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Van Wyck D, Kolls BJ, Wang H, Cantillana V, Maughan M, Laskowitz DT. Prophylactic treatment with CN-105 improves functional outcomes in a murine model of closed head injury. Exp Brain Res 2022; 240:2413-2423. [PMID: 35841411 DOI: 10.1007/s00221-022-06417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
The treatment of traumatic brain injury (TBI) in military populations is hindered by underreporting and underdiagnosis. Clinical symptoms and outcomes may be mitigated with an effective pre-injury prophylaxis. This study evaluates whether CN-105, a 5-amino acid apolipoprotein E (ApoE) mimetic peptide previously shown to modify the post-traumatic neuroinflammatory response, would maintain its neuroprotective effects if administered prior to closed-head injury in a clinically relevant murine model. CN-105 was synthesized by Polypeptide Inc. (San Diego, CA) and administered to C57-BL/6 mice intravenously (IV) and/or by intraperitoneal (IP) injection at various time points prior to injury while vehicle treated animals received IV and/or IP normal saline. Animals were randomized following injury and behavioral observations were conducted by investigators blinded to treatment. Vestibulomotor function was assessed using an automated Rotarod (Ugo Basile, Comerio, Italy), and hippocampal microglial activation was assessed using F4/80 immunohistochemical staining in treated and untreated mice 7 days post-TBI. Separate, in vivo assessments of the pharmacokinetics was performed in healthy CD-1. IV CN-105 administered prior to head injury improved vestibulomotor function compared to vehicle control-treated animals. CN-105 co-administered by IP and IV dosing 6 h prior to injury also improved vestibulomotor function up to 28 days following injury. Microglia counted in CN-105 treated specimens were significantly fewer (P = 0.03) than in vehicle specimens. CN-105 improves functional outcomes and reduces hippocampal microglial activation when administered prior to injury and could be adapted as a pre-injury prophylaxis for soldiers at high risk for TBI.
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Affiliation(s)
- David Van Wyck
- 3Rd Special Forces Group (A), U.S. Army Special Operations Command, 111 Enduring Freedom Drive (Stop A), Fort Bragg, NC, 28310, USA. .,Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA.
| | - Bradley J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Haichen Wang
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Viviana Cantillana
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA
| | | | - Daniel T Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, NC, 27710, USA.,Department of Neurobiology, Duke University School of Medicine, Durham, NC, 27710, USA.,Aegis-CN LLC., 701 W Main Street, Durham, NC, 27701, USA
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2
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Zogas A. "We have no magic bullet": Diagnostic ideals in veterans' mild traumatic brain injury evaluations. PATIENT EDUCATION AND COUNSELING 2022; 105:654-659. [PMID: 34127333 DOI: 10.1016/j.pec.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To understand military veterans' and healthcare providers' experiences identifying veterans' personal histories of combat-related mild traumatic brain injury (mTBI) months or years after the injury. METHODS Patients and clinical staff of a Veterans Health Administration (VA) Polytrauma/TBI clinic participated in a seven-month ethnographic study, which combined direct observation and interviews with veterans (n = 12) and VA clinicians (n = 11). Data were analyzed thematically. RESULTS Veterans and staff have different understandings of the value of neuroimaging in care for patients with post-acute mTBI, and different understandings of the role of diagnostic certainty in clinical care. Veterans sought to understand the relationship between their past head injuries and their current symptoms. Clinicians educated veterans that their symptoms could be caused by multiple factors and embraced ambiguity as part of treating this patient population. CONCLUSIONS Patient-provider communication may be enhanced by conversations about common norms of diagnosis and why evaluating mTBI histories departs from these norms. PRACTICE IMPLICATIONS Clinicians should anticipate that patients may expect a diagnostic process that entails neuroimaging and resolves their uncertainty. In the case of post-acute mTBI, patients would likely benefit from education about the diagnostic process, itself.
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Affiliation(s)
- Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
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3
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Eagle SR, Collins MW, Dretsch MN, Uomoto JM, Connaboy C, Flanagan SD, Kontos AP. Network Analysis of Research on Mild Traumatic Brain Injury in US Military Service Members and Veterans During the Past Decade (2010-2019). J Head Trauma Rehabil 2021; 36:E345-E354. [PMID: 33741827 DOI: 10.1097/htr.0000000000000675] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate trends in the extant literature on mild traumatic brain injury (mTBI) in military service members and veterans using network analysis based on a comprehensive search of original, peer-reviewed research articles involving human participants published between January 1, 2010, and December 31, 2019. Specifically, we employed network analysis to evaluate associations in the following areas: (1) peer-reviewed journals, (2) authors, (3) organizations/institutions, and (4) relevant key words. PARTICIPANTS Included studies were published in peer-reviewed journals available on Web of Science database, using US military service members or veterans. DESIGN Bibliometric network analytical review. MAIN MEASURES Outcomes for each analysis included number of articles, citations, total link strength, and clusters. RESULTS The top publishing journals were (1) Journal of Head Trauma and Rehabilitation, (2) Military Medicine, (3) Brain Injury, (4) Journal of Neurotrauma, and (5) Journal of Rehabilitation Research and Development. The top publishing authors were (1) French, (2) Lange, (3) Cooper, (4) Vanderploeg, and (5) Brickell. The top research institutions were (1) Defense and Veterans Brain Injury Center, (2) Uniformed Services University of the Health Sciences, (3) University of California San Diego, (4) Walter Reed National Military Medical Center, and (5) Boston University. The top co-occurring key words in this analysis were (1) posttraumatic stress disorder (PTSD), (2) persistent postconcussion symptoms (PPCS), (3) blast injury, (4) postconcussion syndrome (PCS), and (5) Alzheimer's disease. CONCLUSIONS The results of this network analysis indicate a clear focus on veteran health, as well as investigations on chronic effects of mTBI. Research in civilian mTBI indicates that delaying treatment for symptoms and impairments related to mTBI may not be the most precise treatment strategy. Increasing the number of early, active, and targeted treatment trials in military personnel could translate to meaningful improvements in clinical practices for managing mTBI in this population.
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Affiliation(s)
- Shawn R Eagle
- Departments of Orthopaedic Surgery (Drs Eagle, Collins, and Kontos) and Sports Medicine and Nutrition (Drs Connaboy and Flanagan), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Collins and Kontos); US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington (Dr Dretsch); and VA Puget Sound Health Care System-American Lake Division, Tacoma, Washington (Dr Uomoto)
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4
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Sia RK, Ryan DS, Brooks DI, Kagemann JM, Bower KS, French LM, Justin GA, Colyer MH. The Impact of Combat Ocular Trauma and Traumatic Brain Injury on Vision- and Health-Related Quality of Life Among U.S. Military Casualties. Mil Med 2021; 187:209-215. [PMID: 34117765 DOI: 10.1093/milmed/usab233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to assess visual and health-related quality of life (QOL) among U.S. military service members who sustained combat ocular trauma (COT) with or without associated traumatic brain injury (TBI). METHODS This was a single-center, prospective observational study of U.S. service members (n = 88) with COT who were treated at Walter Reed National Military Medical Center. Participants completed the National Eye Institute Visual Function Questionnaire (VFQ-25) at enrollment and at follow-up (>1 year) and supplemental surveys: Neurobehavioral Symptom Inventory, the Medical Outcomes 36-item Short Form Survey (SF-36), and Mayo-Portland Adaptability Inventory. RESULTS Initial and follow-up VFQ-25 showed a statistically significant increase in median scores for near activities (initial: 75.0, follow-up 83.3; P = .004) and peripheral vision (initial: 50.0, follow-up: 75.0; P = .009) and in composite scores (initial: 79.5, follow-up: 79.8; P = .022). Comparing those who did (n = 78) and did not (n = 8) have a TBI history, there were no significant differences in median change in VFQ-25 composite scores (with TBI: 2.3 vs. no TBI: 10.7; P = .179). Participants with a TBI history had a significantly lower median SF-36 General Health score (with TBI: 67.5 vs. no TBI: 92.5; P = .009). CONCLUSIONS Vision-related QOL of COT patients is generally good in the long term. However, those with both COT and a history of TBI conditions showed significantly worse functioning in several domains than those without TBI. As TBI is a common finding in COT, this association is an important factor impacting this population's overall clinical presentation and daily functions.
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Affiliation(s)
- Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Janice M Kagemann
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, MD 20817, USA.,Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Lutherville, MD 21093, USA
| | - Louis M French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Grant A Justin
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA.,Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Trotta JK, Ekanayake V, Ettenhofer ML, Hungerford LD, Lange RT, Bailie JM, Brickell TA, Kennedy JE, French LM. Intracranial Abnormalities Are Associated With Fewer Self-Reported Symptoms in Military Service Members Following Moderate-to-Severe Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:164-174. [PMID: 33201040 DOI: 10.1097/htr.0000000000000637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined the relationship between intracranial abnormalities (ICAs) and self-reported neurobehavioral and posttraumatic stress (PTS) symptoms in members of the military with moderate-to-severe traumatic brain injury (msTBI). METHOD Participants included 539 members of the US military with nonpenetrating msTBI. Self-reported neurobehavioral and PTS symptoms were assessed using the Neurobehavioral Symptom Inventory and the PTSD Checklist-Civilian Version. ICAs were categorized as present/absent (by subtype) based upon medical record review. Spearman rank-order correlations and stepwise multiple regression analyses examined univariate and combined predictive relationships between ICAs and self-reported symptoms. RESULTS The presence of any ICA was associated with reduced self-reported neurobehavioral and PTS symptoms. ICA-associated reductions were largest for PTS, followed by affective and cognitive neurobehavioral symptoms, and relatively weak for somatic/sensory and vestibular symptoms. Effects of different types of ICAs were comparable. Greater time since injury was related to greater symptom report, whereas duration of loss of consciousness and posttraumatic amnesia were not consistently related to self-reported symptoms. CONCLUSIONS Results suggest that ICAs are associated with suppression of reported PTS and neurobehavioral symptoms-potentially via reduction in self-awareness. These findings support comprehensive, objective evaluation to identify impairments in self-awareness and functioning in msTBI patients.
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Affiliation(s)
- Jenna K Trotta
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland (Mss Trotta and Ekanayake and Drs Ettenhofer, Hungerford, Lange, Bailie, Brickell, Kennedy, and French); Naval Medical Center San Diego, San Diego, California (Mss Trotta and Ekanayake and Drs Ettenhofer and Hungerford); General Dynamics Health Solutions, Falls Church, Virginia (Ms Trotta and Drs Ettenhofer, Hungerford, Lange, Bailie, Brickell, and Kennedy); American Hospital Services Group, Exton, Pennsylvania (Ms Ekanayake); Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Ettenhofer, Brickell, and French); University of California, San Diego (Dr Ettenhofer); University of British Columbia, Vancouver, British Columbia, Canada (Dr Lange); National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland (Drs Lange, Brickell, and French); Naval Hospital Camp Pendleton, Camp Pendleton, California (Dr Bailie); and Brooke Army Medical Center, Fort Sam Houston, Texas (Dr Kennedy)
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6
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Affiliation(s)
- Anna Zogas
- US Department of Veterans Affairs, Center for Healthcare Organization & Implementation Research, Boston, Massachusetts, USA
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Gray M, Adamson MM, Thompson RC, Kapphahn KI, Han S, Chung JS, Harris OA. Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI. Brain Inj 2020; 34:535-547. [DOI: 10.1080/02699052.2020.1725979] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Max Gray
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Maheen M. Adamson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Ryan C. Thompson
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | | | - Summer Han
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
| | - Joyce S. Chung
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
| | - Odette A. Harris
- Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, CA, USA
- Department of Polytrauma, VA Palo Alto Health Care System (VAPAHCS), Palo Alto, CA, USA
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8
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TiO 2-Nanowired Delivery of DL-3-n-butylphthalide (DL-NBP) Attenuates Blood-Brain Barrier Disruption, Brain Edema Formation, and Neuronal Damages Following Concussive Head Injury. Mol Neurobiol 2019; 55:350-358. [PMID: 28856586 DOI: 10.1007/s12035-017-0746-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
DL-3-n-butylphthalide (DL-NBP) is one of the constituents of Chinese celery extract that is used to treat stroke, dementia, and ischemic diseases. However, its role in traumatic brain injury is less well known. In this investigation, neuroprotective effects of DL-NBP in concussive head injury (CHI) on brain pathology were explored in a rat model. CHI was inflicted in anesthetized rats by dropping a weight of 114.6 g from a height of 20 cm through a guide tube on the exposed right parietal bone inducing an impact of 0.224 N and allowed them to survive 4 to 24 h after the primary insult. DL-NBP was administered (40 or 60 mg/kg, i.p.) 2 and 4 h after injury in 8-h survival group and 8 and 12 h after trauma in 24-h survival group. In addition, TiO2-nanowired delivery of DL-NBP (20 or 40 mg/kg, i.p.) in 8 and 24 h CHI rats was also examined. Untreated CHI showed a progressive increase in blood-brain barrier (BBB) breakdown to Evans blue albumin (EBA) and radioiodine ([131]-I), edema formation, and neuronal injuries. The magnitude and intensity of these pathological changes were most marked in the left hemisphere. Treatment with DL-NBP significantly reduced brain pathology in CHI following 8 to 12 h at 40-mg dose. However, 60-mg dose is needed to thwart brain pathology at 24 h following CHI. On the other hand, TiO2-DL-NBP was effective in reducing brain damage up to 8 or 12 h using a 20-mg dose and only 40-mg dose was needed for neuroprotection in CHI at 24 h. These observations are the first to suggest that (i) DL-NBP is quite effective in reducing brain pathology and (ii) nanodelivery of DL-NBP has far more superior effects in CHI, not reported earlier.
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9
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Postconcussion Symptom Reporting After Mild Traumatic Brain Injury in Female Service Members: Impact of Gender, Posttraumatic Stress Disorder, Severity of Injury, and Associated Bodily Injuries. J Head Trauma Rehabil 2018; 33:101-112. [DOI: 10.1097/htr.0000000000000353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Polimanti R, Chen CY, Ursano RJ, Heeringa SG, Jain S, Kessler RC, Nock MK, Smoller JW, Sun X, Gelernter J, Stein MB. Cross-Phenotype Polygenic Risk Score Analysis of Persistent Post-Concussive Symptoms in U.S. Army Soldiers with Deployment-Acquired Traumatic Brain Injury. J Neurotrauma 2016; 34:781-789. [PMID: 27439997 DOI: 10.1089/neu.2016.4550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) contributes to the increased rates of suicide and post-traumatic stress disorder in military personnel and veterans, and it is also associated with the risk for neurodegenerative and psychiatric disorders. A cross-phenotype high-resolution polygenic risk score (PRS) analysis of persistent post-concussive symptoms (PCS) was conducted in 845 U.S. Army soldiers who sustained TBI during their deployment. We used a prospective longitudinal survey of three brigade combat teams to assess deployment-acquired TBI and persistent physical, cognitive, and emotional PCS. PRS was derived from summary statistics of large genome-wide association studies of Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, and major depressive disorder (MDD); and for years of schooling, college completion, childhood intelligence, infant head circumference (IHC), and adult intracranial volume. Although our study had more than 95% of statistical power to detect moderate-to-large effect sizes, no association was observed with neurodegenerative and psychiatric disorders, suggesting that persistent PCS does not share genetic components with these traits to a moderate-to-large degree. We observed a significant finding: subjects with high IHC PRS recovered better from cognitive/emotional persistent PCS than the other individuals (R2 = 1.11%; p = 3.37 × 10-3). Enrichment analysis identified two significant Gene Ontology (GO) terms related to this result: GO:0050839∼Cell adhesion molecule binding (p = 8.9 × 10-6) and GO:0050905∼Neuromuscular process (p = 9.8 × 10-5). In summary, our study indicated that the genetic predisposition to persistent PCS after TBI does not have substantial overlap with neurodegenerative and psychiatric diseases, but mechanisms related to early brain growth may be involved.
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Affiliation(s)
- Renato Polimanti
- 1 Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center , West Haven, Connecticut
| | - Chia-Yen Chen
- 2 Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard , Cambridge, Massachusetts
| | - Robert J Ursano
- 3 Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Steven G Heeringa
- 4 Institute for Social Research, University of Michigan , Ann Arbor, Michigan
| | - Sonia Jain
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California
| | - Ronald C Kessler
- 6 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts
| | - Matthew K Nock
- 7 Department of Psychology, Harvard University , Cambridge, Massachusetts
| | - Jordan W Smoller
- 2 Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard , Cambridge, Massachusetts
| | - Xiaoying Sun
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California
| | - Joel Gelernter
- 8 Departments of Psychiatry, Genetics, and Neuroscience, Yale School of Medicine and VA CT Healthcare Center , West Haven, Connecticut
| | - Murray B Stein
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California.,9 Department of Psychiatry, University of California , La Jolla, California.,10 VA San Diego Healthcare System , San Diego, California
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