (TBI) is a well-known consequence of participation in activities such as military combat or collision sports. But the wide variability in eliciting circumstances and injury severities makes the study of TBI as a uniform disease state impossible. Military Service members are under additional, unique threats such as exposure to explosive blast and its unique effects on the body. This review is aimed toward TBI researchers, as it covers important concepts and considerations for studying blast-induced head trauma. These include the comparability of blast-induced head trauma to other mechanisms of TBI, whether blast overpressure induces measureable biomarkers, and whether a biodosimeter can link blast exposure to health outcomes, using acute radiation exposure as a corollary. This examination is contextualized by the understanding of concussive events and their psychological effects throughout the past century's wars, as well as the variables that predict sustaining a TBI and those that precipitate or exacerbate psychological conditions. Disclaimer: The views expressed in this article are solely the views of the authors and not those of the Department of Defense Blast Injury Research Coordinating Office, US Army Medical Research and Development Command, US Army Futures Command, US Army, or the Department of Defense.
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Affiliation(s)
- Daniel W Bryden
- Booz Allen Hamilton, contract support to
DoD Blast Injury Research Coordinating Office, US Army Medical Research and
Development Command, Fort Detrick, MD, USA
| | - Jessica I Tilghman
- Booz Allen Hamilton, contract support to
DoD Blast Injury Research Coordinating Office, US Army Medical Research and
Development Command, Fort Detrick, MD, USA
| | - Sidney R Hinds
- DoD Blast Injury Research Coordinating
Office, US Army Medical Research and Development Command, Fort Detrick, MD,
USA
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Gupte R, Brooks W, Vukas R, Pierce J, Harris J. Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know. J Neurotrauma 2019; 36:3063-3091. [PMID: 30794028 PMCID: PMC6818488 DOI: 10.1089/neu.2018.6171] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing recognition of the problem of male bias in neuroscience research, including in the field of traumatic brain injury (TBI) where fewer women than men are recruited to clinical trials and male rodents have predominantly been used as an experimental injury model. Despite TBI being a leading cause of mortality and disability worldwide, sex differences in pathophysiology and recovery are poorly understood, limiting clinical care and successful drug development. Given growing interest in sex as a biological variable affecting injury outcomes and treatment efficacy, there is a clear need to summarize sex differences in TBI. This scoping review presents an overview of current knowledge of sex differences in TBI and a comparison of human and animal studies. We found that overall, human studies report worse outcomes in women than men, whereas animal studies report better outcomes in females than males. However, closer examination shows that multiple factors including injury severity, sample size, and experimental injury model may differentially interact with sex to affect TBI outcomes. Additionally, we explore how sex differences in mitochondrial structure and function might contribute to possible sex differences in TBI outcomes. We propose recommendations for future investigations of sex differences in TBI, which we hope will lead to improved patient management, prognosis, and translation of therapies from bench to bedside.
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Affiliation(s)
- Raeesa Gupte
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - William Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Clinical and Translational Sciences Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel Vukas
- School of Medicine, Dykes Library of Health Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Janet Pierce
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Janna Harris
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Janna Harris, PhD, Hoglund Brain Imaging Center, MS 1052, 3901 Rainbow Boulevard, Kansas City, KS 66160
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25
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Booker J, Sinha S, Choudhari K, Dawson J, Singh R. Description of the predictors of persistent post-concussion symptoms and disability after mild traumatic brain injury: the SHEFBIT cohort. Br J Neurosurg 2019; 33:367-375. [DOI: 10.1080/02688697.2019.1598542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- James Booker
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Kishor Choudhari
- Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jeremy Dawson
- Institute of Work Psychology, University of Sheffield Management School, Sheffield, UK
| | - Rajiv Singh
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
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26
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Apolipoprotein E deletion has no effect on copper-induced oxidative stress in the mice brain. Biosci Rep 2018; 38:BSR20180719. [PMID: 30126847 PMCID: PMC6127668 DOI: 10.1042/bsr20180719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/23/2022] Open
Abstract
The current study was designed to investigate effect of copper administration on oxidative damage to the brain in ApoE−/− mice and to explore the putative neuroprotective effects rendered by apolipoprotein E (ApoE). Male C57BL/6 ApoE−/− and wild-type mice were randomly assigned into four groups, ApoE−/− mice wild-type mice treated with either copper or saline. Copper sulphate pentahydrate or saline (200 µl) were administered intragastrically daily for 12 weeks. Expression of malondialdehyde, superoxide dismutase (SOD), hemeoxygenase 1 (HO-1), and NAD(P)H: quinone oxidoreductase 1 (NQO1) were determined by a combination of biochemical assays. The concentration of copper in the brain of C57BL/6 mice and ApoE−/− mice treated by copper significantly increased compared with mice treated by saline (P=0.0099 and P=0.0443). Compared with the C57BL/6 mice treated by copper, the level of the ApoE−/− mice treated by copper was higher (P=0.018). TBARS and SOD activities or the expressions of NQO1 and HO-1 in the brain were not significantly different amongst the four experimental groups of mice. The relative value of NQO1/β-actin expression in the brain of the ApoE−/− mice was similar in both saline and copper administration experimental groups. However, Western blot analysis showed that NQO1 expression was significantly higher in the ApoE−/− mice brain treated with saline compared with saline treated wild-type mice (P=0.0449). ApoE does not function in protecting the brain from oxidative damage resulting from copper build-up in Wilson’s disease, but may play a role in regulating copper accumulation in the brain.
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27
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Esopenko C, Simonds AH, Anderson EZ. The synergistic effect of concussions and aging in women? Disparities and perspectives on moving forward. Concussion 2018; 3:CNC55. [PMID: 30364380 PMCID: PMC6195093 DOI: 10.2217/cnc-2018-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Adrienne H Simonds
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
| | - Ellen Z Anderson
- Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA.,Department of Health Informatics, School of Health Professions, Rutgers, The State University of New Jersey, New Brunswick, NJ, 08901, USA
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28
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Newcombe EA, Camats-Perna J, Silva ML, Valmas N, Huat TJ, Medeiros R. Inflammation: the link between comorbidities, genetics, and Alzheimer's disease. J Neuroinflammation 2018; 15:276. [PMID: 30249283 PMCID: PMC6154824 DOI: 10.1186/s12974-018-1313-3] [Citation(s) in RCA: 321] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/11/2018] [Indexed: 12/21/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurodegenerative disorder, most cases of which lack a clear causative event. This has made the disease difficult to characterize and, thus, diagnose. Although some cases are genetically linked, there are many diseases and lifestyle factors that can lead to an increased risk of developing AD, including traumatic brain injury, diabetes, hypertension, obesity, and other metabolic syndromes, in addition to aging. Identifying common factors and trends between these conditions could enhance our understanding of AD and lead to the development of more effective treatments. Although the immune system is one of the body’s key defense mechanisms, chronic inflammation has been increasingly linked with several age-related diseases. Moreover, it is now well accepted that chronic inflammation has an important role in the onset and progression of AD. In this review, the different inflammatory signals associated with AD and its risk factors will be outlined to demonstrate how chronic inflammation may be influencing individual susceptibility to AD. Our goal is to bring attention to potential shared signals presented by the immune system during different conditions that could lead to the development of successful treatments.
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Affiliation(s)
- Estella A Newcombe
- Neurula Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Building 79, Brisbane, 4072, QLD, Australia.
| | - Judith Camats-Perna
- Neurula Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Building 79, Brisbane, 4072, QLD, Australia
| | - Mallone L Silva
- Neurula Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Building 79, Brisbane, 4072, QLD, Australia
| | - Nicholas Valmas
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, QLD, Australia
| | - Tee Jong Huat
- Neurula Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Building 79, Brisbane, 4072, QLD, Australia.,Centre for Stem Cell Ageing and Regenerative Engineering, The University of Queensland, Brisbane, 4072, QLD, Australia
| | - Rodrigo Medeiros
- Neurula Laboratory, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, The University of Queensland, Building 79, Brisbane, 4072, QLD, Australia.
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29
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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
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30
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Emamzadeh FN. Role of Apolipoproteins and α-Synuclein in Parkinson's Disease. J Mol Neurosci 2017; 62:344-355. [PMID: 28695482 PMCID: PMC5541107 DOI: 10.1007/s12031-017-0942-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022]
Abstract
Parkinson's disease (PD) is a progressive brain disorder that interferes with activities of normal life. The main pathological feature of this disease is the loss of more than 80% of dopamine-producing neurons in the substantia nigra (SN). Dopaminergic neuronal cell death occurs when intraneuronal, insoluble, aggregated proteins start to form Lewy bodies (LBs), the most important component of which is a protein called α-synuclein (α-syn). α-Syn structurally contains hexameric repeats of 11 amino acids, which are characteristic of apolipoproteins and thus α-syn can also be considered an apolipoprotein. Moreover, apolipoproteins seem to be involved in the incidence and development of PD. Some apolipoproteins such as ApoD have a neuroprotective role in the brain. In PD, apoD levels increase in glial cells surrounding dopaminergic cells. However, elevated levels of some other apolipoproteins such as ApaA1 and ApoE are reported as a vulnerability factor of PD. At present, when a clinical diagnosis of PD is made, based on symptoms such as shaking, stiff muscles and slow movement, serious damage has already been done to nerve cells of the SN. The diagnosis of PD in its earlier stages, before this irreversible damage, would be of enormous benefit for future treatment strategies designed to slow or halt the progression of PD. This review presents the roles of apolipoproteins and α-syn in PD and how some of them could potentially be used as biomarkers for PD.
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Affiliation(s)
- Fatemeh Nouri Emamzadeh
- Division of Biomedical and Life Sciences, Faculty of Health and Medicine, University of Lancaster, Lancaster, LA1 4AY, UK.
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Esopenko C, Chow TW, Tartaglia MC, Bacopulos A, Kumar P, Binns MA, Kennedy JL, Müller DJ, Levine B. Cognitive and psychosocial function in retired professional hockey players. J Neurol Neurosurg Psychiatry 2017; 88:512-519. [PMID: 28396361 DOI: 10.1136/jnnp-2016-315260] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE The relationship between repeated concussions and neurodegenerative disease has received significant attention, particularly research in postmortem samples. Our objective was to characterise retired professional ice hockey players' cognitive and psychosocial functioning in relation to concussion exposure and apolipoprotein ε4 status. METHODS Alumni athletes (N=33, aged 34-71 years) and an age-matched sample of comparison participants (N=18) were administered measures of cognitive function and questionnaires concerning psychosocial and psychiatric functioning. RESULTS No significant group differences were found on neuropsychological measures of speeded attention, verbal memory or visuospatial functions, nor were significant differences observed on computerised measures of response speed, inhibitory control and visuospatial problem solving. Reliable group differences in cognitive performance were observed on tests of executive and intellectual function; performance on these measures was associated with concussion exposure. Group differences were observed for cognitive, affective and behavioural impairment on psychosocial questionnaires and psychiatric diagnoses. There was no evidence of differential effects associated with age in the alumni athletes. Possession of an apolipoprotein ε4 allele was associated with increased endorsement of psychiatric complaints, but not with objective cognitive performance. CONCLUSIONS We found only subtle objective cognitive impairment in alumni athletes in the context of high subjective complaints and psychiatric impairment. Apolipoprotein ε4 status related to psychiatric, but not cognitive status. These findings provide benchmarks for the degree of cognitive and behavioural impairment in retired professional athletes and a point of comparison for future neuroimaging and longitudinal studies.
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Affiliation(s)
- Carrie Esopenko
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada.,Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Tiffany W Chow
- University of Southern California, Los Angeles, California, USA
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada.,Division of Neurology, Krembil Neuroscience Centre, Toronto, Canada
| | - Agnes Bacopulos
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
| | - Priya Kumar
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Malcolm A Binns
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brian Levine
- Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada.,University of Toronto, Toronto, Canada
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Kurowski BG, Treble-Barna A, Pitzer AJ, Wade SL, Martin LJ, Chima RS, Jegga A. Applying Systems Biology Methodology To Identify Genetic Factors Possibly Associated with Recovery after Traumatic Brain Injury. J Neurotrauma 2017; 34:2280-2290. [PMID: 28301983 DOI: 10.1089/neu.2016.4856] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality worldwide. It is linked with a number of medical, neurological, cognitive, and behavioral sequelae. The influence of genetic factors on the biology and related recovery after TBI is poorly understood. Studies that seek to elucidate the impact of genetic influences on neurorecovery after TBI will lead to better individualization of prognosis and inform development of novel treatments, which are considerably lacking. Current genetic studies related to TBI have focused on specific candidate genes. The objectives of this study were to use a system biology-based approach to identify biologic processes over-represented with genetic variants previously implicated in clinical outcomes after TBI and identify unique genes potentially related to recovery after TBI. After performing a systematic review to identify genes in the literature associated with clinical outcomes, we used the genes identified to perform a systems biology-based integrative computational analysis to ascertain the interactions between molecular components and to develop models for regulation and function of genes involved in TBI recovery. The analysis identified over-representation of genetic variants primarily in two biologic processes: response to injury (cell proliferation, cell death, inflammatory response, and cellular metabolism) and neurocognitive and behavioral reserve (brain development, cognition, and behavior). Overall, this study demonstrates the use of a systems biology-based approach to identify unique/novel genes or sets of genes important to the recovery process. Findings from this systems biology-based approach provide additional insight into the potential impact of genetic variants on the underlying complex biological processes important to TBI recovery and may inform the development of empirical genetic-related studies for TBI. Future studies that combine systems biology methodology and genomic, proteomic, and epigenetic approaches are needed in TBI.
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Affiliation(s)
- Brad G Kurowski
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Amery Treble-Barna
- 2 Division of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Alexis J Pitzer
- 3 Department of Psychology, Xavier University , Cincinnati, Ohio
| | - Shari L Wade
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Lisa J Martin
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Ranjit S Chima
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Anil Jegga
- 1 Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati, Ohio
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Chen H, Desai A, Kim HY. Repetitive Closed-Head Impact Model of Engineered Rotational Acceleration Induces Long-Term Cognitive Impairments with Persistent Astrogliosis and Microgliosis in Mice. J Neurotrauma 2017; 34:2291-2302. [PMID: 28288551 DOI: 10.1089/neu.2016.4870] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Repeated mild traumatic brain injury (rmTBI) has been identified by epidemiology as a high-risk factor for dementia at a later stage in life. Animal models to replicate complex features of human rmTBI and/or to evaluate long-term effects on brain function have not been established. In this study, we used a novel closed-head impact model of engineered rotational acceleration (CHIMERA) to investigate the long-term neuropathological and cognitive functional consequences of rmTBI. Adult C57BL/6 male mice were subjected to CHIMERA for 3 consecutive days 24 h apart. Functional outcomes were assessed by the beam walk and Morris water maze tests. Neuropathology was evaluated by immunostaining of glial fibrillary acidic protein (GFAP), amyloid precursor protein (APP), and ionizing calcium-binding adaptor molecule-1 (Iba-1), and by quantitative reverse transcription polymerase chain reaction (qRT-PCR) or Western blotting of GFAP, Iba-1, and tumor necrosis factor (TNF)-α. Repeated CHIMERA (rCHIMERA) resulted in motor deficits at 3 days, and in learning and memory impairments that were sustained up to 6 months post injury. GFAP and TNF-α gene expression was increased within a week, whereas astrogliosis and microgliosis were induced starting from day 1 up to 6.5 months after rCHIMERA with upregulated GFAP and Iba-1 protein levels. rCHIMERA also induced APP deposition from day 1 to day 7, but this diminished by 1 month. In conclusion, rCHIMERA produces long-lasting cognitive impairments with astrogliosis and microgliosis in mice, suggesting that rCHIMERA can be a useful animal model to study the long-term complications, as well as the cellular and molecular mechanisms, of human rmTBI.
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Affiliation(s)
- Huazhen Chen
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland.,2 Center for Neuroscience and Regenerative Medicine at the Uniformed Services University of Health Sciences , Bethesda, Maryland
| | - Abhishek Desai
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland
| | - Hee-Yong Kim
- 1 Laboratory of Molecular Signaling, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health , Rockville, Maryland
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Abstract
Traumatic brain injury (TBI) has come to the forefront of both the scientific and popular culture. Specifically, sports-related concussions or mild TBI (mTBI) has become the center of scientific scrutiny with a large amount of research focusing on the long-term sequela of this type of injury. As the populace continues to age, the impact of TBI on the aging brain will become clearer. Currently, reports have come to light that link TBI to neurodegenerative disorders such as Alzheimer's and Parkinson's diseases, as well as certain psychiatric diseases. Whether these associations are causations, however, is yet to be determined. Other long-term sequelae, such as chronic traumatic encephalopathy (CTE), appear to be associated with repetitive injuries. Going forward, as we gain better understanding of the pathophysiological process involved in TBI and subclinical head traumas, and individual traits that influence susceptibility to neurocognitive diseases, a clearer, more comprehensive understanding of the connection between brain injury and resultant disease processes in the aging brain will become evident.
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Does Apolipoprotein e4 Status Moderate the Association of Family Environment with Long-Term Child Functioning following Early Moderate to Severe Traumatic Brain Injury? A Preliminary Study. J Int Neuropsychol Soc 2016; 22:859-64. [PMID: 27480909 PMCID: PMC5476473 DOI: 10.1017/s1355617716000631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine whether apolipoprotein e4 (APOE) status moderates the association of family environment with child functioning following early traumatic brain injury (TBI). METHODS Sixty-five children with moderate to severe TBI and 70 children with orthopedic injury (OI) completed assessments 6, 12, 18 months, and 3.5 and 6.8 years post injury. DNA was extracted from saliva samples and genotyped for APOE e4 status. Linear mixed models examined moderating effects of APOE e4 status on associations between two family environment factors (parenting style, home environment) and three child outcomes (executive functioning, behavioral adjustment, adaptive functioning). RESULTS Children with TBI who were carriers of the e4 allele showed poorer adaptive functioning relative to non-carriers with TBI and children with OI in the context of low authoritarianism. At high levels of authoritarianism, non-carriers with TBI showed the poorest adaptive functioning among groups. There were no main effects or interactions involving APOE and executive functioning or behavioral adjustment. CONCLUSIONS The APOE e4 allele was detrimental for long-term adaptive functioning in the context of positive parenting, whereas in less optimal parenting contexts, being a non-carrier was detrimental. We provide preliminary evidence for an interaction of APOE e4 status and parenting style in predicting long-term outcomes following early TBI. (JINS, 2016, 22, 859-864).
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McMillan T, Wilson L, Ponsford J, Levin H, Teasdale G, Bond M. The Glasgow Outcome Scale - 40 years of application and refinement. Nat Rev Neurol 2016; 12:477-85. [PMID: 27418377 DOI: 10.1038/nrneurol.2016.89] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Glasgow Outcome Scale (GOS) was first published in 1975 by Bryan Jennett and Michael Bond. With over 4,000 citations to the original paper, it is the most highly cited outcome measure in studies of brain injury and the second most-cited paper in clinical neurosurgery. The original GOS and the subsequently developed extended GOS (GOSE) are recommended by several national bodies as the outcome measure for major trauma and for head injury. The enduring appeal of the GOS is linked to its simplicity, short administration time, reliability and validity, stability, flexibility of administration (face-to-face, over the telephone and by post), cost-free availability and ease of access. These benefits apply to other derivatives of the scale, including the Glasgow Outcome at Discharge Scale (GODS) and the GOS paediatric revision. The GOS was devised to provide an overview of outcome and to focus on social recovery. Since the initial development of the GOS, there has been an increasing focus on the multidimensional nature of outcome after head injury. This Review charts the development of the GOS, its refinement and usage over the past 40 years, and considers its current and future roles in developing an understanding of brain injury.
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Affiliation(s)
- Tom McMillan
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
| | - Lindsay Wilson
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Victoria 3800, Australia
| | - Harvey Levin
- Department of Physical Medicine &Rehabilitation, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
| | - Graham Teasdale
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
| | - Michael Bond
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 8RZ, UK
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Juth V, Holman EA, Chan MK, Cramer SC. Genetics as a molecular window into recovery, its treatment, and stress responses after stroke. J Investig Med 2016; 64:983-8. [PMID: 27045100 PMCID: PMC4942179 DOI: 10.1136/jim-2016-000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 01/13/2023]
Abstract
Stroke remains a major source of adult disability in the USA and worldwide. Most patients show some recovery during the weeks to months following a stroke, but this is generally incomplete. An emerging branch of therapeutics targets the processes underlying this behavioral recovery from stroke toward the goal of reducing long-term disability. A key factor hampering these efforts is the very large degree of variability between stroke survivors. Available data suggest that genetic differences could explain an important fraction of the differences between subjects. The current review considers this from several angles, including genetic differences in relation to drugs that promote recovery. Genetic factors related to physiological and psychological stress responses may also be critically important to understanding recovery after stroke and its treatment. The studies reviewed provide insights into recovery and suggest directions for further research to improve clinical decision-making in this setting. Genetic differences between patients might be used to help clinical trials select specific patient subgroups, on a biological basis, in order to sharpen the precision with which new treatments are evaluated. Pharmacogenomic factors might also provide insights into inter-subject differences in treatment side effects for pharmacological prescriptions, and behavioral interventions, and others. These efforts must be conducted with the strictest ethical standards given the highly sensitive nature of genetic data. Understanding the effect of selected genetic measures could improve a clinician's ability to predict the risk and efficacy of a restorative therapy and to make maximally informed decisions, and in so doing, facilitate individual patient care.
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Affiliation(s)
- Vanessa Juth
- Program in Nursing Science, UC Irvine, Irvine, California, USA
| | - E Alison Holman
- Program in Nursing Science, UC Irvine, Irvine, California, USA
| | - Michelle K Chan
- Program in Nursing Science, UC Irvine, Irvine, California, USA
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Kassam I, Gagnon F, Cusimano MD. Association of the APOE-ε4 allele with outcome of traumatic brain injury in children and youth: a meta-analysis and meta-regression. J Neurol Neurosurg Psychiatry 2016; 87:433-40. [PMID: 25904811 DOI: 10.1136/jnnp-2015-310500] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/03/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To disentangle the temporal relationship between the APOE-ε4 allele and outcomes of paediatric traumatic brain injury (TBI). METHODS PubMed, EMBASE, Web of Science, MEDLINE, PsychINFO and HuGE Navigator Genopedia databases were searched from their inception up to January 2015 without language limitations. Included studies were analysed under a dominant genetic model to assess the association between the APOE-ε4 allele and poor outcomes of paediatric TBI at 6 months. Meta-regression was used to assess trends over time. RESULTS Of the 325 initially identified records, 6 studies were selected and analysed based on inclusion/exclusion criteria. A total of 358 cases of paediatric TBI were included. 2 studies assessed outcomes at multiple time points ranging from 3 to 36 months; 4 studies assessed outcomes at a single time point (either 6 or 12 months). At 6 months, there is 2.36 (95% CI 1.26 to 4.42; p=0.007) times higher odds of poor outcome following TBI in children with at least one APOE-ε4 allele, compared with the children without. Further, the adjusted odds suggested an increasing trend of 7% per month (95% CI -9 to 25; p=0.359). CONCLUSIONS This meta-analysis provides cumulative evidence that the APOE-ε4 allele is important to the prognosis of paediatric TBI, but may have a different effect compared with adult TBI; moreover, this effect may be time dependent.
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Affiliation(s)
- Irfahan Kassam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - France Gagnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Cusimano
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Division of Neurosurgery, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Padgett CR, Summers MJ, Vickers JC, McCormack GH, Skilbeck CE. Exploring the effect of the apolipoprotein E (APOE) gene on executive function, working memory, and processing speed during the early recovery period following traumatic brain injury. J Clin Exp Neuropsychol 2016; 38:551-60. [PMID: 26898659 DOI: 10.1080/13803395.2015.1137557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is evidence that the e4 allele of the apolipoprotein E (APOE) gene is detrimental to cognitive function, but results from traumatic brain injury (TBI) populations are mixed. A possible explanation is that APOEe2 carriers have routinely been incorporated into APOEe4 and non-e4 groups, despite APOEe2 being proposed to have an ameliorative effect. Our primary aim was to investigate the influence of APOEe4 on cognitive impairment during early recovery following TBI, excluding the potential confound of APOEe2 possession. A secondary objective was to explore whether APOEe4 displays more pronounced effects in moderate to severe TBI and to consider the potential postinjury protective influence of the APOEe2 allele. METHOD Participants who recently sustained a TBI (posttraumatic amnesia > 5 minutes) were assessed on measures of information processing speed, executive function, and working memory upon remission of posttraumatic amnesia. APOE genotype was determined by buccal saliva DNA extraction (APOEe4 n = 37, APOEe3 n = 92, APOEe2 n = 13). RESULTS Stepwise multiple regressions were performed to compare APOEe4 carriers to APOEe3 homozygotes, with injury severity, age, and estimated premorbid IQ included in the first step. This model was found to significantly predict performance on all tasks, accounting for 17.3-24.3% of the variance. When APOEe4 status was added for the second step, there were no significant changes on any tasks (additional variance <1%). The effect of APOEe4 in moderate to severe TBI and the effect of APOEe2 were explored by analysis of covariance (ANCOVA), with no significant effects revealed. CONCLUSIONS It is unlikely that APOE genotype influences cognitive function in the initial recovery period following TBI, regardless of injury severity. However, a more nuanced and long-term exploration of the effect of APOE genotype in the TBI population is warranted.
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Affiliation(s)
- Christine R Padgett
- a School of Medicine , University of Tasmania , Launceston , TAS , Australia.,b Tasmanian Neurotrauma Register , Royal Hobart Hospital , Hobart , TAS , Australia
| | - Mathew J Summers
- c School of Social Sciences , University of the Sunshine Coast , Maroochydore , QLD , Australia.,d Wicking Dementia Research and Education Centre , University of Tasmania , Hobart , TAS , Australia
| | - James C Vickers
- d Wicking Dementia Research and Education Centre , University of Tasmania , Hobart , TAS , Australia
| | - Graeme H McCormack
- d Wicking Dementia Research and Education Centre , University of Tasmania , Hobart , TAS , Australia
| | - Clive E Skilbeck
- a School of Medicine , University of Tasmania , Launceston , TAS , Australia.,b Tasmanian Neurotrauma Register , Royal Hobart Hospital , Hobart , TAS , Australia
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Bird SM, Sohrabi HR, Sutton TA, Weinborn M, Rainey-Smith SR, Brown B, Patterson L, Taddei K, Gupta V, Carruthers M, Lenzo N, Knuckey N, Bucks RS, Verdile G, Martins RN. Cerebral amyloid-β accumulation and deposition following traumatic brain injury--A narrative review and meta-analysis of animal studies. Neurosci Biobehav Rev 2016; 64:215-28. [PMID: 26899257 DOI: 10.1016/j.neubiorev.2016.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) increases the risk of neurodegenerative disorders many years post-injury. However, molecular mechanisms underlying the relationship between TBI and neurodegenerative diseases, such as Alzheimer's disease (AD), remain to be elucidated. Nevertheless, previous studies have demonstrated a link between TBI and increased amyloid-β (Aβ), a protein involved in AD pathogenesis. Here, we review animal studies that measured Aβ levels following TBI. In addition, from a pool of initially identified 1209 published papers, we examined data from 19 eligible animal model studies using a meta-analytic approach. We found an acute increase in cerebral Aβ levels ranging from 24h to one month following TBI (overall log OR=2.97 ± 0.40, p<0.001). These findings may contribute to further understanding the relationship between TBI and future dementia risk. The methodological inconsistencies of the studies discussed in this review suggest the need for improved and more standardised data collection and study design, in order to properly elucidate the role of TBI in the expression and accumulation of Aβ.
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Affiliation(s)
- Sabine M Bird
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Hamid R Sohrabi
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia; Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Thomas A Sutton
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia
| | - Michael Weinborn
- Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia; School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia
| | - Stephanie R Rainey-Smith
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Belinda Brown
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Leigh Patterson
- Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Kevin Taddei
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Veer Gupta
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Malcolm Carruthers
- Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Centre for Men's Health, 96 Harley Street, London, W1G 7HY, United Kingdom
| | - Nat Lenzo
- Oceanic Medical Imaging, Hollywood Medical Centre, 85 Monash Avenue, Nedlands, 6009 WA, Australia
| | - Neville Knuckey
- Centre for Neuromuscular and Neurological Disorders (CNND), University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia
| | - Romola S Bucks
- School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia
| | - Giuseppe Verdile
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia; Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; School of Biomedical Sciences, CHIRI Biosciences, Curtin University, Kent Street, Bentley, 6102 WA, Australia
| | - Ralph N Martins
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, 35 Stirling Hwy, Crawley, 6009 WA, Australia; Centre of Excellence for Alzheimer's Disease Research & Care, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027 WA, Australia; Sir James McCusker Alzheimer's Disease Research Unit (Hollywood Private Hospital), 115 Monash Avenue, Nedlands, 6009 WA, Australia.
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Scott G, Ramlackhansingh AF, Edison P, Hellyer P, Cole J, Veronese M, Leech R, Greenwood RJ, Turkheimer FE, Gentleman SM, Heckemann RA, Matthews PM, Brooks DJ, Sharp DJ. Amyloid pathology and axonal injury after brain trauma. Neurology 2016; 86:821-8. [PMID: 26843562 PMCID: PMC4793784 DOI: 10.1212/wnl.0000000000002413] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/03/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To image β-amyloid (Aβ) plaque burden in long-term survivors of traumatic brain injury (TBI), test whether traumatic axonal injury and Aβ are correlated, and compare the spatial distribution of Aβ to Alzheimer disease (AD). METHODS Patients 11 months to 17 years after moderate-severe TBI underwent (11)C-Pittsburgh compound B ((11)C-PiB)-PET, structural and diffusion MRI, and neuropsychological examination. Healthy aged controls and patients with AD underwent PET and structural MRI. Binding potential (BPND) images of (11)C-PiB, which index Aβ plaque density, were computed using an automatic reference region extraction procedure. Voxelwise and regional differences in BPND were assessed. In TBI, a measure of white matter integrity, fractional anisotropy, was estimated and correlated with (11)C-PiB BPND. RESULTS Twenty-eight participants (9 with TBI, 9 controls, 10 with AD) were assessed. Increased (11)C-PiB BPND was found in TBI vs controls in the posterior cingulate cortex and cerebellum. Binding in the posterior cingulate cortex increased with decreasing fractional anisotropy of associated white matter tracts and increased with time since injury. Compared to AD, binding after TBI was lower in neocortical regions but increased in the cerebellum. CONCLUSIONS Increased Aβ burden was observed in TBI. The distribution overlaps with, but is distinct from, that of AD. This suggests a mechanistic link between TBI and the development of neuropathologic features of dementia, which may relate to axonal damage produced by the injury.
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Affiliation(s)
- Gregory Scott
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Anil F Ramlackhansingh
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Paul Edison
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Peter Hellyer
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - James Cole
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Mattia Veronese
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Rob Leech
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Richard J Greenwood
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Federico E Turkheimer
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Steve M Gentleman
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Rolf A Heckemann
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - Paul M Matthews
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - David J Brooks
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark
| | - David J Sharp
- From the Division of Brain Sciences (G.S., A.F.R., P.E., P.H., J.C., R.L., S.M.G., R.A.H., P.M.M., D.J.B., D.J.S.), Department of Medicine, Imperial College London; Institute of Psychiatry, Psychology & Neuroscience (P.H., M.V., F.E.T.), King's College London; Institute of Neurology (R.J.G.), University College London, UK; MedTech West at Sahlgrenska University Hospital (R.A.H.), University of Gothenburg, Sweden; and Institute of Clinical Medicine (D.J.B.), Aarhus University, Denmark.
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Kassberg AC, Prellwitz M, Malinowsky C, Larsson-Lund M. Interventions aimed at improving the ability to use everyday technology in work after brain injury. Scand J Occup Ther 2015; 23:147-57. [PMID: 26651230 DOI: 10.3109/11038128.2015.1122835] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI). METHOD A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions. RESULTS The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved. CONCLUSIONS Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.
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Affiliation(s)
- Ann-Charlotte Kassberg
- a Department of Research , Norrbotten County Council , Luleå , Sweden ;,b Department of Health Sciences, Division of Occupational Therapy , Luleå University of Technology , Luleå , Sweden
| | - Maria Prellwitz
- b Department of Health Sciences, Division of Occupational Therapy , Luleå University of Technology , Luleå , Sweden
| | - Camilla Malinowsky
- c Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Maria Larsson-Lund
- b Department of Health Sciences, Division of Occupational Therapy , Luleå University of Technology , Luleå , Sweden
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Gatson JW, Stebbins C, Mathews D, Harris TS, Madden C, Batjer H, Diaz-Arrastia R, Minei JP. Evidence of increased brain amyloid in severe TBI survivors at 1, 12, and 24 months after injury: report of 2 cases. J Neurosurg 2015; 124:1646-53. [PMID: 26613169 DOI: 10.3171/2015.6.jns15639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Traumatic brain injury (TBI) is a major risk factor for Alzheimer's disease. With respect to amyloid deposition, there are no published serial data regarding the deposition rate of amyloid throughout the brain after TBI. The authors conducted serial (18)F-AV-45 (florbetapir F18) positron emission tomography (PET) imaging in 2 patients with severe TBI at 1, 12, and 24 months after injury. A total of 12 brain regions were surveyed for changes in amyloid levels. Case 1 involved a 50-year-old man who experienced a severe TBI. Compared with the 1-month time point, of the 12 brain regions that were surveyed, a decrease in amyloid (as indicated by standard uptake value ratios) was only observed in the hippocampus (-16%, left; -12%, right) and caudate nucleus (-18%, left; -18%, right), suggesting that initial amyloid accumulation in the brain was cleared between time points 1 and 12 months after injury. Compared to the scan at 1 year, a greater increase in amyloid (+15%) was observed in the right hippocampus at the 24-month time point. The patient in Case 2 was a 37-year-old man who suffered severe trauma to the head and a subsequent stroke; he had poor cognitive/functional outcomes and underwent 1.5 years of rehabilitation. Due to a large infarct area on the injured side of the brain (right side), the authors focused primarily on brain regions affected within the left hemisphere. Compared with the 1-month scan, they only found an increase in brain amyloid within the left anterior putamen (+11%) at 12 months after injury. In contrast, decreased amyloid burden was detected in the left caudate nucleus (-48%), occipital cortex (-21%), and precuneus (-19%) brain regions at the 12-month time point, which is indicative of early accumulation and subsequent clearance. In comparison with 12-month values, more clearance was observed, since a reduction in amyloid was found at 24 months after trauma within the left anterior putamen (-12%) and occipital cortex (-15%). Also, by 24 months, most of the amyloid had been cleared and the patient demonstrated improved results on the Rivermead symptom questionnaire, Glasgow Outcome Scale-Extended, and Disability Rating Scale. With respect to APOE status, the patient in Case 1 had two ε3 alleles and the patient in Case 2 had one ε2 and one ε3 allele. In comparison to the findings of the initial scan at 1 month after TBI, by 12 and 24 months after injury amyloid was cleared in some brain regions and increased in others. Serial imaging conducted here suggests that florbetapir F18 PET imaging may be useful in monitoring amyloid dynamics within specific brain regions following severe TBI and may be predictive of cognitive deficits.
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Affiliation(s)
| | | | | | - Thomas S Harris
- Neurology, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | | | | | - Ramon Diaz-Arrastia
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Rockville, Maryland
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Li L, Bao Y, He S, Wang G, Guan Y, Ma D, Wu R, Wang P, Huang X, Tao S, Liu Q, Wang Y, Yang J. The Association Between Apolipoprotein E and Functional Outcome After Traumatic Brain Injury: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e2028. [PMID: 26579811 PMCID: PMC4652820 DOI: 10.1097/md.0000000000002028] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability. Previous studies have investigated the association of apolipoprotein E (APOE) ε4 with functional outcome after TBI and reported inconsistent results.The purpose of this study was to perform a systematic literature search and conduct meta-analyses to examine whether APOE ε4 is associated with poorer functional outcome in patients with TBI.We performed a systematic literature search in PubMed, Cochrane Library, Embase, Google Scholar, and HuGE.The eligibility criteria of this study included the following: Patients had TBI; the studies reported APOE genotype data or provided odds ratios (ORs) and the corresponding 95% confidence intervals (CIs); the functional outcome was assessed using the Glasgow Outcome Scale (GOS) or the Glasgow Outcome Scale Extended (GOSE); and patients were followed for at least 3 months after TBI.In all meta-analyses, we used random-effects models to calculate the odds ratio as a measure of association. We examined the association of APOE ε4 with functional outcome at different time points after TBI.A total of 12 studies met the eligibility criteria and were included in the meta-analyses. We did not find a significant association between APOE ε4 and functional outcome at 6 (P = 0.23), 12 (P = 0.44), and 24 months (P = 0.85) after TBI. However, APOE ε4 was associated with an increased risk of unfavorable long-term (≥6 months) functional outcome after TBI (OR = 1.36, 95% CI: 1.07-1.74, P = 0.01).Limitations of this study include The sample size was limited; the initial severity of TBI varied within and across studies; we could not control for potential confounding factors, such as age at injury and sex; a meta-analysis of the genotype dosage effect was not feasible; and we could not examine the association with specific factors such as neurobehavioral or specific cognitive functions.Our meta-analysis indicates APOE ε4 is associated with the long-term functional outcome of patients with TBI. Future studies that control for confounding factors, with large sample sizes and more homogeneous initial TBI severity levels, are needed to validate the findings from this study.
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Affiliation(s)
- Lizhuo Li
- From the Department of Critical Care and Emergency Medicine, The Affiliated Hospital of Hainan Medical University, Haikou, Hainan (LL); Emergency Department, Shengjing Hospital of China Medical University (LL, SH, GW, QL); Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning (YB, YG, PW, XH, ST, YW); Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai (DM); Department of Occupational and Environmental Health, School of Public Health, Shenyang Medical College, Shenyang, Liaoning, China (RW); Rush Alzheimer's Disease Center (JY); and Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois (JY)
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Turner RC, Lucke-Wold BP, Logsdon AF, Robson MJ, Lee JM, Bailes JE, Dashnaw ML, Huber JD, Petraglia AL, Rosen CL. Modeling Chronic Traumatic Encephalopathy: The Way Forward for Future Discovery. Front Neurol 2015; 6:223. [PMID: 26579067 PMCID: PMC4620695 DOI: 10.3389/fneur.2015.00223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/09/2015] [Indexed: 02/05/2023] Open
Abstract
Despite the extensive media coverage associated with the diagnosis of chronic traumatic encephalopathy (CTE), our fundamental understanding of the disease pathophysiology remains in its infancy. Only recently have scientific laboratories and personnel begun to explore CTE pathophysiology through the use of preclinical models of neurotrauma. Some studies have shown the ability to recapitulate some aspects of CTE in rodent models, through the use of various neuropathological, biochemical, and/or behavioral assays. Many questions related to CTE development, however, remain unanswered. These include the role of impact severity, the time interval between impacts, the age at which impacts occur, and the total number of impacts sustained. Other important variables such as the location of impacts, character of impacts, and effect of environment/lifestyle and genetics also warrant further study. In this work, we attempt to address some of these questions by exploring work previously completed using single- and repetitive-injury paradigms. Despite some models producing some deficits similar to CTE symptoms, it is clear that further studies are required to understand the development of neuropathological and neurobehavioral features consistent with CTE-like features in rodents. Specifically, acute and chronic studies are needed that characterize the development of tau-based pathology.
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Affiliation(s)
- Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Aric F. Logsdon
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Matthew J. Robson
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John M. Lee
- Department of Pathology and Laboratory Medicine, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Julian E. Bailes
- Department of Neurosurgery, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
| | - Matthew L. Dashnaw
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jason D. Huber
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Charles L. Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
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Hong S, Washington PM, Kim A, Yang CP, Yu TS, Kernie SG. Apolipoprotein E Regulates Injury-Induced Activation of Hippocampal Neural Stem and Progenitor Cells. J Neurotrauma 2015; 33:362-74. [PMID: 25905575 DOI: 10.1089/neu.2014.3860] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Partial recovery from even severe traumatic brain injury (TBI) is ubiquitous and occurs largely through unknown mechanisms. Recent evidence suggests that hippocampal neural stem/progenitor cell (NSPC) activation and subsequent neurogenesis are responsible for at least some aspects of spontaneous recovery following TBI. Apolipoprotein E (ApoE) regulates postnatal neurogenesis in the hippocampus and is therefore a putative mediator of injury-induced neurogenesis. Further, ApoE isoforms in humans are associated with different cognitive outcomes following TBI. To investigate the role of ApoE in injury-induced neurogenesis, we exposed wild-type, ApoE-deficient, and human ApoE isoform-specific (ApoE3 and ApoE4) transgenic mice crossed with nestin-green fluorescent protein (GFP) reporter mice to controlled cortical impact (CCI) and assessed progenitor activation at 2 d post-injury using unbiased stereology. GFP+ progenitor cells were increased by approximately 120% in the ipsilateral hippocampus in injured wild-type mice, compared with sham mice (p<0.01). Co-localization of GFP+ cells with bromodeoxyrudine (BrdU) to label dividing cells indicated increased proliferation of progenitors in the injured hippocampus (p<0.001). This proliferative injury response was absent in ApoE-deficient mice, as no increase in GFP+ cells was observed in the injured hippocampus, compared with sham mice, despite an overall increase in proliferation indicated by increased BrdU+ cells (86%; p<0.05). CCI-induced proliferation of GFP+ cells in both ApoE3 and ApoE4 mice but the overall response was attenuated in ApoE4 mice due to fewer GFP+ cells at baseline. We demonstrate that ApoE is required for injury-induced proliferation of NSPCs after experimental TBI, and that this response is influenced by human APOE genotype.
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Affiliation(s)
- Sue Hong
- 1 Departments of Pediatrics and Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, New York
| | - Patricia M Washington
- 1 Departments of Pediatrics and Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, New York
| | - Ahleum Kim
- 1 Departments of Pediatrics and Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, New York
| | - Cui-Ping Yang
- 2 Key Laboratory of Animal Models and Human Disease Mechanisms , Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Tzong-Shiue Yu
- 1 Departments of Pediatrics and Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, New York
| | - Steven G Kernie
- 1 Departments of Pediatrics and Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York, New York
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Lawrence DW, Comper P, Hutchison MG, Sharma B. The role of apolipoprotein E episilon (ɛ)-4 allele on outcome following traumatic brain injury: A systematic review. Brain Inj 2015; 29:1018-31. [DOI: 10.3109/02699052.2015.1005131] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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49
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Expert consensus document: Mind the gaps—advancing research into short-term and long-term neuropsychological outcomes of youth sports-related concussions. Nat Rev Neurol 2015; 11:230-44. [PMID: 25776822 DOI: 10.1038/nrneurol.2015.30] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sports-related concussions and repetitive subconcussive exposure are increasingly recognized as potential dangers to paediatric populations, but much remains unknown about the short-term and long-term consequences of these events, including potential cognitive impairment and risk of later-life dementia. This Expert Consensus Document is the result of a 1-day meeting convened by Safe Kids Worldwide, the Alzheimer's Drug Discovery Foundation, and the Andrews Institute for Orthopaedics and Sports Medicine. The goal is to highlight knowledge gaps and areas of critically needed research in the areas of concussion science, dementia, genetics, diagnostic and prognostic biomarkers, neuroimaging, sports injury surveillance, and information sharing. For each of these areas, we propose clear and achievable paths to improve the understanding, treatment and prevention of youth sports-related concussions.
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50
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Chen Y, Li B, Zhao RR, Zhang HF, Zhen C, Guo L. Increased sensitivity of apolipoprotein E knockout mice to copper-induced oxidative injury to the liver. Biochem Biophys Res Commun 2015; 459:529-33. [PMID: 25749341 DOI: 10.1016/j.bbrc.2015.02.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/25/2015] [Indexed: 01/07/2023]
Abstract
Apolipoprotein E (ApoE) genotypes are related to clinical presentations in patients with Wilson's disease, indicating that ApoE may play an important role in the disease. However, our understanding of the role of ApoE in Wilson's disease is limited. High copper concentration in Wilson's disease induces excessive generation of free oxygen radicals. Meanwhile, ApoE proteins possess antioxidant effects. We therefore determined whether copper-induced oxidative damage differ in the liver of wild-type and ApoE knockout (ApoE(-/-)) mice. Both wild-type and ApoE(-/-) mice were intragastrically administered with 0.2 mL of copper sulfate pentahydrate (200 mg/kg; a total dose of 4 mg/d) or the same volume of saline daily for 12 weeks, respectively. Copper and oxidative stress markers in the liver tissue and in the serum were assessed. Our results showed that, compared with the wild-type mice administered with copper, TBARS as a marker of lipid peroxidation, the expression of oxygenase-1 (HO-1), NAD(P)H dehydrogenase, and quinone 1 (NQO1) significantly increased in the ApoE(-/-) mice administered with copper, meanwhile superoxide dismutase (SOD) activity significantly decreased. Thus, it is concluded that ApoE may protect the liver from copper-induced oxidative damage in Wilson's disease.
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Affiliation(s)
- Yuan Chen
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 057100, PR China; Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei 057100, PR China.
| | - Bin Li
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei 057100, PR China; Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 057100, PR China
| | - Ran-ran Zhao
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei 057100, PR China; Department of Emergency, The First Hospital of Handan, Handan, Hebei 056002, PR China
| | - Hui-feng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 057100, PR China
| | - Chao Zhen
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei 057100, PR China
| | - Li Guo
- Key Laboratory of Neurology of Hebei Province, Shijiazhuang, Hebei 057100, PR China; Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 057100, PR China.
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