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Friberg S, Lindblad C, Zeiler FA, Zetterberg H, Granberg T, Svenningsson P, Piehl F, Thelin EP. Fluid biomarkers of chronic traumatic brain injury. Nat Rev Neurol 2024:10.1038/s41582-024-01024-z. [PMID: 39363129 DOI: 10.1038/s41582-024-01024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/05/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of long-term disability across the world. Evidence for the usefulness of imaging and fluid biomarkers to predict outcomes and screen for the need to monitor complications in the acute stage is steadily increasing. Still, many people experience symptoms such as fatigue and cognitive and motor dysfunction in the chronic phase of TBI, where objective assessments for brain injury are lacking. Consensus criteria for traumatic encephalopathy syndrome, a clinical syndrome possibly associated with the neurodegenerative disease chronic traumatic encephalopathy, which is commonly associated with sports concussion, have been defined only recently. However, these criteria do not fit all individuals living with chronic consequences of TBI. The pathophysiology of chronic TBI shares many similarities with other neurodegenerative and neuroinflammatory conditions, such as Alzheimer disease. As with Alzheimer disease, advancements in fluid biomarkers represent one of the most promising paths for unravelling the chain of pathophysiological events to enable discrimination between these conditions and, with time, provide prediction modelling and therapeutic end points. This Review summarizes fluid biomarker findings in the chronic phase of TBI (≥6 months after injury) that demonstrate the involvement of inflammation, glial biology and neurodegeneration in the long-term complications of TBI. We explore how the biomarkers associate with outcome and imaging findings and aim to establish mechanistic differences in biomarker patterns between types of chronic TBI and other neurodegenerative conditions. Finally, current limitations and areas of priority for future fluid biomarker research are highlighted.
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Affiliation(s)
- Susanna Friberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Lindblad
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Frederick A Zeiler
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Section of Neurosurgery, Department of Surgery, University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Department of Biomedical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, Manitoba, Canada
- Pan Am Clinic Foundation, Winnipeg, Manitoba, Canada
- Division of Anaesthesia, Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute, University College London, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Department of Neurodegenerative Disease, University College London, Queen Square Institute of Neurology, London, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Basic and Clinical Neuroscience, King's College London, London, UK
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Eric P Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
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Yue JK, Etemad LL, Elguindy MM, van Essen TA, Belton PJ, Nelson LD, McCrea MA, Vreeburg RJG, Gotthardt CJ, Tracey JX, Coskun BC, Krishnan N, Halabi C, Eagle SR, Korley FK, Robertson CS, Duhaime AC, Satris GG, Tarapore PE, Huang MC, Madhok DY, Giacino JT, Mukherjee P, Yuh EL, Valadka AB, Puccio AM, Okonkwo DO, Sun X, Jain S, Manley GT, DiGiorgio AM, Badjatia N, Barber J, Bodien YG, Fabian B, Ferguson AR, Foreman B, Gardner RC, Gopinath S, Grandhi R, Russell Huie J, Dirk Keene C, Lingsma HF, MacDonald CL, Markowitz AJ, Merchant R, Ngwenya LB, Rodgers RB, Schneider ALC, Schnyer DM, Taylor SR, Temkin NR, Torres-Espin A, Vassar MJ, Wang KKW, Wong JC, Zafonte RD. Prior traumatic brain injury is a risk factor for in-hospital mortality in moderate to severe traumatic brain injury: a TRACK-TBI cohort study. Trauma Surg Acute Care Open 2024; 9:e001501. [PMID: 39081460 PMCID: PMC11287071 DOI: 10.1136/tsaco-2024-001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
ABSTRACT Objectives An estimated 14-23% of patients with traumatic brain injury (TBI) incur multiple lifetime TBIs. The relationship between prior TBI and outcomes in patients with moderate to severe TBI (msTBI) is not well delineated. We examined the associations between prior TBI, in-hospital mortality, and outcomes up to 12 months after injury in a prospective US msTBI cohort. Methods Data from hospitalized subjects with Glasgow Coma Scale score of 3-12 were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study (enrollment period: 2014-2019). Prior TBI with amnesia or alteration of consciousness was assessed using the Ohio State University TBI Identification Method. Competing risk regressions adjusting for age, sex, psychiatric history, cranial injury and extracranial injury severity examined the associations between prior TBI and in-hospital mortality, with hospital discharged alive as the competing risk. Adjusted HRs (aHR (95% CI)) were reported. Multivariable logistic regressions assessed the associations between prior TBI, mortality, and unfavorable outcome (Glasgow Outcome Scale-Extended score 1-3 (vs. 4-8)) at 3, 6, and 12 months after injury. Results Of 405 acute msTBI subjects, 21.5% had prior TBI, which was associated with male sex (87.4% vs. 77.0%, p=0.037) and psychiatric history (34.5% vs. 20.7%, p=0.010). In-hospital mortality was 10.1% (prior TBI: 17.2%, no prior TBI: 8.2%, p=0.025). Competing risk regressions indicated that prior TBI was associated with likelihood of in-hospital mortality (aHR=2.06 (1.01-4.22)), but not with hospital discharged alive. Prior TBI was not associated with mortality or unfavorable outcomes at 3, 6, and 12 months. Conclusions After acute msTBI, prior TBI history is independently associated with in-hospital mortality but not with mortality or unfavorable outcomes within 12 months after injury. This selective association underscores the importance of collecting standardized prior TBI history data early after acute hospitalization to inform risk stratification. Prospective validation studies are needed. Level of evidence IV. Trial registration number NCT02119182.
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Affiliation(s)
- John K Yue
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Leila L Etemad
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Mahmoud M Elguindy
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Thomas A van Essen
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Patrick J Belton
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lindsay D Nelson
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rick J G Vreeburg
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Christine J Gotthardt
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Joye X Tracey
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bukre C Coskun
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nishanth Krishnan
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Cathra Halabi
- Neurology, University of California San Francisco, San Francisco, California, USA
| | - Shawn R Eagle
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | | | | | | | - Gabriela G Satris
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Phiroz E Tarapore
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael C Huang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joseph T Giacino
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Esther L Yuh
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Alex B Valadka
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ava M Puccio
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Geoffrey T Manley
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Anthony M DiGiorgio
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Neeraj Badjatia
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jason Barber
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Yelena G Bodien
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brian Fabian
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Adam R Ferguson
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Brandon Foreman
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Raquel C Gardner
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Shankar Gopinath
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ramesh Grandhi
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - J Russell Huie
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - C Dirk Keene
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Hester F Lingsma
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Christine L MacDonald
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Amy J Markowitz
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Randall Merchant
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Laura B Ngwenya
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Richard B Rodgers
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Andrea L C Schneider
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David M Schnyer
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sabrina R Taylor
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Nancy R Temkin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Abel Torres-Espin
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Mary J Vassar
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Kevin K W Wang
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Justin C Wong
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Ross D Zafonte
- Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, Leiden University Medical Center, Leiden, Netherlands
- Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Neurology, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
- Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California, USA
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3
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Iannucci J, Dominy R, Bandopadhyay S, Arthur EM, Noarbe B, Jullienne A, Krkasharyan M, Tobin RP, Pereverzev A, Beevers S, Venkatasamy L, Souza KA, Jupiter DC, Dabney A, Obenaus A, Newell-Rogers MK, Shapiro LA. Traumatic brain injury alters the effects of class II invariant peptide (CLIP) antagonism on chronic meningeal CLIP + B cells, neuropathology, and neurobehavioral impairment in 5xFAD mice. J Neuroinflammation 2024; 21:165. [PMID: 38937750 PMCID: PMC11212436 DOI: 10.1186/s12974-024-03146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a significant risk factor for Alzheimer's disease (AD), and accumulating evidence supports a role for adaptive immune B and T cells in both TBI and AD pathogenesis. We previously identified B cell and major histocompatibility complex class II (MHCII)-associated invariant chain peptide (CLIP)-positive B cell expansion after TBI. We also showed that antagonizing CLIP binding to the antigen presenting groove of MHCII after TBI acutely reduced CLIP + splenic B cells and was neuroprotective. The current study investigated the chronic effects of antagonizing CLIP in the 5xFAD Alzheimer's mouse model, with and without TBI. METHODS 12-week-old male wild type (WT) and 5xFAD mice were administered either CLIP antagonist peptide (CAP) or vehicle, once at 30 min after either sham or a lateral fluid percussion injury (FPI). Analyses included flow cytometric analysis of immune cells in dural meninges and spleen, histopathological analysis of the brain, magnetic resonance diffusion tensor imaging, cerebrovascular analysis, and assessment of motor and neurobehavioral function over the ensuing 6 months. RESULTS 9-month-old 5xFAD mice had significantly more CLIP + B cells in the meninges compared to age-matched WT mice. A one-time treatment with CAP significantly reduced this population in 5xFAD mice. Importantly, CAP also improved some of the immune, histopathological, and neurobehavioral impairments in 5xFAD mice over the ensuing six months. Although FPI did not further elevate meningeal CLIP + B cells, it did negate the ability of CAP to reduce meningeal CLIP + B cells in the 5xFAD mice. FPI at 3 months of age exacerbated some aspects of AD pathology in 5xFAD mice, including further reducing hippocampal neurogenesis, increasing plaque deposition in CA3, altering microgliosis, and disrupting the cerebrovascular structure. CAP treatment after injury ameliorated some but not all of these FPI effects.
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Affiliation(s)
- Jaclyn Iannucci
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Reagan Dominy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Shreya Bandopadhyay
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - E Madison Arthur
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Brenda Noarbe
- Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Amandine Jullienne
- Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Margret Krkasharyan
- Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - Richard P Tobin
- Department of Surgery, Division of Surgical Oncology, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Aleksandr Pereverzev
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Samantha Beevers
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Lavanya Venkatasamy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Karienn A Souza
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, Department of Orthopaedics and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Alan Dabney
- Department of Statistics, College of Arts & Sciences, Texas A&M University, College Station, TX, USA
| | - Andre Obenaus
- Division of Biomedical Sciences, University of California Riverside, Riverside, CA, USA
| | - M Karen Newell-Rogers
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA.
- Department of Medical Physiology, College of Medicine, Texas A&M University, Bryan, TX, USA.
| | - Lee A Shapiro
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University, Bryan, TX, USA.
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4
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Zhang H, Wang J, Qu Y, Yang Y, Guo ZN. Brain Injury Biomarkers and Applications in Neurological Diseases. Chin Med J (Engl) 2024:00029330-990000000-01116. [PMID: 38915214 DOI: 10.1097/cm9.0000000000003061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 06/26/2024] Open
Abstract
ABSTRACT Neurological diseases are a major health concern, and brain injury is a typical pathological process in various neurological disorders. Different biomarkers in the blood or the cerebrospinal fluid are associated with specific physiological and pathological processes. They are vital in identifying, diagnosing, and treating brain injuries. In this review, we described biomarkers for neuronal cell body injury (neuron-specific enolase, ubiquitin C-terminal hydrolase-L1, αII-spectrin), axonal injury (neurofilament proteins, tau), astrocyte injury (S100β, glial fibrillary acidic protein), demyelination (myelin basic protein), autoantibodies, and other emerging biomarkers (extracellular vesicles, microRNAs). We aimed to summarize the applications of these biomarkers and their related interests and limits in the diagnosis and prognosis for neurological diseases, including traumatic brain injury, status epilepticus, stroke, Alzheimer's disease, and infection. In addition, a reasonable outlook for brain injury biomarkers as ideal detection tools for neurological diseases is presented.
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Affiliation(s)
- Han Zhang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
| | - Jing Wang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
| | - Yang Qu
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
| | - Yi Yang
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
| | - Zhen-Ni Guo
- Stroke Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
- Neuroscience Research Center, Department of Neurology, the First Hospital of Jilin University, Chang Chun, Jilin 130021, China
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5
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Charan BD, Priya S, Goel V, Chhatarpal P, Jain S, Gupta A, Garg A. Unveiling Distinctive MRI Characteristics in the Diagnosis of GFAP Astrocytopathy: A Rare Autoimmune Neuroinflammatory Disorder. Ann Indian Acad Neurol 2024; 27:316-318. [PMID: 38856160 PMCID: PMC11232841 DOI: 10.4103/aian.aian_1134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/21/2024] [Accepted: 04/21/2024] [Indexed: 06/11/2024] Open
Abstract
Glial fibrillary acidic protein (GFAP) astrocytopathy is a rare autoimmune inflammatory disorder affecting the central nervous system, involving the meninges, brain parenchyma, and spinal cord. The distinctive radiologic feature observed on magnetic resonance imaging (MRI) is characterized by periventricular radial and linear contrast enhancement. This case report details a 45-year-old male who initially exhibited constitutional symptoms, followed by encephalitis, lower limb weakness, and urinary retention. The MRI findings revealed meningoencephalitis with longitudinal extensive myelitis. Notably, the cerebrospinal fluid analysis confirmed the presence of anti-GFAP antibodies.
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Affiliation(s)
- Bheru D Charan
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Priya
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goel
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pinky Chhatarpal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Savyasachi Jain
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
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6
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Lynch S, Saez Calveras N, Amin A. Neuromyelitis Optica Spectrum Disorder Resembling Wernicke's Encephalopathy: A Case Report and Review of the Literature. Neurohospitalist 2024; 14:213-217. [PMID: 38666289 PMCID: PMC11040630 DOI: 10.1177/19418744241228004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
We describe a case of Neuromyelitis Optica Spectrum Disorder (NMOSD) mimicking Wernicke's Encephalopathy (WE) to highlight an atypical presentation of NMOSD. A 39-year-old female presented with subacute encephalopathy and progressive ophthalmoplegia. Her MRI revealed T2 hyperintensities involving the mammillary bodies, periaqueductal grey matter, medial thalami, third ventricle, and area postrema. Whole blood thiamine levels were elevated and she did not improve with IV thiamine. CSF was notable for lymphocytic pleocytosis and elevated protein. She tested positive for serum Aquaporin-4 (AQP4) antibody. Subsequent imaging revealed multilevel lesions in the cervical and thoracic spinal cord. Her CSF GFAP antibody also came back positive. She steadily and significantly improved after high-dose IV steroids and plasmapheresis. She later started on chronic rituximab therapy. This represents a unique case of NMOSD presenting with the classical clinical and imaging features of WE, as opposed to the typical presenting symptoms of NMOSD. As such, demyelinating disorders should be considered when there is concern for diencephalic and midline pathologies, particularly without classic WE risk factors. Conversely, clinicians should be aware of secondary nutritional complications arising from severe area postrema syndrome.
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Affiliation(s)
- Sloan Lynch
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Nil Saez Calveras
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
| | - Anik Amin
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health, Dallas, TX, USA
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7
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Agoston DV. Traumatic Brain Injury in the Long-COVID Era. Neurotrauma Rep 2024; 5:81-94. [PMID: 38463416 PMCID: PMC10923549 DOI: 10.1089/neur.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Major determinants of the biological background or reserve, such as age, biological sex, comorbidities (diabetes, hypertension, obesity, etc.), and medications (e.g., anticoagulants), are known to affect outcome after traumatic brain injury (TBI). With the unparalleled data richness of coronavirus disease 2019 (COVID-19; ∼375,000 and counting!) as well as the chronic form, long-COVID, also called post-acute sequelae SARS-CoV-2 infection (PASC), publications (∼30,000 and counting) covering virtually every aspect of the diseases, pathomechanisms, biomarkers, disease phases, symptomatology, etc., have provided a unique opportunity to better understand and appreciate the holistic nature of diseases, interconnectivity between organ systems, and importance of biological background in modifying disease trajectories and affecting outcomes. Such a holistic approach is badly needed to better understand TBI-induced conditions in their totality. Here, I briefly review what is known about long-COVID/PASC, its underlying-suspected-pathologies, the pathobiological changes induced by TBI, in other words, the TBI endophenotypes, discuss the intersection of long-COVID/PASC and TBI-induced pathobiologies, and how by considering some of the known factors affecting the person's biological background and the inclusion of mechanistic molecular biomarkers can help to improve the clinical management of TBI patients.
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Affiliation(s)
- Denes V. Agoston
- Department of Anatomy, Physiology, and Genetics, School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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8
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Kobeissy F, Goli M, Yadikar H, Shakkour Z, Kurup M, Haidar MA, Alroumi S, Mondello S, Wang KK, Mechref Y. Advances in neuroproteomics for neurotrauma: unraveling insights for personalized medicine and future prospects. Front Neurol 2023; 14:1288740. [PMID: 38073638 PMCID: PMC10703396 DOI: 10.3389/fneur.2023.1288740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 02/12/2024] Open
Abstract
Neuroproteomics, an emerging field at the intersection of neuroscience and proteomics, has garnered significant attention in the context of neurotrauma research. Neuroproteomics involves the quantitative and qualitative analysis of nervous system components, essential for understanding the dynamic events involved in the vast areas of neuroscience, including, but not limited to, neuropsychiatric disorders, neurodegenerative disorders, mental illness, traumatic brain injury, chronic traumatic encephalopathy, and other neurodegenerative diseases. With advancements in mass spectrometry coupled with bioinformatics and systems biology, neuroproteomics has led to the development of innovative techniques such as microproteomics, single-cell proteomics, and imaging mass spectrometry, which have significantly impacted neuronal biomarker research. By analyzing the complex protein interactions and alterations that occur in the injured brain, neuroproteomics provides valuable insights into the pathophysiological mechanisms underlying neurotrauma. This review explores how such insights can be harnessed to advance personalized medicine (PM) approaches, tailoring treatments based on individual patient profiles. Additionally, we highlight the potential future prospects of neuroproteomics, such as identifying novel biomarkers and developing targeted therapies by employing artificial intelligence (AI) and machine learning (ML). By shedding light on neurotrauma's current state and future directions, this review aims to stimulate further research and collaboration in this promising and transformative field.
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Affiliation(s)
- Firas Kobeissy
- Department of Neurobiology, School of Medicine, Neuroscience Institute, Atlanta, GA, United States
| | - Mona Goli
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, United States
| | - Hamad Yadikar
- Department of Biological Sciences Faculty of Science, Kuwait University, Safat, Kuwait
| | - Zaynab Shakkour
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO, United States
| | - Milin Kurup
- Alabama College of Osteopathic Medicine, Dothan, AL, United States
| | | | - Shahad Alroumi
- Department of Biological Sciences Faculty of Science, Kuwait University, Safat, Kuwait
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Kevin K. Wang
- Department of Neurobiology, School of Medicine, Neuroscience Institute, Atlanta, GA, United States
| | - Yehia Mechref
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, United States
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9
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Zhang W, Xie Y, Wang Y, Liu F, Wang L, Lian Y, Liu H, Wang C, Xie N. Clinical characteristics and prognostic factors for short-term outcomes of autoimmune glial fibrillary acidic protein astrocytopathy: a retrospective analysis of 33 patients. Front Immunol 2023; 14:1136955. [PMID: 37350972 PMCID: PMC10282742 DOI: 10.3389/fimmu.2023.1136955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Background Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a recently discovered inflammatory central nervous system (CNS) disease, whose clinical characteristics and prognostic factors for short-term outcomes have not been defined yet. We aimed to assess the symptoms, laboratory tests, imaging findings, treatment, and short-term prognosis of GFAP-A. Methods A double-center retrospective cohort study was performed between May 2018 and July 2022. The clinical characteristics and prognostic factors for short-term outcomes were determined. Results We enrolled 33 patients with a median age of 28 years (range: 2-68 years), 15 of whom were children (<18 years). The clinical spectrum is dominated by meningoencephalomyelitis. Besides, we also found nausea, vomiting, poor appetite, and neuropathic pain in some GFAP-A patients, which were not mentioned in previous reports. And adults were more prone to limb numbness than children. Magnetic resonance imaging revealed lesions involving the brain parenchyma, meninges, and spinal cord, exhibiting patchy, linear, punctate, and strip T2 hyperintensities. First-line immunotherapy, including corticosteroid and gamma globulin, was effective in most patients in the acute phase (P = 0.02). However, patients with overlapping AQP4 antibodies did not respond well to first-line immunotherapy and coexisting neural autoantibodies were more common in women. Additionally, the short-term prognosis was significantly better in children than in adults (P = 0.04). Positive non-neural autoantibodies and proven viral infection were independent factors associated with poor outcomes (P = 0.03, 0.02, respectively). Conclusion We expanded the spectrum of clinical symptoms of autoimmune GFAP-A. The clinical symptoms and short-term prognosis differed between children and adults. Positive non-neural autoantibodies and proven viral infection at admission suggest a poor short-term prognosis.
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Affiliation(s)
- Wanwan Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinyin Xie
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yali Wang
- Department of Neurology, Henan Children’s Hospital, Zhengzhou, China
| | - Fengxia Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Wang
- Department of Neurology, Henan Children’s Hospital, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongbo Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cui Wang
- Department of Clinical Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nanchang Xie
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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10
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Poppell M, Hammel G, Ren Y. Immune Regulatory Functions of Macrophages and Microglia in Central Nervous System Diseases. Int J Mol Sci 2023; 24:5925. [PMID: 36982999 PMCID: PMC10059890 DOI: 10.3390/ijms24065925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Macrophages can be characterized as a very multifunctional cell type with a spectrum of phenotypes and functions being observed spatially and temporally in various disease states. Ample studies have now demonstrated a possible causal link between macrophage activation and the development of autoimmune disorders. How these cells may be contributing to the adaptive immune response and potentially perpetuating the progression of neurodegenerative diseases and neural injuries is not fully understood. Within this review, we hope to illustrate the role that macrophages and microglia play as initiators of adaptive immune response in various CNS diseases by offering evidence of: (1) the types of immune responses and the processes of antigen presentation in each disease, (2) receptors involved in macrophage/microglial phagocytosis of disease-related cell debris or molecules, and, finally, (3) the implications of macrophages/microglia on the pathogenesis of the diseases.
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Affiliation(s)
| | | | - Yi Ren
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA
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11
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Zhu B, Sun M, Yang T, Yu H, Wang L. Clinical, imaging features and outcomes of patients with anti-GFAP antibodies: a retrospective study. Front Immunol 2023; 14:1106490. [PMID: 37205100 PMCID: PMC10187143 DOI: 10.3389/fimmu.2023.1106490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Objective To evaluate and compare the clinical features, imaging, overlapping antibodies, and prognosis of pediatric and adult patients with anti-GFAP antibodies. Methods This study included 59 patients with anti-GFAP antibodies (28 females and 31 males) who were admitted between December 2019 and September 2022. Results Out of 59 patients, 18 were children (under 18 years old), and 31 were adults. The overall cohort's median age at onset was 32 years old, 7 for children, and 42 for adults. There were 23 (41.1%) patients with prodromic infection, 1 (1.7%) patient with a tumor, 29 (53.7%) patients with other non-neurological autoimmune diseases, and 17 (22.8%) patients with hyponatremia. Fourteen (23.7%) patients had multiple neural autoantibodies, with the AQP4 antibody being the most common. Encephalitis (30.5%) was the most common phenotypic syndrome. Common clinical symptoms included fever (59.3%), headache (47.5%), nausea and vomiting (35.6%), limb weakness (35.6%), and disturbance of consciousness (33.9%). Brain MRI lesions were primarily located in the cortex/subcortex (37.3%), brainstem (27.1%), thalamus (23.7%), and basal ganglia (22.0%). Spinal cord MRI lesions often involved the cervical and thoracic spinal cord. There was no statistically significant difference in the MRI lesion site between children and adults. Out of 58 patients, 47 (81.0%) had a monophasic course, and 4 died. The last follow-up showed that 41/58 (80.7%) patients had an improved functional outcome (mRS <3), and children were more likely than adults to have no residual disability symptoms (p = 0.001). Conclusion There was no statistically significant difference in clinical symptoms and imaging findings between children and adult patients with anti-GFAP antibodies; Patients with anti-GFAP antibodies may present with normal MRI findings or delayed MRI abnormalities, and patients with overlapping antibodies were common. Most patients had monophasic courses, and those with overlapping antibodies were more likely to relapse. Children were more likely than adults to have no disability. Finally, we hypothesize that the presence of anti-GFAP antibodies is a non-specific witness of inflammation.
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12
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Biomarkers in Moderate to Severe Pediatric Traumatic Brain Injury: A Review of the Literature. Pediatr Neurol 2022; 130:60-68. [PMID: 35364462 PMCID: PMC9038667 DOI: 10.1016/j.pediatrneurol.2022.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite decades of research, outcomes in pediatric traumatic brain injury (pTBI) remain highly variable. Brain biofluid-specific biomarkers from pTBI patients may allow us to diagnose and prognosticate earlier and with a greater degree of accuracy than conventional methods. This manuscript reviews the evidence surrounding current brain-specific biomarkers in pTBI and assesses the temporal relationship between the natural history of the traumatic brain injury (TBI) and measured biomarker levels. METHODS A literature search was conducted in the Ovid, PubMed, MEDLINE, and Cochrane databases seeking relevant publications. The study selection and screening process were documented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Extraction forms included developmental stages of patients, type and biofluid source of biomarkers, brain injury type, and other relevant data. RESULTS The search strategy identified 443 articles, of which 150 examining the biomarkers of our interest were included. The references retrieved were examined thoroughly and discussed at length with a pediatric neurocritical care intensivist specializing in pTBI and a Ph.D. scientist with a high degree of involvement in TBI biomarker research, authoring a vast amount of literature in this field. CONCLUSIONS TBI biomarkers might serve as valuable tools in the diagnosis and prognosis of pTBI. However, while each biomarker has its advantages, they are not without limitations, and therefore, further research is critical in pTBI biomarkers.
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13
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Janigro D, Mondello S, Posti JP, Unden J. GFAP and S100B: What You Always Wanted to Know and Never Dared to Ask. Front Neurol 2022; 13:835597. [PMID: 35386417 PMCID: PMC8977512 DOI: 10.3389/fneur.2022.835597] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major global health issue, with outcomes spanning from intracranial bleeding, debilitating sequelae, and invalidity with consequences for individuals, families, and healthcare systems. Early diagnosis of TBI by testing peripheral fluids such as blood or saliva has been the focus of many research efforts, leading to FDA approval for a bench-top assay for blood GFAP and UCH-L1 and a plasma point-of-care test for GFAP. The biomarker S100B has been included in clinical guidelines for mTBI (mTBI) in Europe. Despite these successes, several unresolved issues have been recognized, including the robustness of prior data, the presence of biomarkers in tissues beyond the central nervous system, and the time course of biomarkers in peripheral body fluids. In this review article, we present some of these issues and provide a viewpoint derived from an analysis of existing literature. We focus on two astrocytic proteins, S100B and GFAP, the most commonly employed biomarkers used in mTBI. We also offer recommendations that may translate into a broader acceptance of these clinical tools.
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Affiliation(s)
- Damir Janigro
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, United States.,FloTBI, Cleveland, OH, United States
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku Brain Injury Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Johan Unden
- Department of Operation and Intensive Care, Hallands Hospital Halmstad, Lund University, Lund, Sweden
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14
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Posti JP, Tenovuo O. Blood-based biomarkers and traumatic brain injury-A clinical perspective. Acta Neurol Scand 2022; 146:389-399. [PMID: 35383879 DOI: 10.1111/ane.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 12/19/2022]
Abstract
Blood-based biomarkers are promising tools to complement clinical variables and imaging findings in the diagnosis, monitoring and outcome prediction of traumatic brain injury (TBI). Several promising biomarker candidates have been found for various clinical questions, but the translation of TBI biomarkers into clinical applications has been negligible. Measured biomarker levels are influenced by patient-related variables such as age, blood-brain barrier integrity and renal and liver function. It is not yet fully understood how biomarkers enter the bloodstream from the interstitial fluid of the brain. In addition, the diagnostic performance of TBI biomarkers is affected by sampling timing and analytical methods. In this focused review, the clinical aspects of glial fibrillary acidic protein, neurofilament light, S100 calcium-binding protein B, tau and ubiquitin C-terminal hydrolase-L1 are examined. Current findings and clinical caveats are addressed.
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Affiliation(s)
- Jussi P. Posti
- Neurocenter Department of Neurosurgery and Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Olli Tenovuo
- Neurocenter Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
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15
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Plasma autoantibodies to glial fibrillary acidic protein (GFAP) react with brain areas according to Braak staging of Parkinson's disease. J Neural Transm (Vienna) 2022; 129:545-555. [PMID: 35364741 PMCID: PMC9188503 DOI: 10.1007/s00702-022-02495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/24/2022] [Indexed: 10/26/2022]
Abstract
Idiopathic Parkinson's disease (PD) is characterized by a progredient degeneration of the brain, starting at deep subcortical areas such as the dorsal motor nucleus of the glossopharyngeal and vagal nerves (DM) (stage 1), followed by the coeruleus-subcoeruleus complex; (stage 2), the substantia nigra (SN) (stage 3), the anteromedial temporal mesocortex (MC) (stage 4), high-order sensory association areas and prefrontal fields (HC) (stage 5) and finally first-order sensory association areas, premotor areas, as well as primary sensory and motor field (FC) (stage 6). Autoimmunity might play a role in PD pathogenesis. Here we analyzed whether anti-brain autoantibodies differentially recognize different human brain areas and identified autoantigens that correlate with the above-described dissemination of PD pathology in the brain. Brain tissue was obtained from deceased individuals with no history of neurological or psychiatric disease and no neuropathological abnormalities. Tissue homogenates from different brain regions (DM, SN, MC, HC, FC) were subjected to SDS-PAGE and Western blot. Blots were incubated with plasma samples from 30 PD patients and 30 control subjects and stained with anti-IgG antibodies to detect anti-brain autoantibodies. Signals were quantified. Prominent autoantigens were identified by 2D-gel-coupled mass spectrometry sequencing. Anti-brain autoantibodies are frequent and occur both in healthy controls and individuals with PD. Glial fibrillary acidic protein (GFAP) was identified as a prominent autoantigen recognized in all plasma samples. GFAP immunoreactivity was highest in DM areas and lowest in FC areas with no significant differences in anti-GFAP autoantibody titers between healthy controls and individuals with PD. The anti-GFAP autoimmunoreactivity of different brain areas correlates with the dissemination of histopathological neurodegeneration in PD. We hypothesize that GFAP autoantibodies are physiological but might be involved as a cofactor in PD pathogenesis secondary to a leakage of the blood-brain barrier.
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16
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Schneider L, Rezaeezade-Roukerd M, Faulkner J, Reichert E, Shaar HAA, Flis A, Rubiano A, Hawryluk GW. The Human Anti-Ganglioside GM1 Autoantibody Response Following Traumatic and Surgical Central Nervous System Insults. Neurosci Res 2022; 181:105-114. [DOI: 10.1016/j.neures.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
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Blood GFAP as an emerging biomarker in brain and spinal cord disorders. Nat Rev Neurol 2022; 18:158-172. [PMID: 35115728 DOI: 10.1038/s41582-021-00616-3] [Citation(s) in RCA: 238] [Impact Index Per Article: 119.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
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18
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Agoston DV. COVID-19 and Traumatic Brain Injury (TBI); What We Can Learn From the Viral Pandemic to Better Understand the Biology of TBI, Improve Diagnostics and Develop Evidence-Based Treatments. Front Neurol 2021; 12:752937. [PMID: 34987462 PMCID: PMC8720751 DOI: 10.3389/fneur.2021.752937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Denes V. Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, United States
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19
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Fang H, Hu W, Jiang Z, Yang H, Liao H, Yang L, Wu L. Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy in Children: A Retrospective Analysis of 35 Cases. Front Immunol 2021; 12:761354. [PMID: 34880859 PMCID: PMC8645641 DOI: 10.3389/fimmu.2021.761354] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To analyze the clinical manifestations, imaging, electroencephalography, treatment, and prognosis of 35 cases of autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) in children. Methods Children hospitalized in the Department of Neurology, Hunan Children’s Hospital, China, between January 2015 and June 2021, owing to autoimmune diseases of the central nervous system were subjected to a cell-based assay (CBA). The assay identified 40 children positive for GFAP-immunoglobulin (Ig)G antibodies in the serum and/or the cerebrospinal fluid. Based on clinical manifestations and imaging characteristics, five children who were only positive for GFAP-IgG antibodies in serum were excluded, and the remaining 35 children were diagnosed with autoimmune GFAP-A. The clinical data derived from the 35 children were retrospectively analyzed. Results A total of 35 children, including 23 males and 12 females with a mean age of 6.3 ± 0.6 years, manifested clinical symptoms of fever (62.9%), headache (42.9%), convulsions (42.9%), abnormal mental behavior (51.4%), disorders of consciousness (54.3%), visual disturbance (22.9%), ataxia (11.4%), paralysis (40%), and autonomic dysfunction (25.7%). One child exhibited only the clinical symptom of peripheral facial nerve palsy. Eleven out of 35 children were also positive for other antibodies. In addition to the common overlapping autoimmune syndromes, one case of autoimmune GFAP-A also manifested as Bickerstaff’s brainstem encephalitis. Linear periventricular enhancement upon MRI was significantly less frequent in children (8.5%) than in adults. In pediatric patients, MRI contrast enhancement was principally seen in the meninges and brain lobes. Although repeated relapse (17.1%) and sequelae symptoms (20%) occurred in some cases, most children showed a favorable prognosis. Spearman’s rank correlation showed that the antibody titer was not significantly associated with the severity of the initial disease conditions. Conclusions The disease diagnosis in children seropositive for GFAP antibodies only should receive a comprehensive diagnosis based on their clinical symptoms, imaging, electroencephalographic characteristics, and treatment responses. Some patients with relapses should receive repeated gamma globulin and corticosteroid therapy or the addition of immunosuppressants to their therapeutic regimen, and slow-dose tapering of corticosteroids and extended treatment are recommended for patients with overlapping autoimmune syndromes.
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Affiliation(s)
- Hongjun Fang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Wenjing Hu
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Zhi Jiang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Haiyan Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Hongmei Liao
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Liming Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, China
| | - Liwen Wu
- Department of Neurology, Hunan Children's Hospital, Changsha, China
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20
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McDonald SJ, Shultz SR, Agoston DV. The Known Unknowns: An Overview of the State of Blood-Based Protein Biomarkers of Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2652-2666. [PMID: 33906422 DOI: 10.1089/neu.2021.0011] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Blood-based protein biomarkers have revolutionized several fields of medicine by enabling molecular level diagnosis, as well as monitoring disease progression and treatment efficacy. Traumatic brain injury (TBI) so far has benefitted only moderately from using protein biomarkers to improve injury outcome. Because of its complexity and dynamic nature, TBI, especially its most prevalent mild form (mild TBI; mTBI), presents unique challenges toward protein biomarker discovery and validation given that blood is frequently obtained and processed outside of the clinical laboratory (e.g., athletic fields, battlefield) under variable conditions. As it stands, the field of mTBI blood biomarkers faces a number of outstanding questions. Do elevated blood levels of currently used biomarkers-ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light chain, and tau/p-tau-truly mirror the extent of parenchymal damage? Do these different proteins represent distinct injury mechanisms? Is the blood-brain barrier a "brick wall"? What is the relationship between intra- versus extracranial values? Does prolonged elevation of blood levels reflect de novo release or extended protein half-lives? Does biological sex affect the pathobiological responses after mTBI and thus blood levels of protein biomarkers? At the practical level, it is unknown how pre-analytical variables-sample collection, preparation, handling, and stability-affect the quality and reliability of biomarker data. The ever-increasing sensitivity of assay systems and lack of quality control of samples, combined with the almost complete reliance on antibody-based assay platforms, represent important unsolved issues given that false-negative results can lead to false clinical decision making and adverse outcomes. This article serves as a commentary on the state of mTBI biomarkers and the landscape of significant challenges. We highlight and discusses several biological and methodological "known unknowns" and close with some practical recommendations.
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Affiliation(s)
- Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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21
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Mozaffari K, Dejam D, Duong C, Ding K, French A, Ng E, Preet K, Franks A, Kwan I, Phillips HW, Kim DY, Yang I. Systematic Review of Serum Biomarkers in Traumatic Brain Injury. Cureus 2021; 13:e17056. [PMID: 34522534 PMCID: PMC8428323 DOI: 10.7759/cureus.17056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/20/2022] Open
Abstract
Traumatic brain injury (TBI) is responsible for the majority of trauma-related deaths and is a leading cause of disability. It is characterized by an inflammatory process involved in the progression of secondary brain injury. TBI is measured by the Glasgow Coma Scale (GCS) with scores ranging from 15-3, demonstrating mild to severe brain injury. Apart from this clinical assessment of TBI, compendiums of literature have been published on TBI-related serum markers.Herein we create a comprehensive appraisal of the most prominent serum biomarkers used in the assessment and care of TBI.The PubMed, Scopus, Cochrane, and Web of Science databases were queried with the terms “biomarker” and “traumatic brain injury” as search terms with only full-text, English articles within the past 10 years selected. Non-human studies were excluded, and only adult patients fell within the purview of this analysis. A total of 528 articles were analyzed in the initial search with 289 selected for screening. A further 152 were excluded for primary screening. Of the remaining 137, 54 were included in the final analysis. Serum biomarkers were listed into the following broad categories for ease of discussion: immune markers and markers of inflammation, hormones as biomarkers, coagulation and vasculature, genetic polymorphisms, antioxidants and oxidative stress, apoptosis and degradation pathways, and protein markers. Glial fibrillary acidic protein(GFAP), S100, and neurons specific enolase (NSE) were the most prominent and frequently cited markers. Amongst these three, no single serum biomarker demonstrated neither superior sensitivity nor specificity compared to the other two, therefore noninvasive panels should incorporate these three serum biomarkers to retain sensitivity and maximize specificity for TBI.
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Affiliation(s)
- Khashayar Mozaffari
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Dillon Dejam
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Courtney Duong
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Kevin Ding
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Alexis French
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Edwin Ng
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Komal Preet
- Neurosurgery, University of California, Los Angeles, USA
| | - Alyssa Franks
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Isabelle Kwan
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - H Westley Phillips
- Neurosurgery, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, USA
| | - Dennis Y Kim
- Biomedical Sciences, Harbor University of California Los Angeles Medical Center, Los Angeles, USA
| | - Isaac Yang
- Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, USA
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22
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Hansen N, Fitzner D, Stöcker W, Wiltfang J, Bartels C. Mild Cognitive Impairment in Chronic Brain Injury Associated with Serum Anti-AP3B2 Autoantibodies: Report and Literature Review. Brain Sci 2021; 11:1208. [PMID: 34573230 PMCID: PMC8471279 DOI: 10.3390/brainsci11091208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic traumatic brain injury is a condition that predisposes the brain to activate B-cells and produce neural autoantibodies. Anti-adaptor protein 3, subunit B2 (AP3B2) autoantibodies have thus far been associated with diseases affecting the cerebellum or vestibulocerebellum. Through this case report, we aim to broaden the spectrum of anti-AP3B2-associated disease. CASE DESCRIPTION We report on a 51-year-old woman with a brain injury approximately 28 years ago who recently underwent neuropsychological testing, magnetic resonance imaging of the brain (cMRI), and cerebrospinal fluid (CSF) analysis. Neural autoantibodies were determined in serum and CSF. Our patient suffered from mild cognitive impairment (amnestic MCI, multiple domains) with stable memory deficits and a decline in verbal fluency and processing speed within a two-year interval after the first presentation in our memory clinic. Brain MRI showed brain damage in the right temporoparietal, frontolateral region and thalamus, as well as in the left posterior border of the capsula interna and white matter in the frontal region. Since the brain damage, she suffered paresis of the upper extremities on the left side and lower extremities on the right side as well as gait disturbance. Our search for autoantibodies revealed anti-AP3B2 autoantibodies in serum. CONCLUSIONS Our report expands the spectrum of symptoms to mild cognitive impairment in addition to a gait disturbance associated with anti-AP3B2 autoantibodies. Furthermore, it is conceivable that a prior traumatic brain injury could initiate the development of anti-AP3B2-antibody-associated brain autoimmunity, reported here for the first time.
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Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany; (J.W.); (C.B.)
| | - Dirk Fitzner
- Department of Neurology, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Goettingen, Germany;
| | - Winfried Stöcker
- Euroimmun Reference Laboratory, Seekamp 31, 23650 Luebeck, Germany;
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany; (J.W.); (C.B.)
- German Center for Neurodegenerative Diseases (DZNE), Von-Siebold-Str. 3a, 37075 Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany; (J.W.); (C.B.)
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23
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Huibregtse ME, Bazarian JJ, Shultz SR, Kawata K. The biological significance and clinical utility of emerging blood biomarkers for traumatic brain injury. Neurosci Biobehav Rev 2021; 130:433-447. [PMID: 34474049 DOI: 10.1016/j.neubiorev.2021.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/17/2022]
Abstract
HUIBREGTSE, M.E, Bazarian, J.J., Shultz, S.R., and Kawata K. The biological significance and clinical utility of emerging blood biomarkers for traumatic brain injury. NEUROSCI BIOBEHAV REV XX (130) 433-447, 2021.- Blood biomarkers can serve as objective measures to gauge traumatic brain injury (TBI) severity, identify patients at risk for adverse outcomes, and predict recovery duration, yet the clinical use of blood biomarkers for TBI is limited to a select few and only to rule out the need for CT scanning. The biomarkers often examined in neurotrauma research are proteomic markers, which can reflect a range of pathological processes such as cellular damage, astrogliosis, or neuroinflammation. However, proteomic blood biomarkers are vulnerable to degradation, resulting in short half-lives. Emerging biomarkers for TBI may reflect the complex genetic and neurometabolic alterations that occur following TBI that are not captured by proteomics, are less vulnerable to degradation, and are comprised of microRNA, extracellular vesicles, and neurometabolites. Therefore, this review aims to summarize our understanding of how biomarkers for brain injury escape the brain parenchymal space and appear in the bloodstream, update recent research findings in several proteomic biomarkers, and characterize biological significance and examine clinical utility of microRNA, extracellular vesicles, and neurometabolites.
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Affiliation(s)
- Megan E Huibregtse
- Department of Kinesiology, School of Public Health, Indiana University, 1025 E 7th St, Suite 112, Bloomington, IN 47405, USA.
| | - Jeffrey J Bazarian
- Department of Emergency Medicine, University of Rochester Medical Center, 200 E River Rd, Rochester, NY 14623, USA.
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, The Alfred Centre, Level 6, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Medicine, University of Melbourne, Clinical Sciences Building, 4th Floor, 300 Grattan St, Parkville, VIC 3050, Australia.
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, 1025 E 7th St, Suite 112, Bloomington, IN 47405, USA; Program in Neuroscience, College of Arts and Sciences, Indiana University, 1101 E 10th St, Bloomington, IN 47405, USA.
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Al-Adli N, Akbik OS, Rail B, Montgomery E, Caldwell C, Barrie U, Vira S, Al Tamimi M, Bagley CA, Aoun SG. The Clinical Use of Serum Biomarkers in Traumatic Brain Injury: A Systematic Review Stratified by Injury Severity. World Neurosurg 2021; 155:e418-e438. [PMID: 34438102 DOI: 10.1016/j.wneu.2021.08.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Serum biomarkers have gained significant popularity as an adjunctive measure in the evaluation and prognostication of traumatic brain injury (TBI). However, a concise and clinically oriented report of the major markers in function of TBI severity is lacking. This systematic review aims to report current data on the diagnostic and prognostic utility of blood-based biomarkers across the spectrum of TBI. METHODS A literature search of the PubMed/Medline electronic database was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We excluded systematic reviews and meta-analyses that did not provide novel data. The American College of Cardiology/American Heart Association criteria were used to assess levels of evidence. RESULTS An initial 1463 studies were identified. In total, 115 full-text articles reporting on 94 distinct biomarkers met the inclusion criteria. Glasgow Coma Scale scores, computed tomography/magnetic resonance imaging abnormalities, and injury severity scores were the most used clinical diagnostic variables. Glasgow Outcome Scores and 1-, 3-, and 6-month mortality were the most used clinical prognostic variables. Several biomarkers significantly correlated with these variables and had statistically significant different levels in TBI subjects when compared with healthy, orthopedic, and polytrauma controls. The biomarkers also displayed significant variability across mild, moderate, and severe TBI categories, as well as in concussion cases. CONCLUSIONS This review summarizes existing high-quality evidence that supports the use of severity-specific biomarkers in the diagnostic and prognostic evaluation of TBI. These data can be used as a launching platform for the validation of upcoming clinical studies.
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Affiliation(s)
- Nadeem Al-Adli
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.
| | - Omar S Akbik
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Benjamin Rail
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Eric Montgomery
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Christie Caldwell
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Umaru Barrie
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mazin Al Tamimi
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA; Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Nkiliza A, Joshi U, Evans JE, Ait-Ghezala G, Parks M, Crawford F, Mullan M, Abdullah L. Adaptive Immune Responses Associated with the Central Nervous System Pathology of Gulf War Illness. Neurosci Insights 2021; 16:26331055211018458. [PMID: 34104887 PMCID: PMC8155779 DOI: 10.1177/26331055211018458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/26/2021] [Indexed: 11/17/2022] Open
Abstract
Gulf War Illness is a multisymptomatic condition which affects 30% of veterans
from the 1991 Gulf War. While there is evidence for a role of peripheral
cellular and humoral adaptive immune responses in Gulf War Illness, a potential
role of the adaptive immune system in the central nervous system pathology of
this condition remains unknown. Furthermore, many of the clinical features of
Gulf War Illness resembles those of autoimmune diseases, but the biological
processes are likely different as the etiology of Gulf War Illness is linked to
hazardous chemical exposures specific to the Gulf War theatre. This review
discusses Gulf War chemical–induced maladaptive immune responses and a potential
role of cellular and humoral immune responses that may be relevant to the
central nervous system symptoms and pathology of Gulf War Illness. The
discussion may stimulate investigations into adaptive immunity for developing
novel therapies for Gulf War Illness.
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Turner S, Lazarus R, Marion D, Main KL. Molecular and Diffusion Tensor Imaging Biomarkers of Traumatic Brain Injury: Principles for Investigation and Integration. J Neurotrauma 2021; 38:1762-1782. [PMID: 33446015 DOI: 10.1089/neu.2020.7259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The last 20 years have seen the advent of new technologies that enhance the diagnosis and prognosis of traumatic brain injury (TBI). There is recognition that TBI affects the brain beyond initial injury, in some cases inciting a progressive neuropathology that leads to chronic impairments. Medical researchers are now searching for biomarkers to detect and monitor this condition. Perhaps the most promising developments are in the biomolecular and neuroimaging domains. Molecular assays can identify proteins indicative of neuronal injury and/or degeneration. Diffusion imaging now allows sensitive evaluations of the brain's cellular microstructure. As the pace of discovery accelerates, it is important to survey the research landscape and identify promising avenues of investigation. In this review, we discuss the potential of molecular and diffusion tensor imaging (DTI) biomarkers in TBI research. Integration of these technologies could advance models of disease prognosis, ultimately improving care. To date, however, few studies have explored relationships between molecular and DTI variables in patients with TBI. Here, we provide a short primer on each technology, review the latest research, and discuss how these biomarkers may be incorporated in future studies.
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Affiliation(s)
- Stephanie Turner
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Rachel Lazarus
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Donald Marion
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Keith L Main
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
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Lindblad C, Thelin EP. Inflammation, Neurovascular Clearance and Associated Pathologies: A Translational Review Focusing on Traumatic Brain Injury. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11528-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kövesdi E, Szabó-Meleg E, Abrahám IM. The Role of Estradiol in Traumatic Brain Injury: Mechanism and Treatment Potential. Int J Mol Sci 2020; 22:E11. [PMID: 33374952 PMCID: PMC7792596 DOI: 10.3390/ijms22010011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Patients surviving traumatic brain injury (TBI) face numerous neurological and neuropsychological problems significantly affecting their quality of life. Extensive studies over the past decades have investigated pharmacological treatment options in different animal models, targeting various pathological consequences of TBI. Sex and gender are known to influence the outcome of TBI in animal models and in patients, respectively. Apart from its well-known effects on reproduction, 17β-estradiol (E2) has a neuroprotective role in brain injury. Hence, in this review, we focus on the effect of E2 in TBI in humans and animals. First, we discuss the clinical classification and pathomechanism of TBI, the research in animal models, and the neuroprotective role of E2. Based on the results of animal studies and clinical trials, we discuss possible E2 targets from early to late events in the pathomechanism of TBI, including neuroinflammation and possible disturbances of the endocrine system. Finally, the potential relevance of selective estrogenic compounds in the treatment of TBI will be discussed.
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Affiliation(s)
- Erzsébet Kövesdi
- Molecular Neuroendocrinology Research Group, Institute of Physiology, Medical School, Center for Neuroscience, Szentágothai Research Center, University of Pécs, H-7624 Pecs, Hungary;
| | - Edina Szabó-Meleg
- Department of Biophysics, Medical School, University of Pécs, H-7624 Pecs, Hungary;
| | - István M. Abrahám
- Molecular Neuroendocrinology Research Group, Institute of Physiology, Medical School, Center for Neuroscience, Szentágothai Research Center, University of Pécs, H-7624 Pecs, Hungary;
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Li M, Gao W, Ji L, Li J, Jiang W, Ji W. Methane Saline Ameliorates Traumatic Brain Injury through Anti-Inflammatory, Antiapoptotic, and Antioxidative Effects by Activating the Wnt Signalling Pathway. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3852450. [PMID: 33381552 PMCID: PMC7762637 DOI: 10.1155/2020/3852450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/25/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Methane saline (MS) can be used to treat many diseases via its anti-inflammatory, antiapoptotic, and antioxidative activities. However, to date, there is no published evidence as to whether MS has any effect on traumatic brain injury (TBI). The Wnt signalling pathway regulates cell proliferation, differentiation, migration, and apoptosis; however, whether the Wnt signalling pathway regulates any effect of MS on TBI is unknown. This study was designed to explore the role of MS in the treatment of TBI and whether the Wnt pathway is involved. METHODS Sprague-Dawley rats were randomly divided into five groups: sham, TBI, TBI+10 ml/kg MS, TBI+20 ml/kg MS, and TBI+30 ml/kg MS. After induction of TBI, MS was injected intraperitoneally once daily for seven consecutive days. Neurological function was evaluated by the Neurological Severity Score (NSS) at 1, 7, and 14 days after TBI. Haematoxylin-eosin (HE) staining, inflammatory factors, neuron-specific enolase (NSE) staining, oxidative stress, and cell apoptosis were measured and compared 14 d after TBI to identify the optimal dose of MS and to investigate the effect of MS on TBI. In the second experiment, Sprague-Dawley rats were randomly divided into four groups: sham, TBI, TBI+20 ml/kg MS, and TBI+20 ml/kg MS+Dickkopf-1 (DKK-1, a specific inhibitor of the Wnt pathway). NSE, caspase-3, superoxide dismutase (SOD), Wnt3a, and β-catenin were detected by real-time PCR and Western blotting. The results from each group were compared 14 d after TBI to determine the regulatory role of the Wnt pathway. RESULTS Methane saline significantly inhibited inflammation, oxidative stress, and cell apoptosis, thus protecting neurons within 14 days of TBI. The best treatment effect against TBI was obtained with 20 ml/kg MS. When the Wnt pathway was inhibited, the treatment effect of MS was impaired. CONCLUSION Methane saline ameliorates TBI through its anti-inflammatory, antiapoptotic, and antioxidative effects via activation of the Wnt signalling pathway, which plays a part but is not the only mechanism underlying the effects of MS. Thus, MS may be a novel strategy for treating TBI.
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Affiliation(s)
- Meng Li
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, China
| | - Weiman Gao
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, China
| | - Le Ji
- Department of Orthopedics, Shaanxi Provincial People's Hospital, 710068, China
| | - Jia Li
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, China
| | - Wanting Jiang
- Department of Ultrasound Diagnosis, Xi'an People's Hospital (The Fourth Hospital of Xi'an), 710004, China
| | - Wenchen Ji
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, 710061, China
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Abstract
Traumatic brain injury leads to cellular damage which in turn results in the rapid release of damage-associated molecular patterns (DAMPs) that prompt resident cells to release cytokines and chemokines. These in turn rapidly recruit neutrophils, which assist in limiting the spread of injury and removing cellular debris. Microglia continuously survey the CNS (central nervous system) compartment and identify structural abnormalities in neurons contributing to the response. After some days, when neutrophil numbers start to decline, activated microglia and astrocytes assemble at the injury site—segregating injured tissue from healthy tissue and facilitating restorative processes. Monocytes infiltrate the injury site to produce chemokines that recruit astrocytes which successively extend their processes towards monocytes during the recovery phase. In this fashion, monocytes infiltration serves to help repair the injured brain. Neurons and astrocytes also moderate brain inflammation via downregulation of cytotoxic inflammation. Depending on the severity of the brain injury, T and B cells can also be recruited to the brain pathology sites at later time points.
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31
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Lippa SM, Werner JK, Miller MC, Gill JM, Diaz-Arrastia R, Kenney K. Recent Advances in Blood-Based Biomarkers of Remote Combat-Related Traumatic Brain Injury. Curr Neurol Neurosci Rep 2020; 20:54. [PMID: 32984931 DOI: 10.1007/s11910-020-01076-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) is highly prevalent among service members and Veterans (SMVs) and associated with changes in blood-based biomarkers. This manuscript reviews candidate biomarkers months/years following military-associated TBI. RECENT FINDINGS Several blood-based biomarkers have been investigated for diagnostic or prognostic use to inform care years after military-associated TBI. The most promising include increased levels of plasma/serum and exosomal proteins reflecting neuronal, axonal and/or vascular injury, and inflammation, as well as altered microRNA expression and auto-antibodies of central nervous system markers. Diagnostic and prognostic biomarkers of remote TBI outcomes remain in the discovery phase. Current evidence does not yet support single or combination biomarkers for clinical diagnostic use remotely after injury, but there are promising candidates that require validation in larger, longitudinal studies. The use of prognostic biomarkers of future neurodegeneration, however, holds much promise and could improve treatments and/or preventive measures for serious TBI outcomes.
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Affiliation(s)
- Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - J Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Sleep Medicine, WRNMMC, Bethesda, MD, USA.,CNRM, USUHS, Bethesda, MD, USA
| | - Matthew C Miller
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M Gill
- CNRM, USUHS, Bethesda, MD, USA.,Brain Tissue Injury, NINR, NIH, Bethesda, MD, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA. .,Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Bellastella G, Maiorino MI, Longo M, Cirillo P, Scappaticcio L, Vietri MT, Bellastella A, Esposito K, De Bellis A. Impact of Pituitary Autoimmunity and Genetic Disorders on Growth Hormone Deficiency in Children and Adults. Int J Mol Sci 2020; 21:ijms21041392. [PMID: 32092880 PMCID: PMC7073103 DOI: 10.3390/ijms21041392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/24/2022] Open
Abstract
Growth hormone (GH), mostly through its peripheral mediator, the insulin-like growth factor 1(IGF1), in addition to carrying out its fundamental action to promote linear bone growth, plays an important role throughout life in the regulation of intermediate metabolism, trophism and function of various organs, especially the cardiovascular, muscular and skeletal systems. Therefore, if a prepubertal GH secretory deficiency (GHD) is responsible for short stature, then a deficiency in adulthood identifies a nosographic picture classified as adult GHD syndrome, which is characterized by heart, muscle, bone, metabolic and psychic abnormalities. A GHD may occur in patients with pituitary autoimmunity; moreover, GHD may also be one of the features of some genetic syndromes in association with other neurological, somatic and immune alterations. This review will discuss the impact of pituitary autoimmunity on GHD and the occurrence of GHD in the context of some genetic disorders. Moreover, we will discuss some genetic alterations that cause GH and IGF-1 insensitivity and the arguments in favor and against the influence of GH/IGF-1 on longevity and cancer in the light of the papers on these issues that so far appear in the literature.
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Affiliation(s)
- Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.B.); (M.I.M.); (M.L.)
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.B.); (M.I.M.); (M.L.)
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
| | - Miriam Longo
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.B.); (M.I.M.); (M.L.)
| | - Paolo Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
| | - Maria Teresa Vietri
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Antonio Bellastella
- Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
- Unit of Diabetes, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Annamaria De Bellis
- Unit of Endocrinology and Metabolic Diseases, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.B.); (M.I.M.); (M.L.)
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.C.); (L.S.); (K.E.)
- Correspondence: ; Tel.: +39-0815665245
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Wickel J, Chung HY, Kirchhof K, Boeckler D, Merkelbach S, Kuzman P, Mueller WC, Geis C, Günther A. Encephalitis with radial perivascular emphasis: Not necessarily associated with GFAP antibodies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/2/e670. [PMID: 32019875 PMCID: PMC7051210 DOI: 10.1212/nxi.0000000000000670] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/26/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Autoimmune steroid-responsive meningoencephalomyelitis with linear perivascular gadolinium enhancement in brain MRI is regarded as glial fibrillary acidic protein (GFAP) astrocytopathy characterized by anti-GFAP antibodies (ABs). We questioned whether anti-GFAP ABs are necessarily associated with this syndrome. METHODS Two patients with a strikingly similar disease course suggestive of autoimmune GFAP astrocytopathy are reported. Clinical examination, MRI, laboratory, and CSF analysis were performed. Neuropathologic examination of brain tissue was obtained from one patient. Serum and CSF were additionally tested using mouse brain slices, microglia-astrocyte cocultures, and a GFAP-specific cell-based assay. RESULTS Both patients presented with subacute influenza-like symptoms and developed severe neurocognitive and neurologic deficits and impaired consciousness. MRIs of both patients revealed radial perivascular gadolinium enhancement extending from the lateral ventricles to the white matter suggestive of autoimmune GFAP astrocytopathy. Both patients responded well to high doses of methylprednisolone. Only one patient had anti-GFAP ABs with a typical staining pattern of astrocytes, whereas serum and CSF of the other patient were negative and showed neither reactivity to brain tissue nor to vital or permeabilized astrocytes. Neuropathologic examination of the anti-GFAP AB-negative patient revealed infiltration of macrophages and T cells around blood vessels and activation of microglia without obvious features of clasmatodendrosis. CONCLUSIONS The GFAP-AB negative patient had both a striking (para)clinical similarity and an immediate response to immunotherapy. This supports the hypothesis that the clinical spectrum of steroid-responsive meningoencephalomyelitis suggestive of autoimmune GFAP astrocytopathy may be broader and may comprise also seronegative cases.
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Affiliation(s)
- Jonathan Wickel
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany.
| | - Ha-Yeun Chung
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Klaus Kirchhof
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - David Boeckler
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Stefan Merkelbach
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Peter Kuzman
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Wolf C Mueller
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Christian Geis
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
| | - Albrecht Günther
- From the Hans Berger Department of Neurology (J.W., H.-Y.C., C.G., A.G.), Section of Translational Neuroimmunology, Jena University Hospital Germany; Department of Neuroradiology (K.K.), Jena University Hospital, Germany; Department of Neurology (D.B.), Sana Hospital Borna, Germany; Department of Neurology (S.M.), Heinrich-Braun Hospital, Zwickau; and Department of Neuropathology (P.K., W.C.M.), Leipzig University Hospital, Germany
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Fraunberger E, Esser MJ. Neuro-Inflammation in Pediatric Traumatic Brain Injury-from Mechanisms to Inflammatory Networks. Brain Sci 2019; 9:E319. [PMID: 31717597 PMCID: PMC6895990 DOI: 10.3390/brainsci9110319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022] Open
Abstract
Compared to traumatic brain injury (TBI) in the adult population, pediatric TBI has received less research attention, despite its potential long-term impact on the lives of many children around the world. After numerous clinical trials and preclinical research studies examining various secondary mechanisms of injury, no definitive treatment has been found for pediatric TBIs of any severity. With the advent of high-throughput and high-resolution molecular biology and imaging techniques, inflammation has become an appealing target, due to its mixed effects on outcome, depending on the time point examined. In this review, we outline key mechanisms of inflammation, the contribution and interactions of the peripheral and CNS-based immune cells, and highlight knowledge gaps pertaining to inflammation in pediatric TBI. We also introduce the application of network analysis to leverage growing multivariate and non-linear inflammation data sets with the goal to gain a more comprehensive view of inflammation and develop prognostic and treatment tools in pediatric TBI.
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Affiliation(s)
- Erik Fraunberger
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada;
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Michael J. Esser
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada;
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pediatrics, Cumming School Of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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35
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Neurochemical biomarkers in spinal cord injury. Spinal Cord 2019; 57:819-831. [PMID: 31273298 DOI: 10.1038/s41393-019-0319-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/02/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN This is a narrative review of the literature on neurochemical biomarkers in spinal cord injury (SCI). OBJECTIVES The objective was to summarize the literature on neurochemical biomarkers in SCI and describe their use in facilitating clinical trials for SCI. Clinical trials in spinal cord injury (SCI) have been notoriously difficult to conduct, as exemplified by the paucity of definitive prospective randomized trials that have been completed, to date. This is related to the relatively low incidence and the complexity and heterogeneity of the human SCI condition. Given the increasing number of promising approaches that are emerging from the laboratory which are vying for clinical evaluation, novel strategies to help facilitate clinical trials are needed. METHODS A literature review was conducted, with a focus on neurochemical biomarkers that have been described in human neurotrauma. RESULTS We describe advances in our understanding of neurochemical biomarkers as they pertain to human SCI. The application of biomarkers from serum and cerebrospinal fluid (CSF) has been led by efforts in the human traumatic brain injury (TBI) literature. A number of promising biomarkers have been described in human SCI whereby they may assist in stratifying injury severity and predicting outcome. CONCLUSIONS Several time-specific biomarkers have been described for acute SCI and for chronic SCI. These appear promising for stratifying injury severity and potentially predicting outcome. The subsequent application within a clinical trial will help to demonstrate their utility in facilitating the study of novel approaches for SCI.
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The immunological response to traumatic brain injury. J Neuroimmunol 2019; 332:112-125. [DOI: 10.1016/j.jneuroim.2019.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022]
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Risling M, Smith D, Stein TD, Thelin EP, Zanier ER, Ankarcrona M, Nilsson P. Modelling human pathology of traumatic brain injury in animal models. J Intern Med 2019; 285:594-607. [PMID: 30963638 PMCID: PMC9351987 DOI: 10.1111/joim.12909] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is caused by a head impact with a force exceeding regular exposure from normal body movement which the brain normally can accommodate. People affected include, but are not restricted to, sport athletes in American football, ice hockey, boxing as well as military personnel. Both single and repetitive exposures may affect the brain acutely and can lead to chronic neurodegenerative changes including chronic traumatic encephalopathy associated with the development of dementia. The changes in the brain following TBI include neuroinflammation, white matter lesions, and axonal damage as well as hyperphosphorylation and aggregation of tau protein. Even though the human brain gross anatomy is different from rodents implicating different energy transfer upon impact, especially rotational forces, animal models of TBI are important tools to investigate the changes that occur upon TBI at molecular and cellular levels. Importantly, such models may help to increase the knowledge of how the pathologies develop, including the spreading of tau pathologies, and how to diagnose the severity of the TBI in the clinic. In addition, animal models are helpful in the development of novel biomarkers and can also be used to test potential disease-modifying compounds in a preclinical setting.
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Affiliation(s)
- M Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - D Smith
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - T D Stein
- VA Boston Healthcare System, Boston, MA, USA.,Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - E P Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - E R Zanier
- Department of Neuroscience, Mario Negri Institute, IRCCS Milano, Milano, Italy
| | - M Ankarcrona
- Division of Neurogeriatrics, Department of Neurobiology, Care Science and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - P Nilsson
- Division of Neurogeriatrics, Department of Neurobiology, Care Science and Society, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
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De Bellis A, Bellastella G, Maiorino MI, Costantino A, Cirillo P, Longo M, Pernice V, Bellastella A, Esposito K. The role of autoimmunity in pituitary dysfunction due to traumatic brain injury. Pituitary 2019; 22:236-248. [PMID: 30847776 DOI: 10.1007/s11102-019-00953-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) is one of the most common causes of mortality and long-term disability and it is associated with an increased prevalence of neuroendocrine dysfunctions. Post-traumatic hypopituitarism (PTHP) results in major physical, psychological and social consequences leading to impaired quality of life. PTHP can occur at any time after traumatic event, evolving through various ways and degrees of deficit, requiring appropriate screening for early detection and treatment. Although the PTHP pathophysiology remains to be elucitated, on the basis of proposed hypotheses it seems to be the result of combined pathological processes, with a possible role played by hypothalamic-pituitary autoimmunity (HPA). This review is aimed at focusing on this possible role in the development of PTHP and its potential clinical consequences, on the basis of the data so far appeared in the literature and of some results of personal studies on this issue. METHODS Scrutinizing the data so far appeared in literature on this topic, we have found only few studies evaluating the autoimmune pattern in affected patients, searching in particular for antipituitary and antihypothalamus autoantibodies (APA and AHA, respectively) by simple indirect immunofluorescence. RESULTS The presence of APA and/or AHA at high titers was associated with an increased risk of onset/persistence of PTHP. CONCLUSIONS HPA seems to contribute to TBI-induced pituitary damage and related PTHP. However, further prospective studies in a larger cohort of patients are needed to define etiopathogenic and diagnostic role of APA/AHA in development of post-traumatic hypothalamic/pituitary dysfunctions after a TBI.
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Affiliation(s)
- Annamaria De Bellis
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angela Costantino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Cirillo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vlenia Pernice
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gan ZS, Stein SC, Swanson R, Guan S, Garcia L, Mehta D, Smith DH. Blood Biomarkers for Traumatic Brain Injury: A Quantitative Assessment of Diagnostic and Prognostic Accuracy. Front Neurol 2019; 10:446. [PMID: 31105646 PMCID: PMC6498532 DOI: 10.3389/fneur.2019.00446] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
Blood biomarkers have been explored for their potential to provide objective measures in the assessment of traumatic brain injury (TBI). However, it is not clear which biomarkers are best for diagnosis and prognosis in different severities of TBI. Here, we compare existing studies on the discriminative abilities of serum biomarkers for four commonly studied clinical situations: detecting concussion, predicting intracranial damage after mild TBI (mTBI), predicting delayed recovery after mTBI, and predicting adverse outcome after severe TBI (sTBI). We conducted a literature search of publications on biomarkers in TBI published up until July 2018. Operating characteristics were pooled for each biomarker for comparison. For detecting concussion, 4 biomarker panels and creatine kinase B type had excellent discriminative ability. For detecting intracranial injury and the need for a head CT scan after mTBI, 2 biomarker panels, and hyperphosphorylated tau had excellent operating characteristics. For predicting delayed recovery after mTBI, top candidates included calpain-derived αII-spectrin N-terminal fragment, tau A, neurofilament light, and ghrelin. For predicting adverse outcome following sTBI, no biomarker had excellent performance, but several had good performance, including markers of coagulation and inflammation, structural proteins in the brain, and proteins involved in homeostasis. The highest-performing biomarkers in each of these categories may provide insight into the pathophysiologies underlying mild and severe TBI. With further study, these biomarkers have the potential to be used alongside clinical and radiological data to improve TBI diagnostics, prognostics, and evidence-based medical management.
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Affiliation(s)
- Zoe S Gan
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Sherman C Stein
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Randel Swanson
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Rehabilitation Medicine Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Center for Neurotrauma, Neurodegeneration and Restoration, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Neurosurgery, Perelman School of Medicine, Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
| | - Shaobo Guan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Lizette Garcia
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Devanshi Mehta
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Douglas H Smith
- Department of Neurosurgery, Perelman School of Medicine, Center for Brain Injury and Repair, University of Pennsylvania, Philadelphia, PA, United States
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Javidi E, Magnus T. Autoimmunity After Ischemic Stroke and Brain Injury. Front Immunol 2019; 10:686. [PMID: 31001280 PMCID: PMC6454865 DOI: 10.3389/fimmu.2019.00686] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022] Open
Abstract
Ischemic Stroke is a major cause of morbidity and mortality worldwide. Sterile inflammation occurs after both stroke subtypes and contributes to neuronal injury and damage to the blood-brain barrier with release of brain antigens and a potential induction of autoimmune responses that escape central and peripheral tolerance mechanisms. In stroke patients, the detection of T cells and antibodies specific to neuronal antigens suggests a role of humoral adaptive immunity. In experimental models stroke leads to a significant increase of autoreactive T and B cells to CNS antigens. Lesion volume and functional outcome in stroke patients and murine stroke models are connected to antigen-specific responses to brain proteins. In patients with traumatic brain injury (TBI) a range of antibodies against brain proteins can be detected in serum samples. In this review, we will summarize the role of autoimmunity in post-lesional conditions and discuss the role of B and T cells and their potential neuroprotective or detrimental effects.
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Affiliation(s)
- Ehsan Javidi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Agoston DV, Kamnaksh A. Protein biomarkers of epileptogenicity after traumatic brain injury. Neurobiol Dis 2019; 123:59-68. [PMID: 30030023 PMCID: PMC6800147 DOI: 10.1016/j.nbd.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 12/15/2022] Open
Abstract
Traumatic brain injury (TBI) is a major risk factor for acquired epilepsy. Post-traumatic epilepsy (PTE) develops over time in up to 50% of patients with severe TBI. PTE is mostly unresponsive to traditional anti-seizure treatments suggesting distinct, injury-induced pathomechanisms in the development of this condition. Moderate and severe TBIs cause significant tissue damage, bleeding, neuron and glia death, as well as axonal, vascular, and metabolic abnormalities. These changes trigger a complex biological response aimed at curtailing the physical damage and restoring homeostasis and functionality. Although a positive correlation exists between the type and severity of TBI and PTE, there is only an incomplete understanding of the time-dependent sequelae of TBI pathobiologies and their role in epileptogenesis. Determining the temporal profile of protein biomarkers in the blood (serum or plasma) and cerebrospinal fluid (CSF) can help to identify pathobiologies underlying the development of PTE, high-risk individuals, and disease modifying therapies. Here we review the pathobiological sequelae of TBI in the context of blood- and CSF-based protein biomarkers, their potential role in epileptogenesis, and discuss future directions aimed at improving the diagnosis and treatment of PTE.
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Affiliation(s)
- Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA.
| | - Alaa Kamnaksh
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, MD, USA
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Manchester K, Corrigan JD, Singichetti B, Huang L, Bogner J, Yi H, Yang J. Current health status and history of traumatic brain injury among Ohio adults. Inj Prev 2019; 26:129-137. [PMID: 30803993 DOI: 10.1136/injuryprev-2018-043056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) is prevalent in 21% of adult, non-institutionalised residents of Ohio. Prior history has been associated with lower incomes, inability to work and disability. The current study sought to evaluate the relationship between lifetime history and adverse health conditions. METHODS Data came from the 2014 Ohio Behavioral Risk Factors Surveillance System, which included a state-specific module eliciting lifetime history of TBI. RESULTS Non-institutionalised adults living in Ohio who have had at least one TBI with LOC were more likely to report fair or poor health, more days of poor health, more days when poor health limited activities, being diagnosed with a chronic condition and having less than 7 hours of sleep per night. The relationship with increasing number of TBIs was monotonic, with the likelihood of adverse health increasing as the number increased. A similar relationship was observed for increasing severity of the worst lifetime TBI. Experiencing a first TBI before age 15 was associated with poorer health but was not statistically different than incurring a first after age 15. CONCLUSIONS Adults who have experienced TBI with LOC in their lifetime are two to three times more likely to experience adverse health conditions when compared with same age-matched, sex-matched and race-matched adults without such history. These findings support re-examining the public health burden of TBI in light of lifetime exposure and not just the consequences of an index injury.
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Affiliation(s)
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Bhavna Singichetti
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lihong Huang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghia, China
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Honggang Yi
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Biostatistics, Nanjing Medical University, Nanjing, China
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,College of Medicine, The Ohio State Univeristy, Columbus, Ohio, USA
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Hsu ET, Gangolli M, Su S, Holleran L, Stein TD, Alvarez VE, McKee AC, Schmidt RE, Brody DL. Astrocytic degeneration in chronic traumatic encephalopathy. Acta Neuropathol 2018; 136:955-972. [PMID: 30194648 DOI: 10.1007/s00401-018-1902-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repeated head traumas. Using immunohistochemistry for glial fibrillary acidic protein as a marker, plus automated quantitative analysis, we examined the characteristics and extent of astrogliosis present in stage III and IV CTE, along with Alzheimer's disease (AD), and frontotemporal dementia (FTD) cases. Astrogliosis in CTE patients was more diffuse compared to that of AD and FTD patients, which was concentrated in the sulcal depths. Of 14 patients with CTE, 10 exhibited signs of a degenerating astrocyte pathology, characterized by beaded, broken astrocytic processes. This astrocytic degeneration was typically found to be diffuse throughout the white matter, although two cases demonstrated astrocytic degeneration in the gray matter. The degeneration was also observed in 2 of 3 AD and 2 of 3 FTD brains, with overall similar characteristics across diseases. There was minimal to no astrocytic degeneration in six age-matched controls with no neurodegenerative disease. We found that the extent of the white matter astrocytic degeneration was strongly correlated with the level of overall astrogliosis in both the white and gray matter. However, astrocytic degeneration was not correlated with the overall extent of tau pathology. Specifically, there was no correlation between levels of p-tau in the sulcal depths and astrocytic degeneration in the white matter adjacent to the sulcal depths. Thus, astrocytic degeneration and overall astrogliosis appear to represent distinct pathological features of CTE. Further investigation into these astroglial pathologies could provide new insights into underlying disease mechanisms and represent a potential target for in vivo assessment of CTE as well as other neurodegenerative disorders.
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Kornguth S, Rutledge N. Integration of Biomarkers Into a Signature Profile of Persistent Traumatic Brain Injury Involving Autoimmune Processes Following Water Hammer Injury From Repetitive Head Impacts. Biomark Insights 2018; 13:1177271918808216. [PMID: 30397383 PMCID: PMC6207974 DOI: 10.1177/1177271918808216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assemble an algorithm that will describe a "Signature" predictive of an individual's vulnerability to persistent traumatic brain injury (TBI). SUBJECTS AND METHODS Studies of athletes and warriors who are subjected to repeated head impacts with rapid acceleration/deceleration forces are used to assist in the diagnosis and management of TBI-affected individuals. Data from multiple areas, including clinical, anatomical, magnetic resonance imaging, cognitive function, and biochemical analyses, are integrated to provide a Signature of persistent TBI. RESULTS Studies to date indicate that susceptibility to TBI results from an interaction between host genetic and structural vulnerability factors and force and torque of impact on the head and torso. The host factors include molecular markers affecting immune and inflammatory responses to stress/insult as well as anatomical features such as the degree of transcortical fiber projections and vascular malformations. The host response to forceful impact includes the release of intracellular neural proteins and nucleic acids into the cerebrospinal fluid and vascular compartment as well as mobilization of cytokines and macrophages into the central nervous system with subsequent activation of microglia and inflammatory responses including autoimmune processes. Maximum impact to the base of the sulci via a "water hammer effect" is consistent with the localization of microvascular and inflammatory responses in the affected brain region. CONCLUSIONS An assessment of an individuals' predisposition to persistent TBI with delayed cognitive deficits and behavioral changes requires an understanding of host vulnerability (genetic factors and brain structure) and external stressors (force and torque of impact as well as repetitive head injury and time interval between impacts). An algorithm that has utility in predicting vulnerability to TBI will include qualitative and quantitative measures of the host factors weighted against post impact markers of neural injury. Implementation of the resulting "Signature" of vulnerability at early stages of injury will help inform athletes and warriors, along with commanders and management, of the risk/benefit approaches that will markedly diminish health care costs to the nation and suffering to this population. This report attempts to define a strategy to create such an algorithm.
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Affiliation(s)
- Steven Kornguth
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | - Neal Rutledge
- Department of Psychology, The University of Texas at Austin and Austin Radiological Association, Austin, TX, USA
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Di C, Zeng Y, Mao J, Shen Z, Gu W. Dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein in patients with delayed encephalopathy after acute carbon monoxide poisoning. Pak J Med Sci 2018; 34:945-949. [PMID: 30190758 PMCID: PMC6115593 DOI: 10.12669/pjms.344.15363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To study the dynamic changes and clinical significance of serum S100B protein and glial fibrillary acidic protein (GFAP) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods: This study was conducted among DEACMP patients who were hospitalized from November 2014 to February 2016. Serum levels of S100B and GFAP in 66 DEACMP patients were measured by ELISA. Changes in patient states were examined dynamically using activities of daily living (ADL) scale, information-memory-concentration test (IMCT) and Hasegawa’s dementia scale (HDS), and compared with those of 64 patients without DE after ACMP. Results: Serum S100B [(0.59 ± 0.11) ng/ml] and GFAP [(227.67 ± 12.43) ng/ml] levels of DEACMP group in acute phase were significantly higher than those of ACMP group [(0.48 ± 0.10) ng/ml and (178.91 ± 11.47) ng/ml] and DEACMP group in recovery phase [(0.49 ± 0.12) ng/ml and (179.54 ± 12.32) ng/ml] (all P<0.05). Serum S100B and GFAP levels of DEACMP group were significantly correlated in both acute and recovery phases (r=0.432 in acute phase, P=0.007; r=0.378 in recovery phase, P=0.034). ADL, HDS and IMCT scores of DEACMP group in acute phase were (45.12 ± 3.12), (7.98 ± 1.02) and (9.61 ± 1.41) points respectively, which were significantly different from those of recovery phase [(33.25 ± 3.09), (16.13 ± 1.17) and (19.54 ± 1.43) points respectively] (P<0.05). Conclusions: DEACMP was accompanied by secondary brain injury, for which glial activation may be important. Serum S100B and GFAP levels may be related to prognosis.
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Affiliation(s)
- Chong Di
- Chong Di, Emergency Center, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
| | - Yun Zeng
- Yun Zeng, Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing 210009, Jiangsu Province, China Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine (TCM) Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jingyu Mao
- Jingyu Mao, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine (TCM) Prevention and Treatment of Tumor, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhengjie Shen
- Zhengjie Shen, Medical Oncology of Zhangjiagang First People's Hospital, Zhangjiagang 215600, Jiangsu Province, China
| | - Wenzhe Gu
- Wenzhe Gu, Depr. of Otorhinolaryngology, Zhangjiagang Hospital of Traditional Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
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DeDominicis KE, Hwang H, Cartagena CM, Shear DA, Boutté AM. Cerebrospinal Fluid Biomarkers Are Associated With Glial Fibrillary Acidic Protein and αII-spectrin Breakdown Products in Brain Tissues Following Penetrating Ballistic-Like Brain Injury in Rats. Front Neurol 2018; 9:490. [PMID: 30022967 PMCID: PMC6039567 DOI: 10.3389/fneur.2018.00490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/05/2018] [Indexed: 11/21/2022] Open
Abstract
Treatments to improve outcomes following severe traumatic brain injury (TBI) are limited but may benefit from understanding subacute-chronic brain protein profiles and identifying biomarkers suitable for use in this time. Acute alterations in the well-known TBI biomarkers glial fibrillary acidic protein (GFAP), αII-spectrin, and their breakdown products (BDPs) have been well established, but little is known about the subacute-chronic post-injury profiles of these biomarkers. Thus, the current study was designed to determine the extended profile of these TBI-specific biomarkers both in brain tissue and cerebral spinal fluid (CSF). Protein abundance was evaluated in brain tissue samples taken from regions of interest and in CSF at 24 h, 3 days, 7 days, 1 month, and 3 months following severe TBI in rats. Results showed increased full length GFAP (GFAP-FL) and GFAP-BDPs starting at 24 h that remained significantly elevated in most brain regions out to 3 months post-injury. However, in CSF, neither GFAP-FL nor GFAP-BDPs were elevated as a consequence of injury. Regional-specific reduction in αII-spectrin was evident in brain tissue samples from 24 h through 3 months. In contrast, SBDP-145/150 was robustly elevated in most brain regions and in CSF from 24 h through 7 days. Correlation analyses revealed numerous significant relationships between proteins in CSF and brain tissue or neurological deficits. This work indicates that TBI results in chronic changes in brain protein levels of well-known TBI biomarkers GFAP, αII-spectrin, and their BDPs and that SBDP-145/150 may have utility as an acute-chronic biomarker.
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Affiliation(s)
- Kristen E DeDominicis
- Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Hye Hwang
- Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Casandra M Cartagena
- Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Deborah A Shear
- Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Angela M Boutté
- Brain Trauma Neuroprotection and Neurorestoration Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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Srienc A, Narang P, Sarai S, Xiong Y, Lippmann S. Is Electroconvulsive Therapy a Treatment for Depression Following Traumatic Brain Injury? INNOVATIONS IN CLINICAL NEUROSCIENCE 2018; 15:43-46. [PMID: 29707426 PMCID: PMC5906090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Traumatic brain injury (TBI) can be caused by blunt or penetrating injury to the head. The pathophysiological evolution of TBI involves complex biochemical and genetic changes. Common sequelae of TBI include seizures and psychiatric disorders, particularly depression. In considering pharmacologic interventions for treating post-TBI depression, it is important to remember that TBI patients have a higher risk of seizures; therefore, the benefits of prescribing medications that lower the seizure threshold need to be weighed against the risk of seizures. When post-TBI depression is refractory to pharmacotherapy, electroconvulsive therapy (ECT) could provide an alternative therapeutic strategy. Data remain sparse on using ECT in this seizure-prone population, but three case reports demonstrated good outcomes. Currently, not enough evidence exists to provide clinical recommendations for using ECT for treating post-TBI depression, and more research is needed to generate guidelines on how best to treat depression in TBI patients. However, the preliminary data on using ECT in patients with TBI are promising. If proven safe, ECT could be a powerful tool to treat post-TBI depression.
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Affiliation(s)
- Anja Srienc
- Dr. Srienc is with the Medical Scientist Training Program & Graduate Program in Neuroscience at the University of Minnesota in Minneapolis-St. Paul, Minnesota
- Dr. Narang is Assistant Professor at the University of Minnesota, and Staff Physician, Lead ECT Psychiatrist at the Regions Hospital in Minneapolis-St. Paul, Minnesota
- Dr. Sarai is Research Scholar at the University of Louisville School of Medicine in Louisville, Kentucky
- Dr. Xiong is Psychiatry Resident, HCMC-Regions Psychiatry Residency Program in Minneapolis, Minnesota
- Dr. Lippmann is Professor of Psychiatry at the University of Louisville School of Medicine in Louisville, Kentucky
| | - Puneet Narang
- Dr. Srienc is with the Medical Scientist Training Program & Graduate Program in Neuroscience at the University of Minnesota in Minneapolis-St. Paul, Minnesota
- Dr. Narang is Assistant Professor at the University of Minnesota, and Staff Physician, Lead ECT Psychiatrist at the Regions Hospital in Minneapolis-St. Paul, Minnesota
- Dr. Sarai is Research Scholar at the University of Louisville School of Medicine in Louisville, Kentucky
- Dr. Xiong is Psychiatry Resident, HCMC-Regions Psychiatry Residency Program in Minneapolis, Minnesota
- Dr. Lippmann is Professor of Psychiatry at the University of Louisville School of Medicine in Louisville, Kentucky
| | - Simrat Sarai
- Dr. Srienc is with the Medical Scientist Training Program & Graduate Program in Neuroscience at the University of Minnesota in Minneapolis-St. Paul, Minnesota
- Dr. Narang is Assistant Professor at the University of Minnesota, and Staff Physician, Lead ECT Psychiatrist at the Regions Hospital in Minneapolis-St. Paul, Minnesota
- Dr. Sarai is Research Scholar at the University of Louisville School of Medicine in Louisville, Kentucky
- Dr. Xiong is Psychiatry Resident, HCMC-Regions Psychiatry Residency Program in Minneapolis, Minnesota
- Dr. Lippmann is Professor of Psychiatry at the University of Louisville School of Medicine in Louisville, Kentucky
| | - Yee Xiong
- Dr. Srienc is with the Medical Scientist Training Program & Graduate Program in Neuroscience at the University of Minnesota in Minneapolis-St. Paul, Minnesota
- Dr. Narang is Assistant Professor at the University of Minnesota, and Staff Physician, Lead ECT Psychiatrist at the Regions Hospital in Minneapolis-St. Paul, Minnesota
- Dr. Sarai is Research Scholar at the University of Louisville School of Medicine in Louisville, Kentucky
- Dr. Xiong is Psychiatry Resident, HCMC-Regions Psychiatry Residency Program in Minneapolis, Minnesota
- Dr. Lippmann is Professor of Psychiatry at the University of Louisville School of Medicine in Louisville, Kentucky
| | - Steven Lippmann
- Dr. Srienc is with the Medical Scientist Training Program & Graduate Program in Neuroscience at the University of Minnesota in Minneapolis-St. Paul, Minnesota
- Dr. Narang is Assistant Professor at the University of Minnesota, and Staff Physician, Lead ECT Psychiatrist at the Regions Hospital in Minneapolis-St. Paul, Minnesota
- Dr. Sarai is Research Scholar at the University of Louisville School of Medicine in Louisville, Kentucky
- Dr. Xiong is Psychiatry Resident, HCMC-Regions Psychiatry Residency Program in Minneapolis, Minnesota
- Dr. Lippmann is Professor of Psychiatry at the University of Louisville School of Medicine in Louisville, Kentucky
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48
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Wang KK, Yang Z, Zhu T, Shi Y, Rubenstein R, Tyndall JA, Manley GT. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn 2018; 18:165-180. [PMID: 29338452 PMCID: PMC6359936 DOI: 10.1080/14737159.2018.1428089] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major worldwide neurological disorder of epidemic proportions. To date, there are still no FDA-approved therapies to treat any forms of TBI. Encouragingly, there are emerging data showing that biofluid-based TBI biomarker tests have the potential to diagnose the presence of TBI of different severities including concussion, and to predict outcome. Areas covered: The authors provide an update on the current knowledge of TBI biomarkers, including protein biomarkers for neuronal cell body injury (UCH-L1, NSE), astroglial injury (GFAP, S100B), neuronal cell death (αII-spectrin breakdown products), axonal injury (NF proteins), white matter injury (MBP), post-injury neurodegeneration (total Tau and phospho-Tau), post-injury autoimmune response (brain antigen-targeting autoantibodies), and other emerging non-protein biomarkers. The authors discuss biomarker evidence in TBI diagnosis, outcome prognosis and possible identification of post-TBI neurodegernative diseases (e.g. chronic traumatic encephalopathy and Alzheimer's disease), and as theranostic tools in pre-clinical and clinical settings. Expert commentary: A spectrum of biomarkers is now at or near the stage of formal clinical validation of their diagnostic and prognostic utilities in the management of TBI of varied severities including concussions. TBI biomarkers could serve as a theranostic tool in facilitating drug development and treatment monitoring.
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Affiliation(s)
- Kevin K Wang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Zhihui Yang
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Tian Zhu
- a Program for Neurotrauma, Neuroproteomics & Biomarkers Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry , University of Florida , Gainesville , Florida , USA
| | - Yuan Shi
- b Department Of Pediatrics, Daping Hospital, Chongqing , Third Military Medical University , Chongqing , China
| | - Richard Rubenstein
- c Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology , SUNY Downstate Medical Center , Brooklyn , NY , USA
| | - J Adrian Tyndall
- d Department of Emergency Medicine , University of Florida , Gainesville , Florida , USA
| | - Geoff T Manley
- e Brain and Spinal Injury Center , San Francisco General Hospital , San Francisco , CA , USA
- f Department of Neurological Surgery , University of California, San Francisco , San Francisco , CA , USA
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49
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Najem D, Rennie K, Ribecco-Lutkiewicz M, Ly D, Haukenfrers J, Liu Q, Nzau M, Fraser DD, Bani-Yaghoub M. Traumatic brain injury: classification, models, and markers. Biochem Cell Biol 2018; 96:391-406. [PMID: 29370536 DOI: 10.1139/bcb-2016-0160] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Due to its high incidence rate and often long-term sequelae, TBI contributes significantly to increasing costs of health care expenditures annually. Unfortunately, advances in the field have been stifled by patient and injury heterogeneity that pose a major challenge in TBI prevention, diagnosis, and treatment. In this review, we briefly discuss the causes of TBI, followed by its prevalence, classification, and pathophysiology. The current imaging detection methods and animal models used to study brain injury are examined. We discuss the potential use of molecular markers in detecting and monitoring the progression of TBI, with particular emphasis on microRNAs as a novel class of molecular modulators of injury and its repair in the neural tissue.
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Affiliation(s)
- Dema Najem
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Kerry Rennie
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Maria Ribecco-Lutkiewicz
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Dao Ly
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Julie Haukenfrers
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada
| | - Qing Liu
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada.,b Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Munyao Nzau
- c Paediatric Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Douglas D Fraser
- d Children's Health Research Institute, London, ON N6C 2V5, Canada.,e Departments of Pediatrics and Clinical Neurological Sciences, Western University, London, ON N6A 3K7, Canada
| | - Mahmud Bani-Yaghoub
- a Department of Translational Bioscience, National Research Council Canada, Ottawa, ON K1A 0R6, Canada.,f Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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50
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Kornguth S, Rutledge N, Perlaza G, Bray J, Hardin A. A Proposed Mechanism for Development of CTE Following Concussive Events: Head Impact, Water Hammer Injury, Neurofilament Release, and Autoimmune Processes. Brain Sci 2017; 7:E164. [PMID: 29257064 PMCID: PMC5742767 DOI: 10.3390/brainsci7120164] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 12/25/2022] Open
Abstract
During the past decade, there has been an increasing interest in early diagnosis and treatment of traumatic brain injuries (TBI) that lead to chronic traumatic encephalopathy (CTE). The subjects involved range from soldiers exposed to concussive injuries from improvised explosive devices (IEDs) to a significant number of athletes involved in repetitive high force impacts. Although the forces from IEDs are much greater by a magnitude than those from contact sports, the higher frequency associated with contact sports allows for more controlled assessment of the mechanism of action. In our study, we report findings in university-level women soccer athletes followed over a period of four and a half years from accession to graduation. Parameters investigated included T1-, T2-, and susceptibility-weighted magnetic resonance images (SWI), IMPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and C3 Logix behavioral and physiological assessment measures. The MRI Studies show several significant findings: first, a marked increase in the width of sulci in the frontal to occipital cortices; second, an appearance of subtle hemorrhagic changes at the base of the sulci; third was a sustained reduction in total brain volume in several soccer players at a developmental time when brain growth is generally seen. Although all of the athletes successfully completed their college degree and none exhibited long term clinical deficits at the time of graduation, the changes documented by MRI represent a clue to the pathological mechanism following an injury paradigm. The authors propose that our findings and those of prior publications support a mechanism of injury in CTE caused by an autoimmune process associated with the release of neural proteins from nerve cells at the base of the sulcus from a water hammer injury effect. As evidence accumulates to support this hypothesis, there are pharmacological treatment strategies that may be able to mitigate the development of long-term disability from TBI.
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Affiliation(s)
- Steven Kornguth
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA.
- Department of Neurology Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA.
| | - Neal Rutledge
- Research Imaging Center, Austin Radiological Association, Austin, TX 78705, USA.
| | - Gabe Perlaza
- Department of Intercollegiate Athletics, The University of Texas, Austin, TX 78712, USA.
| | - James Bray
- Department of Intercollegiate Athletics, The University of Texas, Austin, TX 78712, USA.
- Department of Population Health, University of Texas, Austin, TX 78712, USA.
| | - Allen Hardin
- Department of Intercollegiate Athletics, The University of Texas, Austin, TX 78712, USA.
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