A Critical Analysis of the Role of the Neurotrophic Protein S100B in Acute Brain Injury

The Influence of Bone Cement Implantation in Primary Hip Arthroplasty on S100B Protein Serum Concentration and Patients' Cognitive Functions as Markers of Brain Damage

OBJECTIVE

The objective of the study was to evaluate the influence of the bone cement used during primary hip arthroplasty on brain functions assessed at the biochemical and clinical levels. The S100B protein is a biochemical marker of brain damage. Its plasma concentration was compared with the results of neuropsychological tests, conducted during the perioperative period.

PATIENTS AND METHODS

Two groups of patients who underwent primary hip arthroplasty were analyzed; group one (n = 30) with the use of bone cement (cemented), group two (n = 30) without (cementless). All of the procedures were under spinal anesthesia with intravenous sedation. In each group, S100B protein concentration was examined before the surgery and just after the operation, and 6, 24, and 72 h after the procedure. Two neuropsychological tests were conducted before the surgery and 24 and 72 h after. The patients with preexisting blood flow disturbances inside the carotid and vertebral arteries and those with intraoperative mean arterial pressure below 50 mmHg were excluded from the study.

STATISTICAL ANALYSIS

Data were analyzed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). The two groups were compared using the Mann-Whitney U-test. The comparison between the groups was done with Wilcoxon's signed ranks test. The correlations were analyzed using Spearman's rho test.

RESULTS

There were no significant differences between the two groups in S100B protein concentration before the surgery. Just after the operation, the S100B protein concentration was elevated in both groups, but its level in the cemented group was significantly higher, particularly just after the surgery, and its normalization was slower than in the cementless group. The comparison of time points within each group revealed that there were no significant differences in patients' reaction time in the simple reaction test before and after the surgery (p = 0.056 and 0.163 in the cementless and 0.581 and 0.139 in the cemented groups), but a significantly longer mean reaction time in the choice reaction test was observed within each group after the surgery (p = 0.003 and 0.001 in the cementless and 0.001 and 0.014 in the cemented groups). There were no correlations between S100B protein plasma concentration and the results of the neuropsychological tests.

CONCLUSIONS

There was a relationship between bone cement implantation during primary hip arthroplasty and elevated S100B protein plasma concentration during the short postoperative period, but the results of the neuropsychological tests did not reflect this.

Serum S100B protein in early management of patients after mild traumatic brain injury

BACKGROUND AND PURPOSE

Neuronal protein S100B assays are available now with a perspective of being an early screening tool for serious intracranial injury. The aim of the study was to correlate early S100B measurements and initial CCT findings in the patients sustaining mild traumatic brain injury (MTBI).

METHODS

The prospective study included patients of all ages with a history of MTBI. CCT scans and venous blood sampling for S100B analysis were performed within 6 h after injury. Levels of S100B above 0.1 ng/ml (S100B+) and any CCT detectable trauma-relevant intracranial lesions were considered positive (CCT+).

RESULTS

A series of 102 patients were involved in the study. CCT+ scans were present in eighteen (17.6%) and CCT- scans in 84 (82.4%) patients. There were 74 (72.5%) patients in S100B+ and 28 (27.5%) in S100B- group. Sensitivity of S100B assay attained 83.3% with a negative predictive value of 89.3%. Three patients from CCT+ group had negative plasma level of S100B. Two of them required surgical treatment.

DISCUSSION

S100B serum protein marker seems to be an unrealiable screening tool for determination of an intracranial injury risk group due to low sensitivity and negative predictive value seen from samples taken greater than 3 h after an MTBI.

Signal transduction pathways involved in brain death-induced renal injury

Kidneys derived from brain death organ donors show an inferior survival when compared to kidneys derived from living donors. Brain death is known to induce organ injury by evoking an inflammatory response in the donor. Neuronal injury triggers an inflammatory response in the brain, leading to endothelial dysfunction and the release of cytokines in the circulation. Serum levels of interleukin-6, -8, -10, and monocyte chemoattractant protein-1 (MCP-1) are increased after brain death. Binding with cytokine-receptors in kidneys stimulates activation of nuclear factor-kappa B (NF-kappaB), selectins, adhesion molecules and production of chemokines leading to cellular influx. Mitogen-activated protein kinases (MAP-kinases) mediate inflammatory responses and together with NF-kappaB they seem to play an important role in brain death induced renal injury. Altering the activation state of MAP-kinases could be a promising drug target for early intervention to reduce cerebral injury related donor kidney damage and improve outcome after transplantation.

Emerging treatments for traumatic brain injury

BACKGROUND

This review summarizes promising approaches for the treatment of traumatic brain injury (TBI) that are in either preclinical or clinical trials.

OBJECTIVE

The pathophysiology underlying neurological deficits after TBI is described. An overview of select therapies for TBI with neuroprotective and neurorestorative effects is presented.

METHODS

A literature review of preclinical TBI studies and clinical TBI trials related to neuroprotective and neurorestorative therapeutic approaches is provided.

RESULTS/CONCLUSION

Nearly all Phase II/III clinical trials in neuroprotection have failed to show any consistent improvement in outcome for TBI patients. The next decade will witness an increasing number of clinical trials that seek to translate preclinical research discoveries to the clinic. Promising drug- or cell-based therapeutic approaches include erythropoietin and its carbamylated form, statins, bone marrow stromal cells, stem cells singularly or in combination or with biomaterials to reduce brain injury via neuroprotection and promote brain remodeling via angiogenesis, neurogenesis, and synaptogenesis with a final goal to improve functional outcome of TBI patients. In addition, enriched environment and voluntary physical exercise show promise in promoting functional outcome after TBI, and should be evaluated alone or in combination with other treatments as therapeutic approaches for TBI.

Biomarkers in the clinical diagnosis and management of traumatic brain injury

Traumatic brain injury (TBI) is the leading cause of death and disability among young adults. Numerous safety improvements in the workplace, the addition of airbags to vehicles, and the enforcement of speed limits have all helped to reduce the incidence and severity of head trauma. While improvements in emergency response times and acute care have increased TBI survivability, this has heightened the necessity for developing reliable methods to identify patients at risk of developing secondary pathologies. At present, the primary clinical indicators for the presence of brain injury are the Glasgow Coma Scale (GCS), pupil reactivity, and head computed tomography (CT). While these indices have proven useful for stratifying the magnitude and extent of brain damage, they have limited utility for predicting adverse secondary events or detecting subtle damage. Biomarkers, reflecting a biological response to injury or disease, have proven useful for the diagnosis of many pathological conditions including cancer, heart failure, infection, and genetic disorders. For TBI, several proteins synthesized in astroglial cells or neurons have been proposed as potential biomarkers. These proteins include the BB isozyme of creatine kinase (CK-BB, predominant in brain), glial fibrilary acidic protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), and S100B.The presence of these biomarkers in the cerebrospinal fluid and serum of patients with moderate-to-severe TBI, and their correlation with outcome, suggest that they may have utility as surrogate markers in clinical trials. In addition, many of these markers have been found to be sensitive indicators of injury, and therefore may have the potential to diagnose persons with mild TBI. In addition to biomarkers that correlate with long-term outcome, a few studies have identified prognostic biomarkers for secondary injury that may be useful in individualizing patient management.

[Can serum protein S100beta predict neurological deterioration after moderate or minor traumatic brain injury?]

INTRODUCTION

Patients with moderate traumatic brain injury (TBI) (Glasgow Coma Scale, GCS, 9-13) or minor TBI (GCS 14-15) are at risk for subsequent neurological deterioration. Serum protein S-100 is believed to reflect brain damage following TBI. In patients with normal or minor CT scan abnormalities on admission, we tested whether the determination of serum protein S-100 beta could predict secondary neurological deterioration.

METHODS

Sixty-seven patients with moderate or minor TBI were prospectively studied. Serum samples were collected on admission within 12 hours postinjury to measure serum protein S-100 levels. Neurological outcome was assessed up to seven days after trauma. Secondary neurological deterioration was defined as two points or more decrease from the initial GCS, or any treatment for neurological deterioration.

RESULTS

Nine patients had a secondary neurological deterioration after trauma. No differences in serum levels of protein S-100 were found between these patients and those without neurological aggravation (n=58 patients): 0.93 microg/l (0.14-4.85) vs 0.39 microg/l (0.04-6.40), respectively. The proportion of patients with abnormal levels of serum protein S-100 at admission according to two admitted cut-off levels (>0.1 and >0.5 microg/l) was comparable between the two groups of patients. Elevated serum levels of protein S-100 were found in patients with Injury Severity Score (ISS) of more than 16 (n=23 patients): 1.26 microg/l (0.14-6.40) vs 0.22 microg/l (0.04-6.20) in patients with ISS less than 16 (n=44 patients).

DISCUSSION

The dosage of serum protein S-100 on admission failed to predict patients at risk for neurological deterioration after minor or moderate TBI. Extracranial injuries can increase serum protein S-100 levels, then limiting the usefulness of this dosage in this clinical setting.

S100B's double life: intracellular regulator and extracellular signal

The Ca2+-binding protein of the EF-hand type, S100B, exerts both intracellular and extracellular functions. Recent studies have provided more detailed information concerning the mechanism(s) of action of S100B as an intracellular regulator and an extracellular signal. Indeed, intracellular S100B acts as a stimulator of cell proliferation and migration and an inhibitor of apoptosis and differentiation, which might have important implications during brain, cartilage and skeletal muscle development and repair, activation of astrocytes in the course of brain damage and neurodegenerative processes, and of cardiomyocyte remodeling after infarction, as well as in melanomagenesis and gliomagenesis. As an extracellular factor, S100B engages RAGE (receptor for advanced glycation end products) in a variety of cell types with different outcomes (i.e. beneficial or detrimental, pro-proliferative or pro-differentiative) depending on the concentration attained by the protein, the cell type and the microenvironment. Yet, RAGE might not be the sole S100B receptor, and S100B's ability to engage RAGE might be regulated by its interaction with other extracellular factors. Future studies using S100B transgenic and S100B null mice might shed more light on the functional role(s) of the protein.

Astroglial and cognitive effects of chronic cerebral hypoperfusion in the rat

The permanent occlusion of common carotid arteries (2VO) causes a significant reduction of cerebral blood flow (hypoperfusion) in rats and constitutes a well established experimental model to investigate neuronal damage and cognitive impairment that occurs in human ageing and Alzheimer's disease. In the present study, we evaluated two astroglial proteins--S100B and glial fibrillary acidic protein (GFAP)--in cerebral cortex and hippocampus tissue, glutamate uptake and glutamine synthetase activity in hippocampus tissue, as well as S100B in cerebrospinal fluid. Cognition, as assessed by reference and working spatial memory protocols, was also investigated. Adult male Wistar rats were submitted to 10 weeks of chronic cerebral hypoperfusion by the 2VO method. A significant increase of S100B and GFAP in hippocampus tissue was observed, as well a significant decrease in glutamate uptake. Interestingly, we observed a decrease in S100B in cerebrospinal fluid. As for the cognitive outcome, there was an impairment of both reference and working spatial memory in the water maze; positive correlation between cognitive impairment and glutamate uptake decrease was evidenced in hypoperfused rats. These data support the hypothesis that astrocytes play a crucial role in the mechanisms of experimental neurodegeneration and that hippocampal pathology arising after chronic hypoperfusion gives rise to memory deficits.

Biological and methodological features of the measurement of S100B, a putative marker of brain injury

The S100B astroglial protein is widely used as a parameter of glial activation and/or death in several conditions of brain injury. Cerebrospinal fluid and serum S100B variations have been proposed to evaluate clinical outcomes in these situations. Here, we briefly broach some aspects, commonly not sufficiently valorized, concerning the biology and measurements of this protein. S100B has molecular targets and activities in and outside of astrocytes, and variations of intra and extracellular content are not necessarily coupled. We discuss the extracellular origin of this protein in brain tissue, as well as extracerebral sources of this protein in serum, comparing it with other available protein markers of brain damage. The superestimation of the heterodimer S100A1-B in the current clinical literature is also analyzed. We affirm that poor dualistic views that consider S100B elevation as "bad" or "good" simplify clinical practice and delay our comprehension of the role of this protein, both in physiological conditions and in brain disorders.

Effects of early-life LiCl-pilocarpine-induced status epilepticus on memory and anxiety in adult rats are associated with mossy fiber sprouting and elevated CSF S100B protein

PURPOSE

This study investigated putative correlations among behavioral changes and: (1) neuronal loss, (2) hippocampal mossy fiber sprouting, and (3) reactive astrogliosis in adult rats submitted to early-life LiCl-pilocarpine-induced status epilepticus (SE).

METHODS

Rats (P15) received LiCl (3 mEq/kg, i.p.) 12-18 h prior pilocarpine (60 mg/kg; s.c.). At adulthood, animals were submitted to behavioral tasks and after the completion of tasks biochemical and histological analysis were performed.

RESULTS

In SE group, it was observed an increased number of degenerating neurons in the CA1 subfield and in the hilus of animals 24 h after SE. At adulthood, SE group presented an aversive memory deficit in an inhibitory avoidance task and the animals that presented lower latency to the step down showed a higher score for mossy fiber sprouting. In the light-dark exploration task, SE rats returned less and spent less time in the light compartment and present an increased number of risk assessment behavior (RA). There was a negative correlation between the time spent in the light compartment and the score for mossy fiber sprouting and a positive correlation between score for mossy fiber sprouting and number of RA. LiCl-pilocarpine-treated animals showed higher levels of S100B immunocontent in the CSF as well as a positive correlation between the score for sprouting and the GFAP immunocontent in the CA1 subfield, suggesting an astrocytic response to neuronal injury.

CONCLUSIONS

We showed that LiCl-pilocarpine-induced SE during development produced long-lasting behavioral abnormalities, which might be associated with mossy fiber sprouting and elevated CSF S100B levels at adulthood.

S100B levels in the cerebrospinal fluid of rats are sex and anaesthetic dependent

1. S100B is a calcium-binding protein that acts as a neurotrophic cytokine and is expressed in the central nervous system, predominantly by astrocytes. At nanomolar concentrations, S100B stimulates neurite outgrowth and glial glutamate uptake, as well as protecting neurons against glutamate excitoxicity. 2. Peripheral S100B concentrations, particularly in the serum and cerebrospinal fluid (CSF), have been used as a parameter of glial activation or death in several physiological and pathological conditions. 3. In the present study, we investigated the effect of anaesthetics (thiopental, ketamine and halothane) on CSF concentrations of S100B, as well as a possible sex dependence, because several studies have suggested astrocytes as putative targets for oestrogen. 4. Higher levels of CSF S100B were found when rats were anaesthetized with thiopental; these levels, independently of anaesthetic, were sex dependent. Conversely, no effect of anaesthetic or sex was observed on serum concentrations of S100B. 5. The increase in CSF concentrations of S100B induced by thiopental was confirmed in non-anaesthetized neonatal rats and cortical astrocyte cultures. 6. Assuming CSF S100B as a marker of development, glial activation or even brain damage, investigations regarding the sex dependence of its concentration may be useful in gaining an understanding of sex variations in the behaviour and the pathological course of, as well as susceptibility to, many brain disorders. The findings of the present study reinforce the sex effect on synaptic plasticity and suggest a sex dependence of neural communication mediated by extracellular S100B without restricting the influence of astrocytes on the developmental phase.

Cannabinoid CB1 receptor stimulation affords neuroprotection in MPTP-induced neurotoxicity by attenuating S100B up-regulation in vitro

In this study, we investigated the mechanism of S100B neurotoxicity and the effect of cannabinoids, in C6 cells treated with 1-methyl-4-phenyl 1,2,3,6 tetrahydropyridine (MPTP) and co-cultured with differentiated PC12 cells. MPTP concentration- and time-dependently increased S100B density in C6 cells. This effect was followed by increased C6 cell proliferation and decreased cell viability of co-cultured PC12 cells. An antibody against S100B, given to PC12 cells before co-culture, led to their survival. Treatment with arachidonyl-2-chloroethylamide, a CB1 agonist, significantly inhibited MPTP-induced S100B density in C6 cells and protected co-cultured PC12 cells from cell death. Because MPTP selectively increased the levels of anandamide in C6 cells, the involvement of the endocannabinoid system was investigated by using selective inhibitors of endocannabinoid inactivation (cellular re-uptake or enzymatic hydrolysis) and selective cannabinoid CB1 and CB2 receptor antagonists and by silencing the CB1 receptor. Our data suggest that selective activation of CB1 receptors by either exogenous or endogenous cannabinoids might afford neuroprotection in MPTP-induced neurotoxicity also by controlling S100B up-regulation in activated glial cells.

Protective effects of resveratrol on hydrogen peroxide induced toxicity in primary cortical astrocyte cultures

It is well established that the brain is particularly susceptible to oxidative damage due to its high consumption of oxygen and that astrocytes are involved in a variety of important activities for the nervous system, including a protective role against damage induced by reactive oxygen species (ROS). The use of antioxidant compounds, such as polyphenol resveratrol found in red wine, to improve endogenous antioxidant defenses has been proposed for neural protection. The aim of this study is to evaluate the putative protective effect of resveratrol against acute H2O2-induced oxidative stress in astrocyte cultures, evaluating ROS production, glutamate uptake activity, glutathione content and S100B secretion. Our results confirm the ability of resveratrol to counteract oxidative damage caused by H2O2, not only by its antioxidant properties, but also through the modulation of important glial functions, particularly improving glutamate uptake activity, increasing glutathione content and stimulating S100B secretion, which all contribute to the functional recovery after brain injury.

Neuroanesthesiology review--2006

In this article, we will provide a review of the 2006 literature of interest to those readers who provide perioperative care to patients with neurologic disease. This evaluation of the literature is not intended to be comprehensive, nor were systematic criteria used to include or exclude articles. Instead, the authors attempted to highlight those articles of greatest clinical relevance or those that provided unique insights into the physiology, pharmacology, and pathomechanisms of neurologic function for practicing clinicians and clinician-investigators. This article focuses on intracranial hemorrhage, anesthetic considerations in neurosurgical patients, cerebral hemodynamics, electrophysiologic monitoring, neuroprotection, and traumatic brain injury.

S100B protein is released from rat neonatal neurons, astrocytes, and microglia by in vitro trauma and anti-S100 increases trauma-induced delayed neuronal injury and negates the protective effect of exogenous S100B on neurons

S100B protein is found in brain, has been used as a marker for brain injury and is neurotrophic. Using a well-characterized in vitro model of brain cell trauma, we have previously shown that strain injury causes S100B release from neonatal rat neuronal plus glial cultures and that exogenous S100B reduces delayed post-traumatic neuronal damage even when given at 6 or 24 h post-trauma. The purpose of the current studies was to measure post-traumatic S100B release by specific brain cell types and to examine the effect of an antibody to S100 on post-traumatic delayed (48 h) neuronal injury and the protective effect of exogenous S100B. Neonatal rat cortical cells grown on a deformable elastic membrane were subjected to a strain (stretch) injury produced by a 50 ms displacement of the membrane. S100B was measured with an ELISA kit. Trauma released S100B from pure cultures of astrocytes, microglia, and neurons. Anti-S100 reduced released S100B to below detectable levels, increased delayed neuronal injury in traumatized cells and negated the protective effect of exogenous S100B on injured cells. Heat denatured anti-S100 did not exacerbate injury. These studies provide further evidence for a protective role for S100B following neuronal trauma.