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Zimmerman KA, Hain JA, Graham NSN, Rooney EJ, Lee Y, Del-Giovane M, Parker TD, Friedland D, Cross MJ, Kemp S, Wilson MG, Sylvester RJ, Sharp DJ. Prospective cohort study of long-term neurological outcomes in retired elite athletes: the Advanced BiomaRker, Advanced Imaging and Neurocognitive (BRAIN) Health Study protocol. BMJ Open 2024; 14:e082902. [PMID: 38663922 PMCID: PMC11043776 DOI: 10.1136/bmjopen-2023-082902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Although limited, recent research suggests that contact sport participation might have an adverse long-term effect on brain health. Further work is required to determine whether this includes an increased risk of neurodegenerative disease and/or subsequent changes in cognition and behaviour. The Advanced BiomaRker, Advanced Imaging and Neurocognitive Health Study will prospectively examine the neurological, psychiatric, psychological and general health of retired elite-level rugby union and association football/soccer players. METHODS AND ANALYSIS 400 retired athletes will be recruited (200 rugby union and 200 association football players, male and female). Athletes will undergo a detailed clinical assessment, advanced neuroimaging, blood testing for a range of brain health outcomes and neuropsychological assessment longitudinally. Follow-up assessments will be completed at 2 and 4 years after baseline visit. 60 healthy volunteers will be recruited and undergo an aligned assessment protocol including advanced neuroimaging, blood testing and neuropsychological assessment. We will describe the previous exposure to head injuries across the cohort and investigate relationships between biomarkers of brain injury and clinical outcomes including cognitive performance, clinical diagnoses and psychiatric symptom burden. ETHICS AND DISSEMINATION Relevant ethical approvals have been granted by the Camberwell St Giles Research Ethics Committee (Ref: 17/LO/2066). The study findings will be disseminated through manuscripts in clinical/academic journals, presentations at professional conferences and through participant and stakeholder communications.
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Affiliation(s)
- Karl A Zimmerman
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Jessica A Hain
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Neil S N Graham
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
| | - Erin Jane Rooney
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Ying Lee
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Martina Del-Giovane
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
| | - Thomas D Parker
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurodegenerative Disease, The Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel Friedland
- Department of Brain Sciences, Imperial College London, London, UK
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
| | - Matthew J Cross
- Carnegie Applied Rugby Research Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Premiership Rugby, London, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Mathew G Wilson
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- HCA Healthcare Research Institute, London, UK
| | - Richard J Sylvester
- Institute of Sport, Exercise and Health (ISEH), University College London, London, UK
- Acute Stroke and Brain Injury Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - David J Sharp
- Centre for Care, Research and Technology, UK Dementia Research Institute, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Injury Studies, Imperial College London, London, UK
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Parker TD, Zimmerman KA, Laverse E, Bourke NJ, Graham NSN, Mallas EJ, Heslegrave A, Zetterberg H, Kemp S, Morris HR, Sharp DJ. Active elite rugby participation is associated with altered precentral cortical thickness. Brain Commun 2023; 5:fcad257. [PMID: 38025272 PMCID: PMC10667029 DOI: 10.1093/braincomms/fcad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
There is growing concern that elite rugby participation may negatively influence brain health, but the underlying mechanisms are unclear. Cortical thickness is a widely applied biomarker of grey matter structure, but there is limited research into how it may be altered in active professional rugby players. Cross-sectional MRI data from 44 active elite rugby players, including 21 assessed within 1 week of head injury, and 47 healthy controls were analysed. We investigated how active elite rugby participation with and without sub-acute traumatic brain injury influenced grey matter structure using whole cortex and region of interest cortical thickness analyses. Relationships between cortical thickness and biomarkers of traumatic brain injury, including fractional anisotropy, plasma neurofilament light and glial fibrillary acidic protein, were also examined. In whole-cortex analyses, precentral cortical thickness in the right hemisphere was lower in rugby players compared with controls, which was due to reductions in non-injured players. Post hoc region of interest analyses showed non-injured rugby players had reduced cortical thickness in the inferior precentral sulcal thickness bilaterally (P = 0.005) and the left central sulcus (P = 0.037) relative to controls. In contrast, players in the sub-acute phase of mild traumatic brain injury had higher inferior precentral sulcal cortical thickness in the right hemisphere (P = 0.015). Plasma glial fibrillary acidic protein, a marker of astrocyte activation, was positively associated with right inferior precentral sulcal cortical thickness in injured rugby players (P = 0.0012). Elite rugby participation is associated with localized alterations in cortical thickness, specifically in sulcal motor regions. Sub-acute changes after mild traumatic brain injury are associated with evidence of astrocytic activation. The combination of cortical thickness and glial fibrillary acidic protein may be useful in understanding the pathophysiological relationship between sporting head injury and brain health.
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Affiliation(s)
- Thomas D Parker
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | | | - Niall J Bourke
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Neil S N Graham
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | - Emma-Jane Mallas
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
| | - Amanda Heslegrave
- UCL Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1N 3BG, UK
- UKDRI Fluid Biomarker Laboratory, London, WC1N 3BG, UK
| | - Henrik Zetterberg
- UCL Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WC1N 3BG, UK
- UKDRI Fluid Biomarker Laboratory, London, WC1N 3BG, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Mölndal, 431 41, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, 413 45, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Simon Kemp
- Rugby Football Union, Twickenham Stadium, Twickenham, Middlesex TW2 7BA, UK
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Huw R Morris
- UCL Institute of Neurology, London, WC1N 3BG, UK
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, W12 0BZ, UK
- Dementia Research Institute Care, Research and Technology Centre, Imperial College London, London, W12 0BZ, UK
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Zimmerman KA, Cournoyer J, Lai H, Snider SB, Fischer D, Kemp S, Karton C, Hoshizaki TB, Ghajari M, Sharp DJ. The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries. Brain 2023; 146:3063-3078. [PMID: 36546554 PMCID: PMC10316777 DOI: 10.1093/brain/awac485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 12/02/2022] [Indexed: 08/27/2023] Open
Abstract
Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.
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Affiliation(s)
- Karl A Zimmerman
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Janie Cournoyer
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Helen Lai
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Samuel B Snider
- Division of Neurocritical care, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - David Fischer
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Simon Kemp
- Rugby Football Union, Twickenham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Thomas B Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, Ottawa, ON, Canada
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, UK
| | - David J Sharp
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London, London, UK
- Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
- The Royal British Legion Centre for Blast Injury Studies and the Department of Bioengineering, Imperial College London, London, UK
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Li LM, Heslegrave A, Soreq E, Nattino G, Rosnati M, Garbero E, Zimmerman KA, Graham NSN, Moro F, Novelli D, Gradisek P, Magnoni S, Glocker B, Zetterberg H, Bertolini G, Sharp DJ. Investigating the characteristics and correlates of systemic inflammation after traumatic brain injury: the TBI-BraINFLAMM study. BMJ Open 2023; 13:e069594. [PMID: 37221026 DOI: 10.1136/bmjopen-2022-069594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION A significant environmental risk factor for neurodegenerative disease is traumatic brain injury (TBI). However, it is not clear how TBI results in ongoing chronic neurodegeneration. Animal studies show that systemic inflammation is signalled to the brain. This can result in sustained and aggressive microglial activation, which in turn is associated with widespread neurodegeneration. We aim to evaluate systemic inflammation as a mediator of ongoing neurodegeneration after TBI. METHODS AND ANALYSIS TBI-braINFLAMM will combine data already collected from two large prospective TBI studies. The CREACTIVE study, a broad consortium which enrolled >8000 patients with TBI to have CT scans and blood samples in the hyperacute period, has data available from 854 patients. The BIO-AX-TBI study recruited 311 patients to have acute CT scans, longitudinal blood samples and longitudinal MRI brain scans. The BIO-AX-TBI study also has data from 102 healthy and 24 non-TBI trauma controls, comprising blood samples (both control groups) and MRI scans (healthy controls only). All blood samples from BIO-AX-TBI and CREACTIVE have already been tested for neuronal injury markers (GFAP, tau and NfL), and CREACTIVE blood samples have been tested for inflammatory cytokines. We will additionally test inflammatory cytokine levels from the already collected longitudinal blood samples in the BIO-AX-TBI study, as well as matched microdialysate and blood samples taken during the acute period from a subgroup of patients with TBI (n=18).We will use this unique dataset to characterise post-TBI systemic inflammation, and its relationships with injury severity and ongoing neurodegeneration. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the London-Camberwell St Giles Research Ethics Committee (17/LO/2066). Results will be submitted for publication in peer-review journals, presented at conferences and inform the design of larger observational and experimental medicine studies assessing the role and management of post-TBI systemic inflammation.
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Affiliation(s)
- Lucia M Li
- Brain Sciences, Imperial College, London, UK
- UKDRI Centre for Care Research & Technology, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- UKDRI at UCL, London, UK
| | - Eyal Soreq
- Brain Sciences, Imperial College, London, UK
- UKDRI Centre for Care Research & Technology, London, UK
| | - Giovanni Nattino
- IRCCS-"Mario Negri" Institute for Pharmacological Research, Ranica, Bergamo, Italy
| | - Margherita Rosnati
- Brain Sciences, Imperial College, London, UK
- BioMedIA Group, Department of Computing, Imperial College, London, UK
| | - Elena Garbero
- Istituto Di Ricerche Farmacologiche Mario Negri, Ranica, Italy
| | - Karl A Zimmerman
- Brain Sciences, Imperial College, London, UK
- DRI Centre for Care Research and Technology, London, UK
| | - Neil S N Graham
- Brain Sciences, Imperial College, London, UK
- UKDRI Centre for Care Research & Technology, London, UK
| | - Federico Moro
- Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Deborah Novelli
- Cardiovascular Medicine, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Primoz Gradisek
- Clinical Dpt of Anaesthesiology and Intensive Therapy, University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Ben Glocker
- BioMedIA Group, Department of Computing, Imperial College, London, UK
| | - Henrik Zetterberg
- UKDRI at UCL, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Guido Bertolini
- Public Health, Laboratory of Clinical Epidemiology, IRCCS-"Mario Negri" Institute for Pharmacological Research, Ranica, Italy
| | - David J Sharp
- UKDRI Centre for Care Research & Technology, London, UK
- Division of Brain Sciences, Imperial College, London, UK
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Duckworth H, Azor A, Wischmann N, Zimmerman KA, Tanini I, Sharp DJ, Ghajari M. A Finite Element Model of Cerebral Vascular Injury for Predicting Microbleeds Location. Front Bioeng Biotechnol 2022; 10:860112. [PMID: 35519616 PMCID: PMC9065595 DOI: 10.3389/fbioe.2022.860112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
Finite Element (FE) models of brain mechanics have improved our understanding of the brain response to rapid mechanical loads that produce traumatic brain injuries. However, these models have rarely incorporated vasculature, which limits their ability to predict the response of vessels to head impacts. To address this shortcoming, here we used high-resolution MRI scans to map the venous system anatomy at a submillimetre resolution. We then used this map to develop an FE model of veins and incorporated it in an anatomically detailed FE model of the brain. The model prediction of brain displacement at different locations was compared to controlled experiments on post-mortem human subject heads, yielding over 3,100 displacement curve comparisons, which showed fair to excellent correlation between them. We then used the model to predict the distribution of axial strains and strain rates in the veins of a rugby player who had small blood deposits in his white matter, known as microbleeds, after sustaining a head collision. We hypothesised that the distribution of axial strain and strain rate in veins can predict the pattern of microbleeds. We reconstructed the head collision using video footage and multi-body dynamics modelling and used the predicted head accelerations to load the FE model of vascular injury. The model predicted large axial strains in veins where microbleeds were detected. A region of interest analysis using white matter tracts showed that the tract group with microbleeds had 95th percentile peak axial strain and strain rate of 0.197 and 64.9 s−1 respectively, which were significantly larger than those of the group of tracts without microbleeds (0.163 and 57.0 s−1). This study does not derive a threshold for the onset of microbleeds as it investigated a single case, but it provides evidence for a link between strain and strain rate applied to veins during head impacts and structural damage and allows for future work to generate threshold values. Moreover, our results suggest that the FE model has the potential to be used to predict intracranial vascular injuries after TBI, providing a more objective tool for TBI assessment and improving protection against it.
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Affiliation(s)
- Harry Duckworth
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, London, United Kingdom
| | - Adriana Azor
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, London, United Kingdom
| | - Nikolaus Wischmann
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Karl A. Zimmerman
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, London, United Kingdom
| | - Ilaria Tanini
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- Industrial Engineering Department, University of Florence, Florence, Italy
| | - David J. Sharp
- The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, London, United Kingdom
- Care Research and Technology Centre, Dementia Research Institute, London, United Kingdom
| | - Mazdak Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Mazdak Ghajari,
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Xu L, Ramadan S, Akingbade OE, Zhang Y, Alodan S, Graham N, Zimmerman KA, Torres E, Heslegrave A, Petrov PK, Zetterberg H, Sharp DJ, Klein N, Li B. Detection of Glial Fibrillary Acidic Protein in Patient Plasma Using On-Chip Graphene Field-Effect Biosensors, in Comparison with ELISA and Single-Molecule Array. ACS Sens 2022; 7:253-262. [PMID: 34908400 PMCID: PMC8805154 DOI: 10.1021/acssensors.1c02232] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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Glial
fibrillary
acidic protein (GFAP) is a discriminative blood
biomarker for many neurological diseases, such as traumatic brain
injury. Detection of GFAP in buffer solutions using biosensors has
been demonstrated, but accurate quantification of GFAP in patient
samples has not been reported, yet in urgent need. Herein, we demonstrate
a robust on-chip graphene field-effect transistor (GFET) biosensing
method for sensitive and ultrafast detection of GFAP in patient plasma.
Patients with moderate–severe traumatic brain injuries, defined
by the Mayo classification, are recruited to provide plasma samples.
The binding of target GFAP with the specific antibodies that are conjugated
on a monolayer GFET device triggers the shift of its Dirac point,
and this signal change is correlated with the GFAP concentration in
the patient plasma. The limit of detection (LOD) values of 20 fg/mL
(400 aM) in buffer solution and 231 fg/mL (4 fM) in patient plasma
have been achieved using this approach. In parallel, for the first
time, we compare our results to the state-of-the-art single-molecule
array (Simoa) technology and the classic enzyme-linked immunosorbent
assay (ELISA) for reference. The GFET biosensor shows competitive
LOD to Simoa (1.18 pg/mL) and faster sample-to-result time (<15
min), and also it is cheaper and more user-friendly. In comparison
to ELISA, GFET offers advantages of total detection time, detection
sensitivity, and simplicity. This GFET biosensing platform holds high
promise for the point-of-care diagnosis and monitoring of traumatic
brain injury in GP surgeries and patient homes.
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Affiliation(s)
- Lizhou Xu
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Sami Ramadan
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Oluwatomi E. Akingbade
- Department of Brain Sciences, Imperial College London, London W12 0BZ, U.K
- Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, U.K
| | - Yuanzhou Zhang
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Sarah Alodan
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Neil Graham
- Department of Brain Sciences, Imperial College London, London W12 0BZ, U.K
- Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, U.K
| | - Karl A. Zimmerman
- Department of Brain Sciences, Imperial College London, London W12 0BZ, U.K
- Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, U.K
| | - Elias Torres
- Graphenea Semiconductor, Paseo Mikeletegi 83, San Sebastián 20009, Spain
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, University College London, London WC1E 6BT, U.K
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1E 6BT, U.K
| | - Peter K. Petrov
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, University College London, London WC1E 6BT, U.K
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1E 6BT, U.K
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal 43141, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal 43141, Sweden
- Hong Kong Centre for Neurodegenerative Diseases, Hong Kong 999077, China
| | - David J. Sharp
- Department of Brain Sciences, Imperial College London, London W12 0BZ, U.K
- Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, U.K
| | - Norbert Klein
- Department of Materials, Imperial College London, London SW7 2AZ, U.K
| | - Bing Li
- Department of Brain Sciences, Imperial College London, London W12 0BZ, U.K
- Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, U.K
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7
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Li LM, Bourke NJ, Lai HHL, May HG, Zimmerman KA, Bell J, Riches E, Abu-Sway S, Sharp DJ. Conferences in the time of COVID: notes on organizing and delivering the first Brain Conference. Brain Commun 2021; 3:fcab142. [PMID: 34755106 PMCID: PMC8570146 DOI: 10.1093/braincomms/fcab142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/14/2022] Open
Abstract
To further fulfil their missions of promoting teaching, education and research in neurology and related clinical-academic disciplines, the Guarantors of Brain and the Brain journal family invited delegates to the first Brain Conference in Spring of this year. This event aimed to deliver excellent teaching and scientific presentations across a broad spectrum of neuroscience fields, with the key aim of making the content as accessible as possible. We hoped to capitalize on the benefits of an online format, whilst trying to capture a little of the joy of the in-person meeting. This article reports on the approach and practical choices made to achieve these goals, and we hope this will provide some guidance and advice to others organizing their own online conference.
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Affiliation(s)
- Lucia M Li
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, Sir Michael Uren Hub, London, W12 0BZ, UK
| | - Niall J Bourke
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, Sir Michael Uren Hub, London, W12 0BZ, UK
| | - Helen H L Lai
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, Sir Michael Uren Hub, London, W12 0BZ, UK
| | - Hazel G May
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Karl A Zimmerman
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, Sir Michael Uren Hub, London, W12 0BZ, UK
| | - Joanne Bell
- Brain Editorial Office, Ormond House, London WC1N 3JZ, UK
| | - Eleanor Riches
- Brain Editorial Office, Ormond House, London WC1N 3JZ, UK
| | - Safa Abu-Sway
- UKRI CDT Centre for Doctoral Training in AI for Healthcare, London SW7 2AZ, UK
| | - David J Sharp
- Division of Brain Sciences, Department of Medicine, Imperial College London, London W12 0NN, UK.,UK Dementia Research Institute Care Research and Technology Centre, Imperial College London and the University of Surrey, Sir Michael Uren Hub, London, W12 0BZ, UK
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8
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Graham NSN, Zimmerman KA, Moro F, Heslegrave A, Maillard SA, Bernini A, Miroz JP, Donat CK, Lopez MY, Bourke N, Jolly AE, Mallas EJ, Soreq E, Wilson MH, Fatania G, Roi D, Patel MC, Garbero E, Nattino G, Baciu C, Fainardi E, Chieregato A, Gradisek P, Magnoni S, Oddo M, Zetterberg H, Bertolini G, Sharp DJ. Axonal marker neurofilament light predicts long-term outcomes and progressive neurodegeneration after traumatic brain injury. Sci Transl Med 2021; 13:eabg9922. [PMID: 34586833 DOI: 10.1126/scitranslmed.abg9922] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Neil S N Graham
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Federico Moro
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy.,Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Anestesia e Rianimazione, 20122, Milan, Italy
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.,UK Dementia Research Institute at UCL, London WC1N 3BG, UK
| | - Samia Abed Maillard
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Adriano Bernini
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - John-Paul Miroz
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Cornelius K Donat
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Maria Yanez Lopez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Niall Bourke
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Amy E Jolly
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Emma-Jane Mallas
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Eyal Soreq
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK
| | - Mark H Wilson
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London W6 8RF, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Gavin Fatania
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Dylan Roi
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Maneesh C Patel
- Department of Imaging, Imperial College Healthcare NHS Trust, London W6 8RF, UK
| | - Elena Garbero
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - Camelia Baciu
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Enrico Fainardi
- Department of Experimental and Clinical Sciences, Careggi University Hospital, University of Firenze, Florence 50139, Italy
| | - Arturo Chieregato
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Center, Ljubljana 1000, Slovenia
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento 38122, Italy
| | - Mauro Oddo
- Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland.,Medical Direction, CHUV Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal 431 41, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal 431 41, Sweden
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo 24126, Italy
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK.,UK DRI Centre for Care Research and Technology, Imperial College London, London W12 0BZ, UK.,Centre for Injury Studies, Imperial College London, London SW7 2AZ, UK
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9
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Zimmerman KA, Laverse E, Samra R, Yanez Lopez M, Jolly AE, Bourke NJ, Graham NSN, Patel MC, Hardy J, Kemp S, Morris HR, Sharp DJ. White matter abnormalities in active elite adult rugby players. Brain Commun 2021; 3:fcab133. [PMID: 34435188 PMCID: PMC8381344 DOI: 10.1093/braincomms/fcab133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
The recognition, diagnosis and management of mild traumatic brain injuries are difficult and confusing. It is unclear how the severity and number of injuries sustained relate to brain injuries, such as diffuse axonal injury, diffuse vascular injury and progressive neurodegeneration. Advances in neuroimaging techniques enable the investigation of neuropathologies associated with acute and long-term effects of injury. Head injuries are the most commonly reported injury seen during professional rugby. There is increased vigilance for the immediate effects of these injuries in matches, but there has been surprisingly little research investigating the longer-term effects of rugby participation. Here, we present a longitudinal observational study investigating the relationship of exposure to rugby participation and sub-acute head injuries in professional adult male and female rugby union and league players using advanced MRI. Diffusion tensor imaging and susceptibility weighted imaging was used to assess white matter structure and evidence of axonal and diffuse vascular injury. We also studied changes in brain structure over time using Jacobian Determinant statistics extracted from serial volumetric imaging. We tested 41 male and 3 female adult elite rugby players, of whom 21 attended study visits after a head injury, alongside 32 non-sporting controls, 15 non-collision-sport athletic controls and 16 longitudinally assessed controls. Eighteen rugby players participated in the longitudinal arm of the study, with a second visit at least 6 months after their first scan. Neuroimaging evidence of either axonal injury or diffuse vascular injury was present in 23% (10/44) of players. In the non-acutely injured group of rugby players, abnormalities of fractional anisotropy and other diffusion measures were seen. In contrast, non-collision-sport athletic controls were not classified as showing abnormalities. A group level contrast also showed evidence of sub-acute injury using diffusion tensor imaging in rugby players. Examination of longitudinal imaging revealed unexpected reductions in white matter volume in the elite rugby players studied. These changes were not related to self-reported head injury history or neuropsychological test scores and might indicate excess neurodegeneration in white matter tracts affected by injury. Taken together, our findings suggest an association of participation in elite adult rugby with changes in brain structure. Further well-designed large-scale studies are needed to understand the impact of both repeated sports-related head impacts and head injuries on brain structure, and to clarify whether the abnormalities we have observed are related to an increased risk of neurodegenerative disease and impaired neurocognitive function following elite rugby participation.
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Affiliation(s)
- Karl A Zimmerman
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Etienne Laverse
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - Ravjeet Samra
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK
| | - Maria Yanez Lopez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London SE1 7EH, UK
| | - Amy E Jolly
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Niall J Bourke
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Neil S N Graham
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK
| | - Maneesh C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - John Hardy
- Department of Neurodegenerative Disease, Reta Lila Weston Laboratories, Queen Square Genomics, UCL Dementia Research Institute, London WC1N 3BG, UK
| | - Simon Kemp
- Rugby Football Union, Twickenham, London TW2 7BA, UK.,Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Huw R Morris
- Department of Clinical and Movement Neuroscience, University College London, London NW3 2PF, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Hammersmith Hospital, Imperial College London, London W12 0NN, UK.,Care Research & Technology Centre, UK Dementia Research Institute, London W12 0BZ, UK.,The Royal British Legion Centre for Blast Injury Studies, Imperial College London SW7 2AZ, UK
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10
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Zimmerman KA, Kim J, Karton C, Lochhead L, Sharp DJ, Hoshizaki T, Ghajari M. Player position in American football influences the magnitude of mechanical strains produced in the location of chronic traumatic encephalopathy pathology: A computational modelling study. J Biomech 2021; 118:110256. [PMID: 33545573 PMCID: PMC7612336 DOI: 10.1016/j.jbiomech.2021.110256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/24/2020] [Accepted: 01/10/2021] [Indexed: 12/14/2022]
Abstract
American football players are frequently exposed to head impacts, which can cause concussions and may lead to neurodegenerative diseases such as chronic traumatic encephalopathy (CTE). Player position appears to influence the risk of concussion but there is limited work on its effect on the risk of CTE. Computational modelling has shown that large brain deformations during head impacts co-localise with CTE pathology in sulci. Here we test whether player position has an effect on brain deformation within the sulci, a possible biomechanical trigger for CTE. We physically reconstructed 148 head impact events from video footage of American Football games. Players were separated into 3 different position profiles based on the magnitude and frequency of impacts. A detailed finite element model of TBI was then used to predict Green-Lagrange strain and strain rate across the brain and in sulci. Using a one-way ANOVA, we found that in positions where players were exposed to large magnitude and low frequency impacts (e.g. defensive back and wide receiver), strain and strain rate across the brain and in sulci were highest. We also found that rotational head motion is a key determinant in producing large strains and strain rates in the sulci. Our results suggest that player position has a significant effect on impact kinematics, influencing the magnitude of deformations within sulci, which spatially corresponds to where CTE pathology is observed. This work can inform future studies investigating different player-position risks for concussion and CTE and guide design of prevention systems.
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Affiliation(s)
- K A Zimmerman
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK; HEAD Lab, Dyson School of Design Engineering, Imperial College London, UK.
| | - J Kim
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - C Karton
- Neurotrauma Impact Science Laboratory, University of Ottawa, Canada
| | - L Lochhead
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - D J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Hammersmith Hospital, Imperial College London, London, UK; Care Research & Technology Centre, UK Dementia Research Institute, London, UK
| | - T Hoshizaki
- Neurotrauma Impact Science Laboratory, University of Ottawa, Canada
| | - M Ghajari
- HEAD Lab, Dyson School of Design Engineering, Imperial College London, UK
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11
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Graham NSN, Zimmerman KA, Bertolini G, Magnoni S, Oddo M, Zetterberg H, Moro F, Novelli D, Heslegrave A, Chieregato A, Fainardi E, Fleming JM, Garbero E, Abed-Maillard S, Gradisek P, Bernini A, Sharp DJ. Multicentre longitudinal study of fluid and neuroimaging BIOmarkers of AXonal injury after traumatic brain injury: the BIO-AX-TBI study protocol. BMJ Open 2020; 10:e042093. [PMID: 33172948 PMCID: PMC7656955 DOI: 10.1136/bmjopen-2020-042093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/29/2020] [Accepted: 10/21/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION AND AIMS Traumatic brain injury (TBI) often results in persistent disability, due particularly to cognitive impairments. Outcomes remain difficult to predict but appear to relate to axonal injury. Several new approaches involving fluid and neuroimaging biomarkers show promise to sensitively quantify axonal injury. By assessing these longitudinally in a large cohort, we aim both to improve our understanding of the pathophysiology of TBI, and provide better tools to predict clinical outcome. METHODS AND ANALYSIS BIOmarkers of AXonal injury after TBI is a prospective longitudinal study of fluid and neuroimaging biomarkers of axonal injury after moderate-to-severe TBI, currently being conducted across multiple European centres. We will provide a detailed characterisation of axonal injury after TBI, using fluid (such as plasma/microdialysate neurofilament light) and neuroimaging biomarkers (including diffusion tensor MRI), which will then be related to detailed clinical, cognitive and functional outcome measures. We aim to recruit at least 250 patients, including 40 with cerebral microdialysis performed, with serial assessments performed twice in the first 10 days after injury, subacutely at 10 days to 6 weeks, at 6 and 12 months after injury. ETHICS AND DISSEMINATION The relevant ethical approvals have been granted by the following ethics committees: in London, by the Camberwell St Giles Research Ethics Committee; in Policlinico (Milan), by the Comitato Etico Milano Area 2; in Niguarda (Milan), by the Comitato Etico Milano Area 3; in Careggi (Florence), by the Comitato Etico Regionale per la Sperimentazione Clinica della Regione Toscana, Sezione area vasta centro; in Trento, by the Trento Comitato Etico per le Sperimentazioni Cliniche, Azienda Provinciale per i Servizi Sanitari della Provincia autonoma di Trento; in Lausanne, by the Commission cantonale d'éthique de la recherche sur l'être humain; in Ljubljana, by the National Medical Ethics Committee at the Ministry of Health of the Republic of Slovenia. The study findings will be disseminated to patients, healthcare professionals, academics and policy-makers including through presentation at conferences and peer-reviewed publications. Data will be shared with approved researchers to provide further insights for patient benefit. TRIAL REGISTRATION NUMBER NCT03534154.
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Affiliation(s)
- Neil Samuel Nyholm Graham
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
| | - Karl A Zimmerman
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
| | - Guido Bertolini
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, Trento, Italy
| | - Mauro Oddo
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Mölndal, Sweden
| | - Federico Moro
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Deborah Novelli
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | | | - Arturo Chieregato
- Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Enrico Fainardi
- Department of Experimental and Clinical Sciences, Careggi University Hospital, University of Firenze, Florence, Italy
| | - Joanne M Fleming
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Elena Garbero
- Public Health, IRCCS-'Mario Negri' Institute for Pharmacological Research, Ranica, Italy
| | - Samia Abed-Maillard
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - Primoz Gradisek
- Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Center, Ljubljana, Slovenia
| | - Adriano Bernini
- Department of Intensive Care Medicine, CHUV Lausanne University Hospital, Lausanne, Switzerland
| | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
- UK DRI Centre for Care Research and Technology, London, UK
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12
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Gorgoraptis N, Li LM, Whittington A, Zimmerman KA, Maclean LM, McLeod C, Ross E, Heslegrave A, Zetterberg H, Passchier J, Matthews PM, Gunn RN, McMillan TM, Sharp DJ. In vivo detection of cerebral tau pathology in long-term survivors of traumatic brain injury. Sci Transl Med 2019; 11:11/508/eaaw1993. [DOI: 10.1126/scitranslmed.aaw1993] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) can trigger progressive neurodegeneration, with tau pathology seen years after a single moderate-severe TBI. Identifying this type of posttraumatic pathology in vivo might help to understand the role of tau pathology in TBI pathophysiology. We used flortaucipir positron emission tomography (PET) to investigate whether tau pathology is present many years after a single TBI in humans. We examined PET data in relation to markers of neurodegeneration in the cerebrospinal fluid (CSF), structural magnetic resonance imaging measures, and cognitive performance. Cerebral flortaucipir binding was variable, with many participants with TBI showing increases in cortical and white matter regions. At the group level, flortaucipir binding was increased in the right occipital cortex in TBI when compared to healthy controls. Flortaucipir binding was associated with increased total tau, phosphorylated tau, and ubiquitin carboxyl-terminal hydrolase L1 CSF concentrations, as well as with reduced fractional anisotropy and white matter tissue density in TBI. Apolipoprotein E (APOE) ε4 genotype affected the relationship between flortaucipir binding and time since injury, CSF β amyloid 1–42 (Aβ42) concentration, white matter tissue density, and longitudinal Mini-Mental State Examination scores in TBI. The results demonstrate that tau PET is a promising approach to investigating progressive neurodegeneration associated with tauopathy after TBI.
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Affiliation(s)
- Nikos Gorgoraptis
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Lucia M. Li
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Alex Whittington
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
- Invicro London, London W12 0NN, UK
| | - Karl A. Zimmerman
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Linda M. Maclean
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Claire McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - Ewan Ross
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Amanda Heslegrave
- UK Dementia Research Institute, University College London, London WC1N 3BG, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Henrik Zetterberg
- UK Dementia Research Institute, University College London, London WC1N 3BG, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal 431 80, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal 413 45, Sweden
| | | | - Paul M. Matthews
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
- UK Dementia Research Institute, Imperial College London, London W12 0NN, UK
| | - Roger N. Gunn
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
- Invicro London, London W12 0NN, UK
| | - Tom M. McMillan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, UK
| | - David J. Sharp
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK
- UK Dementia Research Institute, Imperial College London, London W12 0NN, UK
- Royal British Legion Centre for Blast Injury Studies, Imperial College London, London, UK
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13
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Hemmi N, Zimmerman KA, Dreger ZA, Gupta YM. High spectral resolution, real-time, Raman spectroscopy in shock compression experiments. Rev Sci Instrum 2011; 82:083109. [PMID: 21895235 DOI: 10.1063/1.3627444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The use of Raman measurements to examine molecular changes associated with shock-induced structural and chemical changes in condensed materials often poses two challenging requirements: high spectral resolution and significantly reduced background light. Here, we describe an experimental method that addresses these requirements and provides better quality data than the time resolved approach used previously. Representative measurements are presented for shock compression of two energetic crystals: pentaerythritol tetranitrate and cyclotrimethylene trinitramine. The high spectral resolution data have provided insight into molecular changes that could not be obtained from lower-resolution, time-resolved methods.
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Affiliation(s)
- N Hemmi
- Institute for Shock Physics and Department of Physics, Washington State University, Pullman, Washington 99164, USA
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14
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Zimmerman KA, Dabezies MA, Schnall SF, Maurer AH, Dempsey DT. Acute gastrointestinal hemorrhage from non-Hodgkin's lymphoma of the jejunum after orthotopic heart transplantation. Am J Gastroenterol 1993; 88:1449-50. [PMID: 8362848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- K A Zimmerman
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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15
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Abstract
To elucidate the molecular events associated with postnatal and compensatory renal growth, the expression of growth/differentiation genes (c-fos, c-myc, c-H-ras, c-K-ras), a stress-related gene (HSP70) and a structural gene (collagen type IV, alpha 1 and 2) were examined. Northern analysis of messenger ribonucleic acid from the newborn mouse reveals high levels of expression of HSP70, c-H-ras, and c-K-ras during the first week of life. By day 40 HSP70-related and c-H-ras expression decreases somewhat, c-K-ras remains unchanged and collagen type IV, which encodes for the renal glomerular basement membrane, expression decreases significantly. During compensatory renal growth increased expression of HSP70, c-H-ras and c-K-ras occurs. The results seem to indicate that growth/differentiation genes may be necessary for continued cell growth (hypertrophy) in postnatal and compensatory renal growth, and that collagen type IV formation continues up through week 2 of postnatal growth consistent with the interval of glomerular basement membrane formation.
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Affiliation(s)
- I S Sawczuk
- Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York
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16
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Maddon PJ, Molineaux SM, Maddon DE, Zimmerman KA, Godfrey M, Alt FW, Chess L, Axel R. Structure and expression of the human and mouse T4 genes. Proc Natl Acad Sci U S A 1987; 84:9155-9. [PMID: 3501122 PMCID: PMC299711 DOI: 10.1073/pnas.84.24.9155] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The T4 molecule may serve as a T-cell receptor recognizing molecules on the surface of specific target cells and also serves as the receptor for the human immunodeficiency virus. To define the mechanisms of interaction of T4 with the surface of antigen-presenting cells as well as with human immunodeficiency virus, we have further analyzed the sequence, structure, and expression of the human and mouse T4 genes. T4 consists of an extracellular segment comprised of a leader sequence followed by four tandem variable-joining (VJ)-like domains, a transmembrane domain, and a cytoplasmic segment. The structural domains of the T4 protein deduced from amino acid sequence are precisely reflected in the intron-exon organization of the gene. Analysis of the expression of the T4 gene indicates that T4 RNA is expressed not only in T lymphocytes, but in B cells, macrophages, and granulocytes. T4 is also expressed in a developmentally regulated manner in specific regions of the brain. It is, therefore, possible that T4 plays a more general role in mediating cell recognition events that are not restricted to the cellular immune response.
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Affiliation(s)
- P J Maddon
- Department of Biochemistry and Molecular Biophysics, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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17
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Nisen PD, Zimmerman KA, Cotter SV, Gilbert F, Alt FW. Enhanced expression of the N-myc gene in Wilms' tumors. Cancer Res 1986; 46:6217-22. [PMID: 2430692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Activation of myc-family oncogenes has been implicated in the genesis of a variety of neoplasms. In addition, these genes exhibit specific patterns of expression during murine development. We now report that N- and c-myc are differentially expressed in normal developing human renal tissues and in Wilms' tumor, a neoplasm which derives from primitive kidney cells. Twelve of 13 Wilms' tumors tested exhibited greatly enhanced levels of expression which occurred in the absence of gene amplification. We also detected N-myc expression in other primitive neoplasms including medulloblastoma and hepatoblastoma. Our observations suggest that N-myc expression is not limited to neuroectodermal tumors as was previously thought, but is a marker for several neoplasms that derive from primitive cell precursors. Finally, high level expression of N-myc was associated with markedly diminished levels of c-myc, suggesting that enhanced expression of N-myc gene might lead to down-regulation of c-myc.
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Yancopoulos GD, DePinho RA, Zimmerman KA, Lutzker SG, Rosenberg N, Alt FW. Secondary genomic rearrangement events in pre-B cells: VHDJH replacement by a LINE-1 sequence and directed class switching. EMBO J 1986; 5:3259-66. [PMID: 3028778 PMCID: PMC1167320 DOI: 10.1002/j.1460-2075.1986.tb04637.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We describe rearrangement events which alter expression from a productive VHDJH rearrangement in an Abelson murine leukemia virus-transformed pre-B cell line. One such rearrangement results in replacement of the initially expressed variable region gene by a site-specific join between the open reading frame of a LINE-1 repetitive element and a remaining JH segment. We discuss this event in the context of the 'accessibility' model of recombinase control, and with respect to similar rearrangements involved in oncogene activation. In another subclone of the same pre-B cell line, altered heavy chain expression resulted from a mu to gamma 2b class switch recombination which occurred by a recombination-deletion mechanism but involved a complex inversion. We provide evidence that the germline gamma 2b region is specifically expressed in pre-B cell lines and early in normal development. We propose that the predisposition of pre-B cell lines to switch to gamma 2b production may reflect a normal physiological phenomenon in which the switch event is directed by an increased 'accessibility' of the germline gamma 2b locus to switch-recombination enzymatic machinery. Our findings support the hypothesis that the apparently distinct recombination systems involved in variable region gene assembly and heavy chain class switching are both directed by the accessibility of their substrate gene segments.
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West JC, Kelley SE, Campbell P, Burns-Morrison B, Zimmerman KA. Philosophy and financing of organ transplants. Pa Med 1986; 89:22, 26. [PMID: 3517762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Zimmerman KA. MENTAL HEALTH IN THE PUBLIC HEALTH PROGRAM. Calif Med 1948; 69:212-216. [PMID: 18731535 PMCID: PMC1643430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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