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Poliva O, Herrera C, Sugai K, Whittle N, Leek MR, Barnes S, Holshouser B, Yi A, Venezia JH. Additive effects of mild head trauma, blast exposure, and aging within white matter tracts: A novel Diffusion Tensor Imaging analysis approach. J Neuropathol Exp Neurol 2024:nlae069. [PMID: 39053000 DOI: 10.1093/jnen/nlae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Existing diffusion tensor imaging (DTI) studies of neurological injury following high-level blast exposure (hlBE) in military personnel have produced widely variable results. This is potentially due to prior studies often not considering the quantity and/or recency of hlBE, as well as co-morbidity with non-blast head trauma (nbHT). Herein, we compare commonly used DTI metrics: fractional anisotropy and mean, axial, and radial diffusivity, in Veterans with and without history of hlBE and/or nbHT. We use both the traditional method of dividing participants into 2 equally weighted groups and an alternative method wherein each participant is weighted by quantity and recency of hlBE and/or nbHT. While no differences were detected using the traditional method, the alternative method revealed diffuse and extensive changes in all DTI metrics. These effects were quantified within 43 anatomically defined white matter tracts, which identified the forceps minor, middle corpus callosum, acoustic and optic radiations, fornix, uncinate, inferior fronto-occipital and inferior longitudinal fasciculi, and cingulum, as the pathways most affected by hlBE and nbHT. Moreover, additive effects of aging were present in many of the same tracts suggesting that these neuroanatomical effects may compound with age.
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Affiliation(s)
- Oren Poliva
- VA Loma Linda Healthcare System, Loma Linda, CA, United States
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | | | - Kelli Sugai
- VA Loma Linda Healthcare System, Loma Linda, CA, United States
| | - Nicole Whittle
- VA Portland Healthcare System, Portland, OR, United States
| | - Marjorie R Leek
- VA Loma Linda Healthcare System, Loma Linda, CA, United States
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Samuel Barnes
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Barbara Holshouser
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Alex Yi
- VA Loma Linda Healthcare System, Loma Linda, CA, United States
| | - Jonathan H Venezia
- VA Loma Linda Healthcare System, Loma Linda, CA, United States
- Department of Otolaryngology-Head & Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
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Barsoum S, Latimer CS, Nolan AL, Barrett A, Chang K, Troncoso J, Keene CD, Benjamini D. Resiliency to Alzheimer's disease neuropathology can be distinguished from dementia using cortical astrogliosis imaging. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.06.592719. [PMID: 38766087 PMCID: PMC11100587 DOI: 10.1101/2024.05.06.592719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Despite the presence of significant Alzheimer's disease (AD) pathology, characterized by amyloid β (Aβ) plaques and phosphorylated tau (pTau) tangles, some cognitively normal elderly individuals do not inevitably develop dementia. These findings give rise to the notion of cognitive 'resilience', suggesting maintained cognitive function despite the presence of AD neuropathology, highlighting the influence of factors beyond classical pathology. Cortical astroglial inflammation, a ubiquitous feature of symptomatic AD, shows a strong correlation with cognitive impairment severity, potentially contributing to the diversity of clinical presentations. However, noninvasively imaging neuroinflammation, particularly astrogliosis, using MRI remains a significant challenge. Here we sought to address this challenge and to leverage multidimensional (MD) MRI, a powerful approach that combines relaxation with diffusion MR contrasts, to map cortical astrogliosis in the human brain by accessing sub-voxel information. Our goal was to test whether MD-MRI can map astroglial pathology in the cerebral cortex, and if so, whether it can distinguish cognitive resiliency from dementia in the presence of hallmark AD neuropathological changes. We adopted a multimodal approach by integrating histological and MRI analyses using human postmortem brain samples. Ex vivo cerebral cortical tissue specimens derived from three groups comprised of non-demented individuals with significant AD pathology postmortem, individuals with both AD pathology and dementia, and non-demented individuals with minimal AD pathology postmortem as controls, underwent MRI at 7 T. We acquired and processed MD-MRI, diffusion tensor, and quantitative T 1 and T 2 MRI data, followed by histopathological processing on slices from the same tissue. By carefully co-registering MRI and microscopy data, we performed quantitative multimodal analyses, leveraging targeted immunostaining to assess MD-MRI sensitivity and specificity towards Aβ, pTau, and glial fibrillary acidic protein (GFAP), a marker for astrogliosis. Our findings reveal a distinct MD-MRI signature of cortical astrogliosis, enabling the creation of predictive maps for cognitive resilience amid AD neuropathological changes. Multiple linear regression linked histological values to MRI changes, revealing that the MD-MRI cortical astrogliosis biomarker was significantly associated with GFAP burden (standardized β=0.658, pFDR<0.0001), but not with Aβ (standardized β=0.009, p FDR =0.913) or pTau (standardized β=-0.196, p FDR =0.051). Conversely, none of the conventional MRI parameters showed significant associations with GFAP burden in the cortex. While the extent to which pathological glial activation contributes to neuronal damage and cognitive impairment in AD is uncertain, developing a noninvasive imaging method to see its affects holds promise from a mechanistic perspective and as a potential predictor of cognitive outcomes.
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Gimbel SI, Hungerford LD, Twamley EW, Ettenhofer ML. White Matter Organization and Cortical Thickness Differ Among Active Duty Service Members With Chronic Mild, Moderate, and Severe Traumatic Brain Injury. J Neurotrauma 2024; 41:818-835. [PMID: 37800726 PMCID: PMC11005384 DOI: 10.1089/neu.2023.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Abstract This study compared findings from whole-brain diffusion tensor imaging (DTI) and volumetric magnetic resonance imaging (MRI) among 90 Active Duty Service Members with chronic mild traumatic brain injury (TBI; n = 52), chronic moderate-to-severe TBI (n = 17), and TBI-negative controls (n = 21). Data were collected on a Philips Ingenia 3T MRI with DTI in 32 directions. Results demonstrated that history of TBI was associated with differences in white matter microstructure, white matter volume, and cortical thickness in both mild TBI and moderate-to-severe TBI groups relative to controls. However, the presence, pattern, and distribution of these findings varied substantially depending on the injury severity. Spatially-defined forms of DTI fractional anisotropy (FA) analyses identified altered white matter organization within the chronic moderate-to-severe TBI group, but they did not provide clear evidence of abnormalities within the chronic mild TBI group. In contrast, DTI FA "pothole" analyses identified widely distributed areas of decreased FA throughout the white matter in both the chronic mild TBI and chronic moderate-to-severe TBI groups. Additionally, decreased white matter volume was found in several brain regions for the chronic moderate-to-severe TBI group compared with the other groups. Greater number of DTI FA potholes and reduced cortical thickness were also related to greater severity of self-reported symptoms. In sum, this study expands upon a growing body of literature using advanced imaging techniques to identify potential effects of brain injury in military Service Members. These findings may differ from work in other TBI populations due to varying mechanisms and frequency of injury, as well as a potentially higher level of functioning in the current sample related to the ability to maintain continued Active Duty status after injury. In conclusion, this study provides DTI and volumetric MRI findings across the spectrum of TBI severity. These results provide support for the use of DTI and volumetric MRI to identify differences in white matter microstructure and volume related to TBI. In particular, DTI FA pothole analysis may provide greater sensitivity for detecting subtle forms of white matter injury than conventional DTI FA analyses.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Elizabeth W. Twamley
- University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- University of California, San Diego, San Diego, California, USA
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Kim SY, Yeh PH, Ollinger JM, Morris HD, Hood MN, Ho VB, Choi KH. Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Transl Psychiatry 2023; 13:289. [PMID: 37652994 PMCID: PMC10471788 DOI: 10.1038/s41398-023-02569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant health burden among military service members. Although mTBI was once considered relatively benign compared to more severe TBIs, a growing body of evidence has demonstrated the devastating neurological consequences of mTBI, including chronic post-concussion symptoms and deficits in cognition, memory, sleep, vision, and hearing. The discovery of reliable biomarkers for mTBI has been challenging due to under-reporting and heterogeneity of military-related mTBI, unpredictability of pathological changes, and delay of post-injury clinical evaluations. Moreover, compared to more severe TBI, mTBI is especially difficult to diagnose due to the lack of overt clinical neuroimaging findings. Yet, advanced neuroimaging techniques using magnetic resonance imaging (MRI) hold promise in detecting microstructural aberrations following mTBI. Using different pulse sequences, MRI enables the evaluation of different tissue characteristics without risks associated with ionizing radiation inherent to other imaging modalities, such as X-ray-based studies or computerized tomography (CT). Accordingly, considering the high morbidity of mTBI in military populations, debilitating post-injury symptoms, and lack of robust neuroimaging biomarkers, this review (1) summarizes the nature and mechanisms of mTBI in military settings, (2) describes clinical characteristics of military-related mTBI and associated comorbidities, such as post-traumatic stress disorder (PTSD), (3) highlights advanced neuroimaging techniques used to study mTBI and the molecular mechanisms that can be inferred, and (4) discusses emerging frontiers in advanced neuroimaging for mTBI. We encourage multi-modal approaches combining neuropsychiatric, blood-based, and genetic data as well as the discovery and employment of new imaging techniques with big data analytics that enable accurate detection of post-injury pathologic aberrations related to tissue microstructure, glymphatic function, and neurodegeneration. Ultimately, this review provides a foundational overview of military-related mTBI and advanced neuroimaging techniques that merit further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- Sharon Y Kim
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John M Ollinger
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Herman D Morris
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Maureen N Hood
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kwang H Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA.
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA.
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA.
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5
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Pankatz L, Rojczyk P, Seitz-Holland J, Bouix S, Jung LB, Wiegand TLT, Bonke EM, Sollmann N, Kaufmann E, Carrington H, Puri T, Rathi Y, Coleman MJ, Pasternak O, George MS, McAllister TW, Zafonte R, Stein MB, Marx CE, Shenton ME, Koerte IK. Adverse Outcome Following Mild Traumatic Brain Injury Is Associated with Microstructure Alterations at the Gray and White Matter Boundary. J Clin Med 2023; 12:5415. [PMID: 37629457 PMCID: PMC10455493 DOI: 10.3390/jcm12165415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The gray matter/white matter (GM/WM) boundary of the brain is vulnerable to shear strain associated with mild traumatic brain injury (mTBI). It is, however, unknown whether GM/WM microstructure is associated with long-term outcomes following mTBI. The diffusion and structural MRI data of 278 participants between 18 and 65 years of age with and without military background from the Department of Defense INTRuST study were analyzed. Fractional anisotropy (FA) was extracted at the GM/WM boundary across the brain and for each lobe. Additionally, two conventional analytic approaches were used: whole-brain deep WM FA (TBSS) and whole-brain cortical thickness (FreeSurfer). ANCOVAs were applied to assess differences between the mTBI cohort (n = 147) and the comparison cohort (n = 131). Associations between imaging features and post-concussive symptom severity, and functional and cognitive impairment were investigated using partial correlations while controlling for mental health comorbidities that are particularly common among military cohorts and were present in both the mTBI and comparison group. Findings revealed significantly lower whole-brain and lobe-specific GM/WM boundary FA (p < 0.011), and deep WM FA (p = 0.001) in the mTBI cohort. Whole-brain and lobe-specific GM/WM boundary FA was significantly negatively correlated with post-concussive symptoms (p < 0.039), functional (p < 0.016), and cognitive impairment (p < 0.049). Deep WM FA was associated with functional impairment (p = 0.002). Finally, no significant difference was observed in cortical thickness, nor between cortical thickness and outcome (p > 0.05). Findings from this study suggest that microstructural alterations at the GM/WM boundary may be sensitive markers of adverse long-term outcomes following mTBI.
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Affiliation(s)
- Lara Pankatz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Philine Rojczyk
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Johanna Seitz-Holland
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sylvain Bouix
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- Département de génie logiciel et TI, École de Technologie Supérieure, Université du Québec, Montreal, QC H3C 1K3, Canada
| | - Leonard B. Jung
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Tim L. T. Wiegand
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
| | - Elena M. Bonke
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, 82152 Planegg, Germany
| | - Nico Sollmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Elisabeth Kaufmann
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Department of Neurology, University Hospital, LMU, 81377 Munich, Germany
| | - Holly Carrington
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Twishi Puri
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
| | - Michael J. Coleman
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mark S. George
- Psychiatry Department, Medical University of South Carolina, Charleston, SC 29425, USA;
- Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA
| | - Thomas W. McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA 02129, USA;
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA;
- School of Public Health, University of California San Diego, La Jolla, CA 92093, USA
- Psychiatry Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Christine E. Marx
- VA Mid-Atlantic Mental Illness Research and Clinical Center (MIRECC) and Durham VA Medical Center, Durham, NC 27705, USA;
- Department of Psychiatry and Behavior Sciences, Duke University School of Medicine, Durham, NC 27710, USA
| | - Martha E. Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Inga K. Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Somerville, MA 02145, USA; (L.P.); (P.R.); (J.S.-H.); (S.B.); (L.B.J.); (T.L.T.W.); (E.M.B.); (N.S.); (E.K.); (H.C.); (T.P.); (Y.R.); (M.J.C.); (O.P.); (M.E.S.)
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilians-Universität, 80336 Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, 82152 Planegg, Germany
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6
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Benjamini D, Priemer DS, Perl DP, Brody DL, Basser PJ. Mapping astrogliosis in the individual human brain using multidimensional MRI. Brain 2023; 146:1212-1226. [PMID: 35953450 PMCID: PMC9976979 DOI: 10.1093/brain/awac298] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 11/14/2022] Open
Abstract
There are currently no non-invasive imaging methods available for astrogliosis assessment or mapping in the central nervous system despite its essential role in the response to many disease states, such as infarcts, neurodegenerative conditions, traumatic brain injury and infection. Multidimensional MRI is an increasingly employed imaging modality that maximizes the amount of encoded chemical and microstructural information by probing relaxation (T1 and T2) and diffusion mechanisms simultaneously. Here, we harness the exquisite sensitivity of this imagining modality to derive a signature of astrogliosis and disentangle it from normative brain at the individual level using machine learning. We investigated ex vivo cerebral cortical tissue specimens derived from seven subjects who sustained blast-induced injuries, which resulted in scar-border forming astrogliosis without being accompanied by other types of neuropathological abnormality, and from seven control brain donors. By performing a combined post-mortem radiology and histopathology correlation study we found that astrogliosis induces microstructural and chemical changes that are robustly detected with multidimensional MRI, and which can be attributed to astrogliosis because no axonal damage, demyelination or tauopathy were histologically observed in any of the cases in the study. Importantly, we showed that no one-dimensional T1, T2 or diffusion MRI measurement can disentangle the microscopic alterations caused by this neuropathology. Based on these findings, we developed a within-subject anomaly detection procedure that generates MRI-based astrogliosis biomarker maps ex vivo, which were significantly and strongly correlated with co-registered histological images of increased glial fibrillary acidic protein deposition (r = 0.856, P < 0.0001; r = 0.789, P < 0.0001; r = 0.793, P < 0.0001, for diffusion-T2, diffusion-T1 and T1-T2 multidimensional data sets, respectively). Our findings elucidate the underpinning of MRI signal response from astrogliosis, and the demonstrated high spatial sensitivity and specificity in detecting reactive astrocytes at the individual level, and if reproduced in vivo, will significantly impact neuroimaging studies of injury, disease, repair and aging, in which astrogliosis has so far been an invisible process radiologically.
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Affiliation(s)
- Dan Benjamini
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD 20891, USA
- Multiscale Imaging and Integrative Biophysics Unit, Laboratory of Behavioral Neuroscience, National Institute on Aging, NIH, Baltimore, MD 21224, USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - David S Priemer
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- The Department of Defense/Uniformed Services, University Brain Tissue Repository, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, MD 20817, USA
| | - Daniel P Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- The Department of Defense/Uniformed Services, University Brain Tissue Repository, Bethesda, MD 20814, USA
| | - David L Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Neurology, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA
| | - Peter J Basser
- Section on Quantitative Imaging and Tissue Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD 20891, USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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7
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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8
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Turner SM, Kiser SA, Gipson BJ, Martin EMM, Smith JM. Surveying the Landscape: A Review of Longitudinal TBI Studies in Service Member and Veteran Populations. J Neurotrauma 2023. [PMID: 36394952 DOI: 10.1089/neu.2022.0237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Traumatic brain injury (TBI) is known to be a signature wound of the post-9/11 conflicts. In response, the U.S. Department of Defense (DOD) and other federal organizations have directed significant investments toward TBI research on characterizing injury populations and understanding long-term outcomes. To address legislative requirements and research gaps, several observational, longitudinal TBI studies were initiated as an effective means of investigating TBI clinical management, outcomes, and recovery. This review synthesizes the landscape (i.e., requirements and gaps, infrastructure, geography, timelines, TBI severity definitions, military and injury populations of interest, and measures) of DOD-funded longitudinal TBI studies being conducted in service member and veteran (SMV) populations. Based on the landscape described here, we present recommended actions and solutions that would allow a consolidated and cooperative future state of longitudinal TBI research, optimized continued investments, and advances in the state of the science without redundancy.
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Affiliation(s)
- Stephanie M Turner
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Seth A Kiser
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Brooke J Gipson
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Silver Spring, Maryland, USA
| | - Elisabeth M Moy Martin
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
| | - Johanna M Smith
- Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, Maryland, USA
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9
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Muresanu DF, Sharma A, Tian ZR, Lafuente JV, Nozari A, Feng L, Buzoianu AD, Wiklund L, Sharma HS. Nanowired Delivery of Cerebrolysin with Mesenchymal Stem Cells Attenuates Heat Stress-Induced Exacerbation of Neuropathology Following Brain Blast Injury. ADVANCES IN NEUROBIOLOGY 2023; 32:231-270. [PMID: 37480463 DOI: 10.1007/978-3-031-32997-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Blast brain injury (bBI) following explosive detonations in warfare is one of the prominent causes of multidimensional insults to the central nervous and other vital organs injury. Several military personnel suffered from bBI during the Middle East conflict at hot environment. The bBI largely occurs due to pressure waves, generation of heat together with release of shrapnel and gun powders explosion with penetrating and/or impact head trauma causing multiple brain damage. As a result, bBI-induced secondary injury causes breakdown of the blood-brain barrier (BBB) and edema formation that further results in neuronal, glial and axonal injuries. Previously, we reported endocrine imbalance and influence of diabetes on bBI-induced brain pathology that was significantly attenuated by nanowired delivery of cerebrolysin in model experiments. Cerebrolysin is a balanced composition of several neurotrophic factors, and active peptide fragment is capable of neuroprotection in several neurological insults. Exposure to heat stress alone causes BBB damage, edema formation and brain pathology. Thus, it is quite likely that hot environment further exacerbates the consequences of bBI. Thus, novel therapeutic strategies using nanodelivery of stem cell and cerebrolysin may further enhance superior neuroprotection in bBI at hot environment. Our observations are the first to show that combined nanowired delivery of mesenchymal stem cells (MSCs) and cerebrolysin significantly attenuated exacerbation of bBI in hot environment and induced superior neuroprotection, not reported earlier. The possible mechanisms of neuroprotection with MSCs and cerebrolysin in bBI are discussed in the light of current literature.
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Affiliation(s)
- Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan, Hebei Province, China
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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10
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Gibbons LE, Power MC, Walker RL, Kumar RG, Murphy A, Latimer CS, Nolan AL, Melief EJ, Beller A, Bogdani M, Keene CD, Larson EB, Crane PK, Dams-O'Connor K. Association of Traumatic Brain Injury with Late Life Neuropathological Outcomes in a Community-Based Cohort. J Alzheimers Dis 2023; 93:949-961. [PMID: 37125552 DOI: 10.3233/jad-221224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Prior studies into the association of head trauma with neuropathology have been limited by incomplete lifetime neurotrauma exposure characterization. OBJECTIVE To investigate the neuropathological sequelae of traumatic brain injury (TBI) in an autopsy sample using three sources of TBI ascertainment, weighting findings to reflect associations in the larger, community-based cohort. METHODS Self-reported head trauma with loss of consciousness (LOC) exposure was collected in biennial clinic visits from 780 older adults from the Adult Changes in Thought study who later died and donated their brain for research. Self-report data were supplemented with medical record abstraction, and, for 244 people, structured interviews on lifetime head trauma. Neuropathology outcomes included Braak stage, CERAD neuritic plaque density, Lewy body distribution, vascular pathology, hippocampal sclerosis, and cerebral/cortical atrophy. Exposures were TBI with or without LOC. Modified Poisson regressions adjusting for age, sex, education, and APOE ɛ4 genotype were weighted back to the full cohort of 5,546 participants. RESULTS TBI with LOC was associated with the presence of cerebral cortical atrophy (Relative Risk 1.22, 95% CI 1.02, 1.42). None of the other outcomes was associated with TBI with or without LOC. CONCLUSION TBI with LOC was associated with increased risk of cerebral cortical atrophy. Despite our enhanced TBI ascertainment, we found no association with the Alzheimer's disease-related neuropathologic outcomes among people who survived to at least age 65 without dementia. This suggests the pathophysiological processes underlying post-traumatic neurodegeneration are distinct from the hallmark pathologies of Alzheimer's disease.
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Affiliation(s)
- Laura E Gibbons
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Melinda C Power
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Raj G Kumar
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alia Murphy
- George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Caitlin S Latimer
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Amber L Nolan
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erica J Melief
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Allison Beller
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Marika Bogdani
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - C Dirk Keene
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eric B Larson
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul K Crane
- General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Edlow BL, Bodien YG, Baxter T, Belanger H, Cali R, Deary K, Fischl B, Foulkes AS, Gilmore N, Greve DN, Hooker JM, Huang SY, Kelemen JN, Kimberly WT, Maffei C, Masood M, Perl D, Polimeni JR, Rosen BR, Tromly S, Tseng CEJ, Yao EF, Zurcher NR, Mac Donald CL, Dams-O'Connor K. Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol. J Neurotrauma 2022; 39:1391-1407. [PMID: 35620901 PMCID: PMC9529318 DOI: 10.1089/neu.2022.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.
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Affiliation(s)
- Brian L Edlow
- Harvard Medical School, 1811, 175 Cambridge Street - Suite 300, Boston, Massachusetts, United States, 02115.,Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Yelena G Bodien
- Massachusetts General Hospital, 2348, Department of Neurology, 101 Merrimac, Boston, Massachusetts, United States, 02114;
| | - Timothy Baxter
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Heather Belanger
- University of South Florida, 7831, Department of Psychiatry and Behavioral Neurosciences, Tampa, Florida, United States;
| | - Ryan Cali
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Katryna Deary
- Navy SEAL Foundation, Virginia Beach, Virginia, United States;
| | - Bruce Fischl
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Room 2301, 149 13th Street, Charlestown, Massachusetts, United States, 02129-2020.,Massachusetts General Hospital;
| | - Andrea S Foulkes
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Natalie Gilmore
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Douglas N Greve
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jacob M Hooker
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Susie Y Huang
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jessica N Kelemen
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - W Taylor Kimberly
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Chiara Maffei
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Maryam Masood
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Daniel Perl
- Uniformed Services University of the Health Sciences, 1685, Pathology, 4301 Jones Bridge Road, Room B3138, Bethesda, Maryland, United States, 20814;
| | - Jonathan R Polimeni
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Bruce R Rosen
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States;
| | - Samantha Tromly
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Chieh-En J Tseng
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Eveline F Yao
- United States Special Operations Command, Office of the Surgeon General, MacDill Air Force Base, United States;
| | - Nicole R Zurcher
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Christine L Mac Donald
- University of Washington, 7284, Department of Neurological Surgery, Seattle, Washington, United States;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
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12
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Yeh PH, Lippa SM, Brickell TA, Ollinger J, French LM, Lange RT. Longitudinal changes of white matter microstructure following traumatic brain injury in U.S. military service members. Brain Commun 2022; 4:fcac132. [PMID: 35702733 PMCID: PMC9185378 DOI: 10.1093/braincomms/fcac132] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/01/2022] [Accepted: 05/24/2022] [Indexed: 09/02/2023] Open
Abstract
The purpose of this study was to analyze quantitative diffusion tensor imaging measures across the spectrum of traumatic brain injury severity and evaluate their trajectories in military service members. Participants were 96 U.S. military service members and veterans who had sustained a mild traumatic brain injury [including complicated mild traumatic brain injury (n = 16) and uncomplicated mild traumatic brain injury (n = 68)], moderate-severe traumatic brain injury (n = 12), and controls (with or without orthopaedic injury, n = 39). All participants had been scanned at least twice, with some receiving up to five scans. Both whole brain voxel-wise analysis and tract-of-interest analysis were applied to assess the group differences of diffusion tensor imaging metrics, and their trajectories between time points of scans and days since injury. Linear mixed modelling was applied to evaluate cross-sectional and longitudinal diffusion tensor imaging metrics changes within and between groups using both tract-of-interest and voxel-wise analyses. Participants with moderate to severe traumatic brain injury had larger white matter disruption both in superficial subcortical and deep white matter, mainly over the anterior part of cerebrum, than those with mild traumatic brain injury, both complicated and uncomplicated, and there was no evidence of recovery over the period of follow-ups in moderate-severe traumatic brain injury, but deterioration was possible. Participants with mild traumatic brain injury had white matter microstructural changes, mainly in deep central white matter over the posterior part of cerebrum, with more spatial involvement in complicated mild traumatic brain injury than in uncomplicated mild traumatic brain injury and possible brain repair through neuroplasticity, e.g. astrocytosis with glial processes and glial scaring. Our results did not replicate 'V-shaped' trajectories in diffusion tensor imaging metrics, which were revealed in a previous study assessing the sub-acute stage of brain injury in service members and veterans following military combat concussion. In addition, non-traumatic brain injury controls, though not demonstrating any evidence of sustaining a traumatic brain injury, might have transient white matter changes with recovery afterward. Our results suggest that white matter integrity following a remote traumatic brain injury may change as a result of different underlying mechanisms at the microstructural level, which can have a significant consequence on the long-term well beings of service members and veterans. In conclusion, longitudinal diffusion tensor imaging improves our understanding of the mechanisms of white matter microstructural changes across the spectrum of traumatic brain injury severity. The quantitative metrics can be useful as guidelines in monitoring the long-term recovery.
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Affiliation(s)
- Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
| | - Sara. M. Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
| | - Tracey A. Brickell
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Contractor, General Dynamics Information Technology, Silver Spring, MD, USA
- Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
| | - Louis M. French
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rael T. Lange
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, RM1128, Bldg 51, Bethesda, MD, USA
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Contractor, General Dynamics Information Technology, Silver Spring, MD, USA
- Centre of Excellence on Post-traumatic Stress Disorder, Ottawa, ON, Canada
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13
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Barkley AS, Sullivan LT, Gibson AW, Zalewski K, Mac Donald CL, Barber JK, Hakimian S, Ko AL, Ojemann JG, Hauptman JS. Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy. Neurosurgery 2022; 91:347-354. [PMID: 35506941 DOI: 10.1227/neu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND MRI-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy is a safe, minimally invasive alternative to traditional surgical approaches. Prognostic factors associated with efficacy are debated; preoperative epilepsy duration and semiology seem to be important variables. OBJECTIVE To determine whether acute postoperative seizure (APOS) after MRgLITT for mesial temporal lobe epilepsy is associated with seizure freedom/Engel class outcome at 1 year. METHODS A single-institution retrospective study including adults undergoing first time MRgLITT for mesial temporal lobe epilepsy (2010-2019) with ≥1-year follow-up. Preoperative data included sex, epilepsy duration, number of antiepileptics attempted, weekly seizure frequency, seizure semiology, and radiographically verified anatomic lesion at seizure focus. Postoperative data included clinical detection of APOS within 7 days postoperatively, and immediate amygdala, hippocampal, entorhinal, and parahippocampal residual volumes determined using quantitative imaging postprocessing. Primary outcome was seizure freedom/Engel classification 1 year postoperatively. RESULTS Of 116 patients, 53% (n = 61) were female, with an average epilepsy duration of 21 (±14) years, average 6 failed antiepileptics (±3), and weekly seizure frequency of 5. APOS was associated with worse Engel class (P = .010), conferring 6.3 times greater odds of having no improvement vs achieving seizure freedom at 1 year. Residual amygdala, hippocampal, entorhinal, and parahippocampal volumes were not statistically significant prognostic factors. CONCLUSION APOS was associated with a lower chance of seizure freedom at 1 year post-MRgLITT for mesial temporal lobe epilepsy. Amygdala, hippocampal, entorhinal, and parahippocampal residual volumes after ablation were not significant prognostic factors.
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Affiliation(s)
- Ariana S Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Liam T Sullivan
- Department of Biology, University of Washington, Seattle, Washington, USA
| | - Alec W Gibson
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kody Zalewski
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Shahin Hakimian
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.,Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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14
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Brett BL, Gardner RC, Godbout J, Dams-O’Connor K, Keene CD. Traumatic Brain Injury and Risk of Neurodegenerative Disorder. Biol Psychiatry 2022; 91:498-507. [PMID: 34364650 PMCID: PMC8636548 DOI: 10.1016/j.biopsych.2021.05.025] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
Traumatic brain injury (TBI), particularly of greater severity (i.e., moderate to severe), has been identified as a risk factor for all-cause dementia and Parkinson's disease, with risk for specific dementia subtypes being more variable. Among the limited studies involving neuropathological (postmortem) confirmation, the association between TBI and risk for neurodegenerative disease increases in complexity, with polypathology often reported on examination. The heterogeneous clinical and neuropathological outcomes associated with TBI are likely reflective of the multifaceted postinjury acute and chronic processes that may contribute to neurodegeneration. Acutely in TBI, axonal injury and disrupted transport influences molecular mechanisms fundamental to the formation of pathological proteins, such as amyloid-β peptide and hyperphosphorylated tau. These protein deposits may develop into amyloid-β plaques, hyperphosphorylated tau-positive neurofibrillary tangles, and dystrophic neurites. These and other characteristic neurodegenerative disease pathologies may then spread across brain regions. The acute immune and neuroinflammatory response involves alteration of microglia, astrocytes, oligodendrocytes, and endothelial cells; release of downstream pro- and anti-inflammatory cytokines and chemokines; and recruitment of peripheral immune cells. Although thought to be neuroprotective and reparative initially, prolongation of these processes may promote neurodegeneration. We review the evidence for TBI as a risk factor for neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease, in clinical and neuropathological studies. Further, we describe the dynamic interactions between acute response to injury and chronic processes that may be involved in TBI-related pathogenesis and progression of neurodegeneration.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Medical College of
Wisconsin,Corresponding author: Benjamin L.
Brett, 414-955-7316, , Medical College of
Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Raquel C. Gardner
- Department of Neurology, Memory and Aging Center, Weill
Institute for Neurosciences, University of California San Francisco and the San
Francisco Veterans Affairs Medical Center
| | - Jonathan Godbout
- Department of Neuroscience, Chronic Brain Injury Program,
The Ohio State Wexner Medical Center, Columbus, OH
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance,
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York NY
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University
of Washington School of Medicine, Seattle, WA
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15
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Mac Donald CL, Barber J, Johnson A, Patterson J, Temkin N. Global Disability Trajectories Over the First Decade Following Combat Concussion. J Head Trauma Rehabil 2022; 37:63-70. [PMID: 35258037 PMCID: PMC8908784 DOI: 10.1097/htr.0000000000000738] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine global disability trajectories in US military with and without traumatic brain injury (TBI) over the first decade following deployment to identify risk profiles for better intervention stratification, hopefully reducing long-term cost. SETTING Patients and participants were enrolled in combat or directly following medical evacuation at the time of injury and followed up every 6 months for 10 years. PARTICIPANTS There are 4 main groups (n = 475), 2 primary and 2 exploratory: (1) combat-deployed controls without a history of blast exposure "non-blast- control" (n = 143), (2) concussive blast TBI "'blast-TBI" (n = 236) (primary), (3) combat-deployed controls with a history of blast exposure "blast-control" (n = 54), and (4) patients sustaining a combat concussion not from blast "non-blast-TBI" (n = 42) (exploratory). DESIGN Prospective, observational, longitudinal study. MAIN MEASURES Combat concussion, blast exposure, and subsequent head injury exposure over the first decade post-deployment. Global disability measured by the Glasgow Outcome Scale Extended (GOSE). RESULTS Latent class growth analysis identified 4 main trajectories of global outcome, with service members sustaining combat concussion 37 to 49 times more likely to be in the worse disability trajectories than non-blast-controls (blast-TBI: odds ratio [OR] = 49.33; CI, 19.77-123.11; P < .001; non-blast-TBI: OR = 37.50; CI, 10.01-140.50; P < .001). Even blast-exposed-controls were 5 times more likely to be in these worse disability categories compared with non-blast-controls (OR = 5.00; CI, 1.59-15.99; P = .007). Adjustment for demographic factors and subsequent head injury exposure did not substantially alter these odds ratios. CONCLUSIONS Very high odds of poor long-term outcome trajectory were identified for those who sustained a concussion in combat, were younger at the time of injury, had lower education, and enlisted in the Army above the risk of deployment alone. These findings help identify a risk profile that could be used to target early intervention and screen for poor long-term outcome to aid in reducing the high public health cost and enhance the long-term quality of life for these service members following deployment.
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Affiliation(s)
- Christine L Mac Donald
- University of Washington School of Medicine, Seattle (Drs Donald and Temkin, Mr Barber, and Ms Patterson); and Washington University, Saint Louis, Missouri (Ms Johnson)
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Jia X, Chang X, Bai L, Wang Y, Dong D, Gan S, Wang S, Li X, Yang X, Sun Y, Li T, Xiong F, Niu X, Yan H. A Longitudinal Study of White Matter Functional Network in Mild Traumatic Brain Injury. J Neurotrauma 2021; 38:2686-2697. [PMID: 33906419 DOI: 10.1089/neu.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Some patients after mild traumatic brain injury (mTBI) experience microstructural damages in the long-distance white matter (WM) connections, which disrupts the functional connectome of large-scale brain networks that support cognitive function. Patterns of WM structural damage following mTBI were well documented using diffusion tensor imaging (DTI). However, the functional organization of WM and its association with gray matter functional networks (GM-FNs) and its DTI metrics remain unknown. The present study adopted resting-state functional magnetic resonance imaging to explore WM functional properties in mTBI patients (108 acute patients, 48 chronic patients, 46 healthy controls [HCs]). Eleven large-scale WM functional networks (WM-FNs) were constructed by the k-means clustering algorithm of voxel-wise WM functional connectivity (FC). Compared with HCs, acute mTBI patients observed enhanced FC between inferior fronto-occipital fasciculus (IFOF) WM-FN and primary sensorimotor WM-FNs, and cortical primary sensorimotor GM-FNs. Further, acute mTBI patients showed increased DTI metrics (mean diffusivity, axial diffusivity, and radial diffusivity) in deep WM-FNs and higher-order cognitive WM-FNs. Moreover, mTBI patients demonstrated full recovery of FC and partial recovery of DTI metrics in the chronic stage. Additionally, enhanced FC between IFOF WM-FN and anterior cerebellar GM-FN was correlated with impaired information processing speed. Our findings provide novel evidence for functional and structural alteration of WM-FNs in mTBI patients. Importantly, the convergent damage of the IFOF network might imply its crucial role in our understanding of the pathophysiology mechanism of mTBI patients.
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Affiliation(s)
- Xiaoyan Jia
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuebin Chang
- School of Life Science and Technology, Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
| | - Lijun Bai
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yulin Wang
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Debo Dong
- School of Life Science and Technology, Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Center Jülich, Jülich, Germany
| | - Shuoqiu Gan
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Shan Wang
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Li
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuefei Yang
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Yinxiang Sun
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tianhui Li
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Feng Xiong
- Department of Biomedical Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Yan
- Key Laboratory for Artificial Intelligence and Cognitive Neuroscience of Language, Xi'an International Studies University, Xi'an, China
- Department of Linguistics, Xidian University, Xi'an, China
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Gan S, Shi W, Wang S, Sun Y, Yin B, Bai G, Jia X, Sun C, Niu X, Wang Z, Jiang X, Liu J, Zhang M, Bai L. Accelerated Brain Aging in Mild Traumatic Brain Injury: Longitudinal Pattern Recognition with White Matter Integrity. J Neurotrauma 2021; 38:2549-2559. [PMID: 33863259 DOI: 10.1089/neu.2020.7551] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) initiating long-term effects on white matter integrity resembles brain-aging changes, implying an aging process accelerated by mTBI. This longitudinal study aims to investigate the mTBI-induced acceleration of the brain-aging process by developing a neuroimaging model to predict brain age. The brain-age prediction model was defined using relevance vector regression based on fractional anisotropy from diffusion tensor imaging of 523 healthy individuals. The model was used to estimate the brain-predicted age difference (brain-PAD) between the chronological and estimated brain age in 116 acute mTBI patients and 63 healthy controls. Fifty patients were followed for 6 ∼ 12 months to evaluate the longitudinal changes in brain-PAD. We investigated whether brain-PAD was greater in patients of older age, post-concussion complaints, and apolipoprotein E (APOE) ɛ4 genotype, and whether it had the potential to predict neuropsychological outcomes. The brain-age prediction model predicted brain age accurately (r = 0.96). The brains of mTBI patients in the acute phase were estimated to be "older," with greater brain-PAD (2.59 ± 5.97 years) than the healthy controls (0.12 ± 3.19 years) (p < 0.05), and remained stable 6-12 month post-injury (2.50 ± 4.54 years). Patients who were older or who had post-concussion complaints, rather than APOE ɛ4 genotype, had greater brain-PADs (p < 0.001, p = 0.024). Additionally, brain-PAD in the acute phase predicted information processing speed at the 6 ∼ 12 month follow-up (r = -0.36, p = 0.01). In conclusion, mTBI accelerates the brain-aging process, and brain-PAD may be capable of evaluating aging-associated issues post-injury, such as increased risks of neurodegeneration.
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Affiliation(s)
- Shuoqiu Gan
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wen Shi
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Shan Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Yingxiang Sun
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yin
- Department of Neurosurgery, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyan Jia
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Chuanzhu Sun
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xuan Niu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhuonan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaofan Jiang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lijun Bai
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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Bradshaw DV, Kim Y, Fu A, Marion CM, Radomski KL, McCabe JT, Armstrong RC. Repetitive Blast Exposure Produces White Matter Axon Damage without Subsequent Myelin Remodeling: In Vivo Analysis of Brain Injury Using Fluorescent Reporter Mice. Neurotrauma Rep 2021; 2:180-192. [PMID: 34013219 PMCID: PMC8127063 DOI: 10.1089/neur.2020.0058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The potential effects of blast exposure on the brain health of military personnel have raised concerns and led to increased surveillance of blast exposures. Neuroimaging studies have reported white matter abnormalities in brains of service members with a history of blast exposure. However, blast effects on white matter microstructure remain poorly understood. As a novel approach to screen for white matter effects, transgenic mice that express fluorescent reporters to sensitively detect axon damage and myelin remodeling were exposed to simulated repetitive blasts (once/day on 5 consecutive days). Axons were visualized using Thy1-YFP-16 reporter mice that express yellow fluorescent protein (YFP) in a broad spectrum of neurons. Swelling along damaged axons forms varicosities that fill with YFP. The frequency and size of axonal varicosities were significantly increased in the corpus callosum (CC) and cingulum at 3 days after the final blast exposure, versus in sham procedures. CC immunolabeling for reactive astrocyte and microglial markers was also significantly increased. NG2CreER;mTmG mice were given tamoxifen (TMX) on days 2 and 3 after the final blast to induce fluorescent labeling of newly synthesized myelin membranes, indicating plasticity and/or repair. Myelin synthesis was not altered in the CC over the intervening 4 or 8 weeks after repetitive blast exposure. These experiments show the advantages of transgenic reporter mice for analysis of white matter injury that detects subtle, diffuse axon damage and the dynamic nature of myelin sheaths. These results show that repetitive low-level blast exposures produce infrequent but significant axon damage along with neuroinflammation in white matter.
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Affiliation(s)
- Donald V Bradshaw
- Graduate Program in Neuroscience, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Yeonho Kim
- Center for Neuroscience and Regenerative Medicine, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Amanda Fu
- Center for Neuroscience and Regenerative Medicine, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Christina M Marion
- Graduate Program in Neuroscience, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Neuroscience, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA
| | - Kryslaine L Radomski
- Center for Neuroscience and Regenerative Medicine, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Joseph T McCabe
- Graduate Program in Neuroscience, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Center for Neuroscience and Regenerative Medicine, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Regina C Armstrong
- Graduate Program in Neuroscience, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Center for Neuroscience and Regenerative Medicine, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Department of Anatomy, Physiology, and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Mac Donald CL, Barber J, Patterson J, Johnson AM, Parsey C, Scott B, Fann JR, Temkin NR. Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion. Neurology 2020; 96:e387-e398. [PMID: 33177226 PMCID: PMC7884983 DOI: 10.1212/wnl.0000000000011089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. METHODS This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups: controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. A total of 347 participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey p values calculated for the pairwise comparisons. RESULTS Significant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in neurobehavioral (Neurobehavioral Rating Scale-Revised [NRS]; Cohen d, -1.10 to -1.40, confidence intervals [CIs] [-0.82, -1.32] to [-0.97, -1.83] by group) and psychiatric domains (Clinician-Administered PTSD Scale for DSM-IV [CAPS]; Cohen d, -0.91 to -1.19, CIs [-0.63, -1.19] to [-0.76, -1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1- to 5-year evaluation (66%-76% neurobehavioral NRS; 41%-54% psychiatric CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%-50% neurobehavioral NRS; 9%-25% psychiatric CAPS by group). CONCLUSIONS There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members.
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Affiliation(s)
- Christine L Mac Donald
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO.
| | - Jason Barber
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Jana Patterson
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Ann M Johnson
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Carolyn Parsey
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Beverly Scott
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Jesse R Fann
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
| | - Nancy R Temkin
- From the Departments of Neurological Surgery (C.L.M., J.B., J.P., B.S., N.R.T.), Neurology (C.P.), and Psychiatry (J.R.F.), School of Medicine, and Department of Biostatistics (N.R.T.), School of Public Health, University of Washington, Seattle; and Center for Clinical Studies (A.M.J.), Washington University School of Medicine, St. Louis, MO
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