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Wang LLW, Gao Y, Chandran Suja V, Boucher ML, Shaha S, Kapate N, Liao R, Sun T, Kumbhojkar N, Prakash S, Clegg JR, Warren K, Janes M, Park KS, Dunne M, Ilelaboye B, Lu A, Darko S, Jaimes C, Mannix R, Mitragotri S. Preclinical characterization of macrophage-adhering gadolinium micropatches for MRI contrast after traumatic brain injury in pigs. Sci Transl Med 2024; 16:eadk5413. [PMID: 38170792 DOI: 10.1126/scitranslmed.adk5413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
The choroid plexus (ChP) of the brain plays a central role in orchestrating the recruitment of peripheral leukocytes into the central nervous system (CNS) through the blood-cerebrospinal fluid (BCSF) barrier in pathological conditions, thus offering a unique niche to diagnose CNS disorders. We explored whether magnetic resonance imaging of the ChP could be optimized for mild traumatic brain injury (mTBI). mTBI induces subtle, yet influential, changes in the brain and is currently severely underdiagnosed. We hypothesized that mTBI induces sufficient alterations in the ChP to cause infiltration of circulating leukocytes through the BCSF barrier and developed macrophage-adhering gadolinium [Gd(III)]-loaded anisotropic micropatches (GLAMs), specifically designed to image infiltrating immune cells. GLAMs are hydrogel-based discoidal microparticles that adhere to macrophages without phagocytosis. We present a fabrication process to prepare GLAMs at scale and demonstrate their loading with Gd(III) at high relaxivities, a key indicator of their effectiveness in enhancing image contrast and clarity in medical imaging. In vitro experiments with primary murine and porcine macrophages demonstrated that GLAMs adhere to macrophages also under shear stress and did not affect macrophage viability or functions. Studies in a porcine mTBI model confirmed that intravenously administered macrophage-adhering GLAMs provide a differential signal in the ChP and lateral ventricles at Gd(III) doses 500- to 1000-fold lower than those used in the current clinical standard Gadavist. Under the same mTBI conditions, Gadavist did not offer a differential signal at clinically used doses. Our results suggest that macrophage-adhering GLAMs could facilitate mTBI diagnosis.
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Affiliation(s)
- Lily Li-Wen Wang
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yongsheng Gao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Vineeth Chandran Suja
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Masen L Boucher
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Suyog Shaha
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Neha Kapate
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Rick Liao
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Tao Sun
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
| | - Ninad Kumbhojkar
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Supriya Prakash
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - John R Clegg
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Kaitlyn Warren
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Morgan Janes
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kyung Soo Park
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Michael Dunne
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
| | - Bolu Ilelaboye
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
| | - Andrew Lu
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
| | - Solomina Darko
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
| | - Camilo Jaimes
- Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Samir Mitragotri
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Allston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA 20115, USA
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Epidemiologic Investigation of Injuries Associated With the 2013 Fertilizer Plant Explosion in West, Texas. Disaster Med Public Health Prep 2016; 10:583-90. [PMID: 26932770 DOI: 10.1017/dmp.2015.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE On April 17, 2013, a fire and subsequent explosion occurred at the West Fertilizer Company plant in West, Texas, and caused extensive damage to the adjacent neighborhood. This investigation described the fatal and nonfatal injuries caused by the explosion. METHODS Persons injured by the fertilizer plant explosion were identified through death certificates, medical examination reports, medical records, and survivor interviews. Data on patient characteristics, type of injury, and location of injury were collected. RESULTS Medical record review indicated that 252 individuals sought medical care for nonfatal injuries directly related to the explosion immediately after the explosion. Fifteen patients died of injuries sustained by the blast. Almost one-quarter of patients were admitted for treatment of injuries. Injuries sustained in the explosion included abrasions/contusions, lacerations/penetrating trauma, traumatic brain injuries/concussions, tinnitus/hearing problems, eye injuries, and inhalational injuries. Patients located closer to the explosion were more likely to be admitted to the hospital for treatment of injuries than were those who were located further away. CONCLUSION Explosions of this magnitude are rare, but can inflict severe damage to a community and its residents. This investigation could be a useful planning resource for other communities, public health agencies, first responders, and medical facilities. (Disaster Med Public Health Preparedness. 2016;10:583-590).
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Duckworth JL, Grimes J, Ling GSF. Pathophysiology of battlefield associated traumatic brain injury. ACTA ACUST UNITED AC 2012; 20:23-30. [PMID: 22703708 DOI: 10.1016/j.pathophys.2012.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 03/07/2012] [Accepted: 11/11/2011] [Indexed: 10/28/2022]
Abstract
As more data is accumulated from Operation Iraqi Freedom and Operation Enduring Freedom (OEF in Afghanistan), it is becoming increasing evident that traumatic brain injury (TBI) is a serious and highly prevalent battle related injury. Although traditional TBIs such as closed head and penetrating occur in the modern battle space, the most common cause of modern battle related TBI is exposure to explosive blast. Many believe that explosive blast TBI is unique from the other forms of TBI. This is because the physical forces responsible for explosive blast TBI are different than those for closed head TBI and penetrating TBI. The unique force associated with explosive blast is the blast shock pressure wave. This shock wave occurs over a very short period, milliseconds, and has a specific profile known as the Freidlander curve. This pressure-time curve is characterized by an initial very rapid up-rise followed by a longer decay that reaches a negative inflection point before returning to baseline. This is important as the effect of this shock pressure on brain parenchyma is distinct. The diffuse interaction of the pressure wave with the brain leads to a complex cascade of events that affects neurons, axons, glia cells, and vasculature. It is only by properly studying this disease will meaningful therapies be realized.
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Affiliation(s)
- Josh L Duckworth
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Abstract
The aim of this study was to review the current protocols of prehospital practice and their impact on outcome in the management of traumatic brain injury. A literature review of the National Library of Medicine encompassing the years 1980 to May 2008 was performed. The primary impact of a head injury sets in motion a cascade of secondary events that can worsen neurological injury and outcome. The goals of care during prehospital triage, stabilization, and transport are to recognize life-threatening raised intracranial pressure and to circumvent cerebral herniation. In that process, prevention of secondary injury and secondary insults is a major determinant of both short- and longterm outcome. Management of brain oxygenation, blood pressure, cerebral perfusion pressure, and raised intracranial pressure in the prehospital setting are discussed. Patient outcomes are dependent upon an organized trauma response system. Dispatch and transport timing, field stabilization, modes of transport, and destination levels of care are addressed. In addition, special considerations for mass casualty and disaster planning are outlined and recommendations are made regarding early response efforts and the ethical impact of aggressive prehospital resuscitation. The most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of prehospital care is a major determinant of long-term outcome for patients with traumatic brain injury.
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Affiliation(s)
- Shirley I Stiver
- Department of Neurosurgery, School of Medicine, University of California San Francisco, California 94110-0899, USA.
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Levine AC, Becker J, Lippert S, Rosborough S, Arnold K. International emergency medicine: a review of the literature from 2007. Acad Emerg Med 2008; 15:860-5. [PMID: 18821861 DOI: 10.1111/j.1553-2712.2008.00222.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The subspecialty of international emergency medicine (IEM) continues to grow within the United States, just as the specialty of emergency medicine (EM) continues to spread to both developed and developing countries around the world. One of the greatest obstacles, however, faced by IEM researchers and practitioners alike, remains the lack of a high-quality, consolidated, and easily accessible evidence-base of literature. In response to this perceived need, members of the Emergency Medicine Resident Association (EMRA) International Emergency Medicine Committee, in conjunction with members of the Society for Academic Emergency Medicine (SAEM) International Health Interest Group, have embarked on the task of creating a recurring review of IEM literature. This publication represents the third annual review, covering the top 30 IEM research articles published in 2007. Articles were selected for the review according to explicit, predetermined criteria that included both methodologic quality and perceived impact of the research. It is hoped that this annual review will act as a forum for disseminating best practices, while also stimulating further research in the field of IEM.
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Affiliation(s)
- Adam C Levine
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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