1
|
Cerebrospinal Fluid and Blood Biomarkers in Patients with Post-Traumatic Disorders of Consciousness: A Scoping Review. Brain Sci 2023; 13:brainsci13020364. [PMID: 36831907 PMCID: PMC9954419 DOI: 10.3390/brainsci13020364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Cerebrospinal fluid (CSF) and blood biomarkers are emerging tools used to obtain information on secondary brain damage and to improve diagnostic and prognostic accuracy for patients with prolonged post-traumatic disorders of consciousness (DoC). We synthesized available data from studies evaluating CSF and blood biomarkers in these patients. (2) Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist to identify and synthesize data from relevant studies. Studies were identified by PubMed and manual searches. Those involving patients with unresponsive wakefulness syndrome or in a minimally conscious state for >28 days, evaluating CSF or blood biomarkers, and conducted on patients with traumatic brain injuries older than 16 years were included in the review. (3) Results: In total, 17 studies were included. Findings on neurofilament light chain, proteins, metabolites, lipids, amyloid-β, tau, melatonin, thyroid hormones, microtubule-associated protein 2, neuron-specific enolase, and brain-derived neurotrophic factor were included in the qualitative synthesis. (4) Conclusions: The most promising applications for CSF and blood biomarkers are the monitoring of secondary neurodegeneration, support of DoC diagnoses, and refinement of prognoses, although current evidence remains too scarce to recommend such uses of these biomarkers in clinical practice.
Collapse
|
2
|
Bagnato S, Andriolo M, Boccagni C, Lucca LF, De Tanti A, Pistarini C, Barone T, Galardi G. Reduced Neuron-Specific Enolase Levels in Chronic Severe Traumatic Brain Injury. J Neurotrauma 2019; 37:423-427. [PMID: 31418324 DOI: 10.1089/neu.2019.6449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Growing evidence suggests that pathophysiological mechanisms leading to neurodegeneration and neuronal loss take place during the chronic phase of a severe traumatic brain injury (TBI). In this study we evaluated a well-established marker of brain injury, the neuron-specific enolase (NSE), in the serum of 51 patients with severe TBI (86% males, mean age 33.8 ± 11.1 years). All patients' samples were available from a previous study and the mean time between TBI and blood sample collection was 23.2 ± 31.5 months (28 patients were evaluated within 12 months of TBI and 23 patients were evaluated ≥12 months after TBI). Patients' NSE levels were compared with those obtained from 30 age and sex-matched healthy controls (87% males, 33.7 ± 11.3 years). We found that NSE levels were significantly lower in patients (median 3.2 ng/mL; 25th, 75th percentile 2.5, 5.1) than in healthy controls (median 4.1 ng/mL; 25th, 75th percentile 3.1, 7.5) (p = 0.026). This finding was mainly driven by data from the chronic patients, that is, those who experienced their TBI at least 12 months before the evaluation. Indeed, these patients had significantly lower NSE levels (median 2.6 ng/mL; 25th, 75th percentile 1.9, 4) than healthy controls (p < 0.01). On the other hand, NSE levels evaluated in patients <12 months from TBI (median 3.9 ng/mL; 25th, 75th percentile 2.8, 5.7) did not significantly differ from controls (p = 0.3). These findings possibly reflect a progressive brain atrophy with reduced baseline NSE release in the chronic phase of a severe TBI.
Collapse
Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Maria Andriolo
- Clinical Pathology and Microbiology Laboratory, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Cristina Boccagni
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| | - Lucia Francesca Lucca
- RAN (Research in Advanced Neuro-rehabilitation), Sant'Anna Institute, Crotone, Italy
| | | | - Caterina Pistarini
- ICS Maugeri SPA SB, Neurorehabilitation Unit, Institute of Genoa, Genoa, Italy
| | - Teresa Barone
- Immunohematology and Transfusion Service, Cefalù, Italy
| | - Giuseppe Galardi
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy
| |
Collapse
|
3
|
Snyder HM, Carare RO, DeKosky ST, de Leon MJ, Dykxhoorn D, Gan L, Gardner R, Hinds SR, Jaffee M, Lamb BT, Landau S, Manley G, McKee A, Perl D, Schneider JA, Weiner M, Wellington C, Yaffe K, Bain L, Pacifico AM, Carrillo MC. Military-related risk factors for dementia. Alzheimers Dement 2018; 14:1651-1662. [PMID: 30415806 PMCID: PMC6281800 DOI: 10.1016/j.jalz.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In recent years, there has been growing discussion to better understand the pathophysiological mechanisms of traumatic brain injury and post-traumatic stress disorder and how they may be linked to an increased risk of neurodegenerative diseases including Alzheimer's disease in veterans. METHODS Building on that discussion, and subsequent to a special issue of Alzheimer's & Dementia published in June 2014, which focused on military risk factors, the Alzheimer's Association convened a continued discussion of the scientific community on December 1, 2016. RESULTS During this meeting, participants presented and evaluated progress made since 2012 and identified outstanding knowledge gaps regarding factors that may impact veterans' risk for later life dementia. DISCUSSION The following is a summary of the invited presentations and moderated discussions of both the review of scientific understanding and identification of gaps to inform further investigations.
Collapse
Affiliation(s)
- Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Roxana O Carare
- Clinical Neuroanatomy, Equality and Diversity Lead, University of Southampton, Southampton, United Kingdom
| | - Steven T DeKosky
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Mony J de Leon
- Department of Psychiatry, New York University Medical Center, New York City, NY, USA
| | - Derek Dykxhoorn
- Department of Microbiology and Immunology, Miami University, Miami, FL, USA
| | - Li Gan
- Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Raquel Gardner
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sidney R Hinds
- Blast Injury Research Program Coordinating Office, United States Army Medical Research and Material Command, Frederick, MD, USA
| | - Michael Jaffee
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Bruce T Lamb
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA
| | - Susan Landau
- Helen Willis Neuroscience Institute, University of California, Berkley, Berkley, CA, USA
| | - Geoff Manley
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Ann McKee
- Department of Neurology and Pathology, Boston University, Boston, MA, USA
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Schneider
- Neurology Department, Rush University Medical Center, Chicago, IL, USA
| | - Michael Weiner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristine Yaffe
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bain
- Independent Science Writer, Philadelphia, PA, USA
| | | | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| |
Collapse
|
4
|
Bagnato S, Andriolo M, Boccagni C, Sant'Angelo A, D'Ippolito ME, Galardi G. Dissociation of cerebrospinal fluid amyloid-β and tau levels in patients with prolonged posttraumatic disorders of consciousness. Brain Inj 2018; 32:1056-1060. [PMID: 29792528 DOI: 10.1080/02699052.2018.1479042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major risk factor for Alzheimer's disease (AD). Although the mechanisms that lead to AD after a TBI are unclear, we hypothesize that changes in amyloid-β (Aβ) metabolism and abnormal tau phosphorylation are reasonable candidates. OBJECTIVE To investigate Aβ and tau dynamics in the chronic phase of TBI. METHODS We evaluated Aβ1-42, total tau (t-tau), and phosphorylated tau (p-tau) levels in the cerebrospinal fluid (CSF) of 15 patients who developed a prolonged disorder of consciousness after a severe TBI (mean time from TBI 271.6 ± 176.5 days). RESULTS Reduced Aβ1-42 levels (median 258 pg/ml, range 90-833.6) were observed in 14/15 patients (93.3%) with severe post-TBI disorders of consciousness. These CSF analysis data did not correlate with time since TBI or with the patients' level of consciousness as determined by the Coma Recovery Scale Revised. Normal t-tau levels (median 95.2 pg/ml, range 52-256.9) were found in all patients. Normal p-tau levels (median 22.2 pg/ml, range 14-72) were observed in 14/15 patients, with just a single patient having a slightly increased p-tau level. CONCLUSION The present findings show that Aβ and tau are differently affected in the chronic phase of severe TBI.
Collapse
Affiliation(s)
- Sergio Bagnato
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Maria Andriolo
- b Clinical Pathology and Microbiology Laboratory , Giuseppe Giglio Foundation , Cefalù , Italy
| | - Cristina Boccagni
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Antonino Sant'Angelo
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| | - Maria Enza D'Ippolito
- b Clinical Pathology and Microbiology Laboratory , Giuseppe Giglio Foundation , Cefalù , Italy
| | - Giuseppe Galardi
- a Rehabilitation Department , Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Giuseppe Giglio Foundation , Cefalù , Italy
| |
Collapse
|
5
|
Brothers HM, Gosztyla ML, Robinson SR. The Physiological Roles of Amyloid-β Peptide Hint at New Ways to Treat Alzheimer's Disease. Front Aging Neurosci 2018; 10:118. [PMID: 29922148 PMCID: PMC5996906 DOI: 10.3389/fnagi.2018.00118] [Citation(s) in RCA: 210] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022] Open
Abstract
Amyloid-ß (Aß) is best known as the misfolded peptide that is involved in the pathogenesis of Alzheimer's disease (AD), and it is currently the primary therapeutic target in attempts to arrest the course of this disease. This notoriety has overshadowed evidence that Aß serves several important physiological functions. Aß is present throughout the lifespan, it has been found in all vertebrates examined thus far, and its molecular sequence shows a high degree of conservation. These features are typical of a factor that contributes significantly to biological fitness, and this suggestion has been supported by evidence of functions that are beneficial for the brain. The putative roles of Aß include protecting the body from infections, repairing leaks in the blood-brain barrier, promoting recovery from injury, and regulating synaptic function. Evidence for these beneficial roles comes from in vitro and in vivo studies, which have shown that the cellular production of Aß rapidly increases in response to a physiological challenge and often diminishes upon recovery. These roles are further supported by the adverse outcomes of clinical trials that have attempted to deplete Aß in order to treat AD. We suggest that anti-Aß therapies will produce fewer adverse effects if the known triggers of Aß deposition (e.g., pathogens, hypertension, and diabetes) are addressed first.
Collapse
Affiliation(s)
- Holly M Brothers
- Department of Psychology, The Ohio State University Columbus, Columbus, OH, United States
| | - Maya L Gosztyla
- Department of Neuroscience, The Ohio State University Columbus, Columbus, OH, United States
| | - Stephen R Robinson
- Discipline of Psychology, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| |
Collapse
|
6
|
Cheng WH, Stukas S, Martens KM, Namjoshi DR, Button EB, Wilkinson A, Bashir A, Robert J, Cripton PA, Wellington CL. Age at injury and genotype modify acute inflammatory and neurofilament-light responses to mild CHIMERA traumatic brain injury in wild-type and APP/PS1 mice. Exp Neurol 2017; 301:26-38. [PMID: 29269117 DOI: 10.1016/j.expneurol.2017.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/11/2017] [Accepted: 12/15/2017] [Indexed: 12/14/2022]
Abstract
Peak incidence of traumatic brain injury (TBI) occurs in both young and old individuals, and older age at injury is associated with worse outcome and poorer recovery. Moderate-severe TBI is a reported risk factor for dementia, including Alzheimer's disease (AD), but whether mild TBI (mTBI) alters AD pathogenesis is not clear. To delineate how age at injury and predisposition to amyloid formation affect the acute response to mTBI, we used the Closed Head Impact Model of Engineered Rotational Acceleration (CHIMERA) model of TBI to induce two mild injuries in wild-type (WT) and APP/PS1 mice at either 6 or 13months of age and assessed behavioural, histological and biochemical changes up to 14days post-injury. Age at injury did not alter acute behavioural responses to mTBI, including measures of neurological status, motor performance, spatial memory, fear, or anxiety, in either strain. Young APP/PS1 mice showed a subtle and transient increase in diffuse Aβ deposits after injury, whereas old APP/PS1 mice showed decreased amyloid deposits, without significant alterations in total soluble or insoluble Aβ levels at either age. Age at injury and genotype showed complex responses with respect to microglial and cytokine outcomes, where post-injury neuroinflammation is increased in old WT mice but attenuated in old APP/PS1 mice. Intriguingly, silver staining confirmed axonal damage in both strains and ages, yet only young WT and APP/PS1 mice showed neurofilament-positive axonal swellings after mTBI, as this response was almost entirely attenuated in old mice. Plasma neurofilament-light levels were significantly elevated after injury only in young APP/PS1 mice. This study suggests that mild TBI has minimal effects on Aβ metabolism, but that age and genotype can each modify acute outcomes related to white matter injury.
Collapse
Affiliation(s)
- Wai Hang Cheng
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Sophie Stukas
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kris M Martens
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Dhananjay R Namjoshi
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Emily B Button
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Anna Wilkinson
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Asma Bashir
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Jerome Robert
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Peter A Cripton
- Department of Mechanical Engineering, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Cheryl L Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| |
Collapse
|