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Nagappan R, Das S, Chaudhari VA, Adole PS, Jinkala S, Thazhath HK. Post-mortem utility of Neuron Specific Enolase (NSE) and Calcium Binding Protein B (S100B) for differentiating traumatic brain injury from other causes of death. Int J Legal Med 2024:10.1007/s00414-024-03332-x. [PMID: 39256257 DOI: 10.1007/s00414-024-03332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 09/02/2024] [Indexed: 09/12/2024]
Abstract
In forensic pathology, identifying causes of death in traumatic brain injuries (TBIs) devoid of observable signs presents a significant challenge. Post-mortem biochemistry plays a crucial role in forensic medicine, particularly in determining causes of death in TBIs that lack macroscopic or histopathological evidence. This study aimed to evaluate the utility of Neuron Specific Enolase (NSE) and S100 Calcium Binding Protein B (S100B) in post-mortem serum and cerebrospinal fluid (CSF) as markers for TBI. The relationship of these biochemical markers with survival time and post-mortem interval was also studied. The study sample consisted of 63 cases each from the TBI and the Non-TBI (NTBI) group. The NTBI group comprised of deaths due to mechanical asphyxia, myocardial infarction and isolated trunk trauma. While serum S100B and CSF NSE emerged as a promising marker for TBI, CSF S100B failed to differentiate TBI from the other causes of death. The absence of an association between the level of markers and survival time or post-mortem interval in TBIs highlights the limitations of these biomarkers in such contexts. This study underscores the potential of biochemical markers like serum S100B and CSF NSE in identifying TBI deaths, aiding forensic diagnoses where there are evidentiary limitations in traditional methods. Further research exploring additional markers and body fluids could enhance diagnostic precision in forensic neuropathology.
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Affiliation(s)
- Ramaswamy Nagappan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhartha Das
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
| | - Vinod Ashok Chaudhari
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Prashant Shankarrao Adole
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - SreeRekha Jinkala
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Shahim P, Pham DL, van der Merwe AJ, Moore B, Chou Y, Lippa SM, Kenney K, Diaz‐Arrastia R, Chan L. Serum NfL and GFAP as biomarkers of progressive neurodegeneration in TBI. Alzheimers Dement 2024; 20:4663-4676. [PMID: 38805359 PMCID: PMC11247683 DOI: 10.1002/alz.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND We examined spatial patterns of brain atrophy after mild, moderate, and severe traumatic brain injury (TBI), the relationship between progression of brain atrophy with initial traumatic axonal injury (TAI), cognitive outcome, and with serum biomarkers of brain injury. METHODS A total of 143 patients with TBI and 43 controls were studied cross-sectionally and longitudinally up to 5 years with multiple assessments, which included brain magnetic resonance imaging, cognitive testing, and serum biomarkers. RESULTS TBI patients showed progressive volume loss regardless of injury severity over several years, and TAI was independently associated with accelerated brain atrophy. Cognitive performance improved over time. Higher baseline serum neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) were associated with greater rate of brain atrophy over 5 years. DISCUSSSION Spatial patterns of atrophy differ by injury severity and TAI is associated with the progression of brain atrophy. Serum NfL and GFAP show promise as non-invasive prognostic biomarkers of progressive neurodegeneration in TBI. HIGHLIGHTS In this longitudinal study of patient with mild, moderate, and severe traumatic brain injury (TBI) who were assessed with paired magnetic resonance imaging (MRI), blood biomarkers, and cognitive assessments, we found that brain atrophy after TBI is progressive and continues for many years even after a mild head trauma without signs of brain injury on conventional MRI. We found that spatial pattern of brain atrophy differs between mild, moderate, and severe TBI, where in patients with mild TBI , atrophy is mainly seen in the gray matter, while in those with moderate to severe brain injury atrophy is predominantly seen in the subcortical gray matter and whiter matter. Cognitive performance improves over time after a TBI. Serum measures of neurofilament light or glial fibrillary acidic protein are associated with progression of brain atrophy after TBI.
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Affiliation(s)
- Pashtun Shahim
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- National Institutes of Neurological Disorders and Stroke, NIHBethesdaMarylandUSA
- Department of NeurologyMedStar Georgetown University Hospital, Pasquerilla Healthcare CenterWashingtonDistrict of ColumbiaUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Dzung L. Pham
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Andre J. van der Merwe
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Brian Moore
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Yi‐Yu Chou
- The Military Traumatic Brain Injury Initiative (MTBI2)BethesdaMarylandUSA
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMarylandUSA
| | - Sara M. Lippa
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Kimbra Kenney
- Uniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of Excellence, Walter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Ramon Diaz‐Arrastia
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Leighton Chan
- Rehabilitation Medicine DepartmentNational Institutes of Health (NIH) Clinical CenterBethesdaMarylandUSA
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Menditto VG, Rossetti G, Sampaolesi M, Buzzo M, Pomponio G. Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J Clin Med 2024; 13:3669. [PMID: 38999235 PMCID: PMC11242576 DOI: 10.3390/jcm13133669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Rossetti
- Internal Medicine, Santa Croce Hospital AST1 Pesaro Urbino, 61032 Fano, Italy
| | - Mattia Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Marta Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
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Roh H, Kim W, Hwang SY, Lee MS, Kim JH. Altered pattern of theta and gamma oscillation to visual stimuli in patients with postconcussion syndrome. J Neurophysiol 2024; 131:1240-1249. [PMID: 38691013 DOI: 10.1152/jn.00253.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024] Open
Abstract
Although many patients with mild traumatic brain injury (mTBI) suffer from postconcussional syndrome (PCS) including abnormal emotional responses, most conventional imaging studies fail to detect any causative brain lesion. We hypothesized that event-related electroencephalography (EEG) recordings with time-frequency analysis would show a distinguishable pattern in patients with mTBI with PCS compared with normal healthy controls. EEG signals were collected from a total of 18 subjects: eight patients with mTBI with PCS and 10 healthy control subjects. The signals were recorded while the subjects were presented with affective visual stimuli, including neutral, pleasant, and unpleasant emotional cues. Event-related spectral perturbation analysis was performed to calculate frontal midline theta activity and posterior midline gamma activity, followed by statistical analysis to identify whether patients with mTBI with PCS have distinct patterns of theta or gamma oscillations in response to affective stimuli. Compared with the healthy control group, patients with mTBI with PCS did not show a significant increase in the power of frontal theta activity in response to the pleasant stimuli, indicating less susceptibility toward pleasant cues. Moreover, the patient group showed attenuated gamma oscillatory activity, with no clear alteration in gamma oscillations in response to either pleasant or unpleasant cues. This study demonstrates that patients with mTBI with PCS exhibited altered patterns of oscillatory activities in the theta and gamma bands in response to affective visual stimuli compared with the normal control group. The current finding implicates that these distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.NEW & NOTEWORTHY Patients with mild traumatic brain injury (mTBI) with postconcussional syndrome (PCS) exhibited altered patterns of changes in oscillatory activities in the theta and gamma bands in response to visual affective stimuli. Distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.
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Affiliation(s)
- Haewon Roh
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Won Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- The Department of Biostatistics, Korea University of Medicine, Seoul, Korea
| | - Moon Soo Lee
- The Department of Psychiatry, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
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Rudolph MD, Sutphen CL, Register TC, Whitlow CT, Solingapuram Sai KK, Hughes TM, Bateman JR, Dage JL, Russ KA, Mielke MM, Craft S, Lockhart SN. Associations among plasma, MRI, and amyloid PET biomarkers of Alzheimer's disease and related dementias and the impact of health-related comorbidities in a community-dwelling cohort. Alzheimers Dement 2024; 20:4159-4173. [PMID: 38747525 PMCID: PMC11180870 DOI: 10.1002/alz.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION We evaluated associations between plasma and neuroimaging-derived biomarkers of Alzheimer's disease and related dementias and the impact of health-related comorbidities. METHODS We examined plasma biomarkers (neurofilament light chain, glial fibrillary acidic protein, amyloid beta [Aβ] 42/40, phosphorylated tau 181) and neuroimaging measures of amyloid deposition (Aβ-positron emission tomography [PET]), total brain volume, white matter hyperintensity volume, diffusion-weighted fractional anisotropy, and neurite orientation dispersion and density imaging free water. Participants were adjudicated as cognitively unimpaired (CU; N = 299), mild cognitive impairment (MCI; N = 192), or dementia (DEM; N = 65). Biomarkers were compared across groups stratified by diagnosis, sex, race, and APOE ε4 carrier status. General linear models examined plasma-imaging associations before and after adjusting for demographics (age, sex, race, education), APOE ε4 status, medications, diagnosis, and other factors (estimated glomerular filtration rate [eGFR], body mass index [BMI]). RESULTS Plasma biomarkers differed across diagnostic groups (DEM > MCI > CU), were altered in Aβ-PET-positive individuals, and were associated with poorer brain health and kidney function. DISCUSSION eGFR and BMI did not substantially impact associations between plasma and neuroimaging biomarkers. HIGHLIGHTS Plasma biomarkers differ across diagnostic groups (DEM > MCI > CU) and are altered in Aβ-PET-positive individuals. Altered plasma biomarker levels are associated with poorer brain health and kidney function. Plasma and neuroimaging biomarker associations are largely independent of comorbidities.
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Affiliation(s)
- Marc D. Rudolph
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Courtney L. Sutphen
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Thomas C. Register
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Christopher T. Whitlow
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kiran K. Solingapuram Sai
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Timothy M. Hughes
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - James R. Bateman
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Jeffrey L. Dage
- Department Of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kristen A. Russ
- Department Of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Michelle M. Mielke
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Suzanne Craft
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Samuel N. Lockhart
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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Werner JK, Albrecht J, Capaldi VF, Jain S, Sun X, Mukherjee P, Williams SG, Collen J, Diaz-Arrastia R, Manley GT, Krystal AD, Wickwire E. Association of Biomarkers of Neuronal Injury and Inflammation With Insomnia Trajectories After Traumatic Brain Injury: A TRACK-TBI Study. Neurology 2024; 102:e209269. [PMID: 38547447 PMCID: PMC11210587 DOI: 10.1212/wnl.0000000000209269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Insomnia affects about one-third of patients with traumatic brain injury and is associated with worsened outcomes after injury. We hypothesized that higher levels of plasma neuroinflammation biomarkers at the time of TBI would be associated with worse 12-month insomnia trajectories. METHODS Participants were prospectively enrolled from 18 level-1 trauma centers participating in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study from February 26, 2014, to August 8, 2018. Plasma glial fibrillary acidic protein (GFAP), high-sensitivity C-reactive protein (hsCRP), S100b, neuron-specific enolase (NSE), and ubiquitin carboxyl-terminal hydrolase-L1 (UCH-L1) were collected on days 1 (D1) and 14 (D14) after TBI. The insomnia severity index was collected at 2 weeks, 3, 6, and 12 months postinjury. Participants were classified into insomnia trajectory classes based on a latent class model. We assessed the association of biomarkers with insomnia trajectories, controlling for medical and psychological comorbidities and demographics. RESULTS Two thousand twenty-two individuals with TBI were studied. Elevations in D1 hsCRP were associated with persistent insomnia (severe, odds ratio [OR] = 1.33 [1.11, 1.59], p = 0.002; mild, OR = 1.10 [1.02, 1.19], p = 0.011). Similarly, D14 hsCRP elevations were associated with persistent insomnia (severe, OR = 1.27 [1.02, 1.59], p = 0.03). Of interest, D1 GFAP was lower in persistent severe insomnia (median [Q1, Q3]: 154 [19, 445] pg/mL) compared with resolving mild (491 [154, 1,423], p < 0.001) and persistent mild (344 [79, 1,287], p < 0.001). D14 GFAP was similarly lower in persistent (11.8 [6.4, 19.4], p = 0.001) and resolving (13.9 [10.3, 20.7], p = 0.011) severe insomnia compared with resolving mild (20.6 [12.4, 39.6]. Accordingly, increases in D1 GFAP were associated with reduced likelihood of having persistent severe (OR = 0.76 [95% CI 0.63-0.92], p = 0.004) and persistent mild (OR = 0.88 [0.81, 0.96], p = 0.003) compared with mild resolving insomnia. No differences were found with other biomarkers. DISCUSSION Elevated plasma hsCRP and, surprisingly, lower GFAP were associated with adverse insomnia trajectories after TBI. Results support future prospective studies to examine their utility in guiding insomnia care after TBI. Further work is needed to explore potential mechanistic connections between GFAP levels and the adverse insomnia trajectories.
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Affiliation(s)
- J Kent Werner
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Jennifer Albrecht
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Vincent F Capaldi
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Sonia Jain
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Xiaoying Sun
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Pratik Mukherjee
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Scott G Williams
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Jacob Collen
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Ramon Diaz-Arrastia
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Geoffrey T Manley
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Andrew D Krystal
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
| | - Emerson Wickwire
- From the Department of Neurology (J.K.W.); Center for Neuroscience and Regenerative Medicine (J.K.W.), Uniformed Services University; Sleep Disorders Center (J.K.W., J.C.), Department of Medicine, Walter Reed National Military Medical Center, Bethesda; Department of Epidemiology and Public Health (J.A.), University of Maryland School of Medicine, Baltimore; Center for Military Psychiatry and Neuroscience (V.F.C., S.G.W.), Walter Reed Army Institute of Research, Silver Spring; Department of Medicine (V.F.C., J.C.), Uniformed Services University of the Health Sciences, Bethesda, MD; Biostatistics Research Center (V.F.C., S.G.W.), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego; Department of Radiology (S.J., X.S.), School of Medicine, University of California San Francisco; Department of Medicine (P.M.), Alexander T. Augusta Military Medical Center, Fort Belvoir, VA; Department of Psychiatry (S.G.W.), Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Neurology (R.D.-A.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Brain and Spinal Injury Center (G.T.M.); Department of Neurosurgery (G.T.M.); Department of Psychiatry and Behavioral Sciences (A.D.K.); Weill Institute for Neurosciences (A.D.K.), University of California, San Francisco; Sleep Disorders Center (E.W.), Division of Pulmonary and Critical Care Medicine, Department of Medicine; and Department of Psychiatry (E.W.), University of Maryland School of Medicine, Baltimore
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7
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Xu H, Wu W, Zhu Q, Wang J, Ding P, Zhuang Z, Li W, Gao Y, Hang C. Systemic Immune-Inflammation Index Predicts the Prognosis of Traumatic Brain Injury. World Neurosurg 2024; 183:e22-e27. [PMID: 37865196 DOI: 10.1016/j.wneu.2023.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Systemic inflammation following traumatic brain injury (TBI) has been extensively studied over the past decades, as it contributes significantly to the pathophysiological injury mechanisms and subsequent poor outcomes. Systemic immune-inflammation (SII) index is a novel biomarker of systemic inflammatory response. However, its predictive value regarding TBI prognosis in clinical practice remains insufficiently investigated. METHODS A total of 102 TBI patients admitted to Nanjing Drum Tower Hospital from July 2019 to February 2022 were enrolled. We employed various statistical analyses to evaluate the correlation between inflammatory indicators upon admission and patient prognosis, compared the predictive accuracy of these indicators, and generated receiver operating curve analysis to test their prognostic performance. RESULTS The SII index, platelet count, absolute lymphocyte count, and neutrophil/lymphocyte ratio (NLR) were capable of distinguishing TBI prognosis according to univariate logistic regression models (P < 0.05). Multivariate logistic regression models revealed that increased SII index, platelet count, and NLR upon admission were independent predictors of poor TBI prognosis (P < 0.05). Receiver operating curve analysis further demonstrated that the SII index (area under the curve = 0.845, 95% confidence interval 0.769-0.921, P = 0.000) exhibited higher predictive ability than the NLR (area under the curve = 0.694, 95% confidence interval 0.591-0.796, P = 0.001). CONCLUSIONS Our findings suggested that increased SII index during the early stages of TBI was an independent risk factor for poor prognosis with satisfactory predictive value. The SII index provides a reliable, convenient, and cost-effective prognostic model to evaluate systemic inflammation after TBI and identify patients at risk of poor outcomes, thereby offering valuable guidance for clinical practice.
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Affiliation(s)
- Huajie Xu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Wei Wu
- Department of Radiology, Sir Run Run Shaw Hospital (SRRSH) of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qi Zhu
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Jie Wang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Pengfei Ding
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Zong Zhuang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Wei Li
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Yongyue Gao
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China; Neurosurgical Institute of Nanjing University, Nanjing, Jiangsu, China.
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8
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Robba C, Graziano F, Picetti E, Åkerlund C, Addis A, Pastore G, Sivero M, Rebora P, Galimberti S, Stocchetti N, Maas A, Menon DK, Citerio G. Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data. Intensive Care Med 2024; 50:371-384. [PMID: 38376517 PMCID: PMC10955000 DOI: 10.1007/s00134-024-07324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). METHODS From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. RESULTS Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). CONCLUSION Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.
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Affiliation(s)
- Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesca Graziano
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Cecilia Åkerlund
- Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Alberto Addis
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Giuseppe Pastore
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mattia Sivero
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stefania Galimberti
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nino Stocchetti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplant, Milan University, Milan, Italy
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - David K Menon
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
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9
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Kanberg N, Grahn A, Stentoft E, Bremell D, Yilmaz A, Studahl M, Nilsson S, Schöll M, Gostner JM, Blennow K, Zetterberg H, Padmanabhan N, Cohen R, Misaghian S, Romero D, Campbell C, Mathew A, Wang M, Sigal G, Stengelin M, Edén A, Gisslén M. COVID-19 Recovery: Consistent Absence of Cerebrospinal Fluid Biomarker Abnormalities in Patients With Neurocognitive Post-COVID Complications. J Infect Dis 2024; 229:493-501. [PMID: 37874918 PMCID: PMC10873166 DOI: 10.1093/infdis/jiad395] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND To investigate evidence of residual viral infection, intrathecal immune activation, central nervous system (CNS) injury, and humoral responses in cerebrospinal fluid (CSF) and plasma in patients recovering from coronavirus disease 2019 (COVID-19), with or without neurocognitive post-COVID condition (PCC). METHODS Thirty-one participants (25 with neurocognitive PCC) underwent clinical examination, lumbar puncture, and venipuncture ≥3 months after COVID-19 symptom onset. Healthy volunteers were included. CSF and plasma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid and spike antigen (N-Ag, S-Ag), and CSF biomarkers of immune activation and neuronal injury were analyzed. RESULTS SARS-CoV-2 N-Ag or S-Ag were undetectable in all samples and no participant had pleocytosis. We detected no significant differences in CSF and plasma cytokine concentrations, albumin ratio, IgG index, neopterin, β2M, or in CSF biomarkers of neuronal injury and astrocytic damage. Furthermore, principal component analysis (PCA1) analysis did not indicate any significant differences between the study groups in the marker sets cytokines, neuronal markers, or anti-cytokine autoantibodies. CONCLUSIONS We found no evidence of ongoing viral replication, immune activation, or CNS injury in plasma or CSF in patients with neurocognitive PCC compared with COVID-19 controls or healthy volunteers, suggesting that neurocognitive PCC is a consequence of events suffered during acute COVID-19 rather than persistent viral CNS infection or residual CNS inflammation.
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Affiliation(s)
- Nelly Kanberg
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Grahn
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erika Stentoft
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Bremell
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Staffan Nilsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Schöll
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Johanna M Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Kaj Blennow
- 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
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurodegenerative Disease, Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Rachel Cohen
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | | | - Daniel Romero
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | | | - Anu Mathew
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | - Mingyue Wang
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | - George Sigal
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | | | - Arvid Edén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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Bjursten S, Zhao Z, Al Remawi H, Studahl M, Pandita A, Simrén J, Zetterberg H, Lundell AC, Rudin A, Ny L, Levin M. Concentrations of S100B and neurofilament light chain in blood as biomarkers for checkpoint inhibitor-induced CNS inflammation. EBioMedicine 2024; 100:104955. [PMID: 38171113 PMCID: PMC10796943 DOI: 10.1016/j.ebiom.2023.104955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Cancer treatment with immune checkpoint inhibition (ICI) can cause immune-related adverse events in the central nervous system (CNS irAE). There are no blood biomarkers to detect CNS irAE. We investigated if concentrations of S100-calcium-binding protein B (S100B) and neurofilament light chain (NfL) in blood can be used as biomarkers for CNS irAE and assessed the incidence of CNS irAE in a cohort of ICI-treated patients. METHODS In this single-centre, retrospective cohort study, we examined medical records and laboratory data of 197 consecutive patients treated with combined CTLA-4 and PD-1 inhibition (ipilimumab; ipi + nivolumab; nivo) for metastatic melanoma or renal cell carcinoma. CNS irAE was diagnosed using established criteria. Concentrations of S100B and NfL in blood were measured in patients with CNS irAE and in 84 patients without CNS irAE. FINDINGS Nine of 197 patients (4.6%) fulfilled criteria for CNS irAE. S100B and NfL in blood increased during CNS inflammation and normalized during immunosuppression. CNS irAE was detected with a sensitivity of 100% (S100B) and 79% (NfL) and a specificity of 89% (S100B) and 74% (NfL). Patients with CNS irAE had simultaneous increased concentration of C-reactive protein (CRP) (9/9) and alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) in blood (8/9). INTERPRETATION Analysis of S100B, NfL and CRP in blood facilitates the diagnosis of CNS irAE. CNS irAE may be more common than previously reported. There may be shared immune mechanisms between CNS and hepatitis irAE. FUNDING Supported by funding from the Swedish Cancer Foundation, the ALF-agreement, and Jubileumsklinikens Cancerfond.
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Affiliation(s)
- Sara Bjursten
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Zhiyuan Zhao
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hifaa Al Remawi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ankur Pandita
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Anna-Carin Lundell
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Max Levin
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Giesler LP, O'Brien WT, Symons GF, Salberg S, Spitz G, Wesselingh R, O'Brien TJ, Mychasiuk R, Shultz SR, McDonald SJ. Investigating the Association Between Extended Participation in Collision Sports and Fluid Biomarkers Among Masters Athletes. Neurotrauma Rep 2024; 5:74-80. [PMID: 38463419 PMCID: PMC10923547 DOI: 10.1089/neur.2023.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Traumatic brain injuries (TBIs) and concussions are prevalent in collision sports, and there is evidence that levels of exposure to such sports may increase the risk of neurological abnormalities. Elevated levels of fluid-based biomarkers have been observed after concussions or among athletes with a history of participating in collision sports, and certain biomarkers exhibit sensitivity toward neurodegeneration. This study investigated a cohort of 28 male amateur athletes competing in "Masters" competitions for persons >35 years of age. The primary objective of this study was to compare the levels of blood and saliva biomarkers associated with brain injury, inflammation, aging, and neurodegeneration between athletes with an extensive history of collision sport participation (i.e., median = 27 years; interquartile range = 18-44, minimum = 8) and those with no history. Plasma proteins associated with neural damage and neurodegeneration were measured using Simoa® assays, and saliva was analyzed for markers associated with inflammation and telomere length using quantitative real-time polymerase chain reaction. There were no significant differences between collision and non-collision sport athletes for plasma levels of glial fibrillary acidic protein, neurofilament light, ubiquitin C-terminal hydrolase L1, tau, tau phosphorylated at threonine 181, and brain-derived neurotrophic factor. Moreover, salivary levels of genes associated with inflammation and telomere length were similar between groups. There were no significant differences between groups in symptom frequency or severity on the Sport Concussion Assessment Tool-5th Edition. Overall, these findings provide preliminary evidence that biomarkers associated with neural tissue damage, neurodegeneration, and inflammation may not exhibit significant alterations in asymptomatic amateur athletes with an extensive history of amateur collision sport participation.
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Affiliation(s)
- Lauren P. Giesler
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - William T. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Georgia F. Symons
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sabrina Salberg
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Gershon Spitz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Robb Wesselingh
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R. Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Health Sciences, Vancouver Island University, Nanaimo, British Columbia, Canada
| | - Stuart J. McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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12
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To XV, Mohamed AZ, Cumming P, Nasrallah FA. Diffusion tensor imaging and plasma immunological biomarker panel in a rat traumatic brain injury (TBI) model and in human clinical TBI. Front Immunol 2024; 14:1293471. [PMID: 38259455 PMCID: PMC10800599 DOI: 10.3389/fimmu.2023.1293471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Neuroinflammatory reactions play a significant role in the pathology and long-term consequences of traumatic brain injury (TBI) and may mediate salutogenic processes that white matter integrity. This study aimed to investigate the relationship between inflammatory markers and white matter integrity following TBI in both a rat TBI model and clinical TBI cases. Methods In the rat model, blood samples were collected following a controlled cortical impact (CCI) to assess a panel of inflammatory markers; MR-based diffusion tensor imaging (DTI) was employed to evaluate white matter integrity 60 days post-injury. 15 clinical TBI patients were similarly assessed for a panel of inflammatory markers and DTI post-intensive care unit discharge. Blood samples from healthy controls were used for comparison of the inflammatory markers. Results Time-dependent elevations in immunological markers were observed in TBI rats, with a correlation to preserved fractional anisotropy (FA) in white matter. Specifically, TBI-induced increased plasma levels of IL-1β, IL-6, G-CSF, CCL3, CCL5, and TNF-α were associated with higher white matter integrity, as measured by FA. Clinical cases had similar findings: elevated inflammatory markers (relative to controls) were associated with preservation of FA in vulnerable white matter regions. Discussion Inflammatory markers in post-TBI plasma samples are ambivalent with respect to prediction of favourable outcome versus a progression to more pervasive pathology and morbidity.
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Affiliation(s)
- Xuan Vinh To
- The Queensland Brain Institute, The University of Queensland, Queensland, Australia
| | - Abdalla Z. Mohamed
- The Queensland Brain Institute, The University of Queensland, Queensland, Australia
- Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fatima A. Nasrallah
- The Queensland Brain Institute, The University of Queensland, Queensland, Australia
- The Centre for Advanced Imaging, The University of Queensland, Queensland, Australia
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13
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Puangmalai N, Bhatt N, Bittar A, Jerez C, Shchankin N, Kayed R. Traumatic brain injury derived pathological tau polymorphs induce the distinct propagation pattern and neuroinflammatory response in wild type mice. Prog Neurobiol 2024; 232:102562. [PMID: 38135105 DOI: 10.1016/j.pneurobio.2023.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
The misfolding and aggregation of the tau protein into neurofibrillary tangles constitutes a central feature of tauopathies. Traumatic brain injury (TBI) has emerged as a potential risk factor, triggering the onset and progression of tauopathies. Our previous research revealed distinct polymorphisms in soluble tau oligomers originating from single versus repetitive mild TBIs. However, the mechanisms orchestrating the dissemination of TBI brain-derived tau polymorphs (TBI-BDTPs) remain elusive. In this study, we explored whether TBI-BDTPs could initiate pathological tau formation, leading to distinct pathogenic trajectories. Wild-type mice were exposed to TBI-BDTPs from sham, single-blast (SB), or repeated-blast (RB) conditions, and their memory function was assessed through behavioral assays at 2- and 8-month post-injection. Our findings revealed that RB-BDTPs induced cognitive and motor deficits, concurrently fostering the emergence of toxic tau aggregates within the injected hippocampus. Strikingly, this tau pathology propagated to cortical layers, intensifying over time. Importantly, RB-BDTP-exposed animals displayed heightened glial cell activation, NLRP3 inflammasome formation, and increased TBI biomarkers, particularly triggering the aggregation of S100B, which is indicative of a neuroinflammatory response. Collectively, our results shed light on the intricate mechanisms underlying TBI-BDTP-induced tau pathology and its association with neuroinflammatory processes. This investigation enhances our understanding of tauopathies and their interplay with neurodegenerative and inflammatory pathways following traumatic brain injury.
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Affiliation(s)
- Nicha Puangmalai
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Nemil Bhatt
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Alice Bittar
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Cynthia Jerez
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Nikita Shchankin
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Rakez Kayed
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX 77555, USA; Departments of Neurology, Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, TX 77555, USA.
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14
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Eisenhut K, Faber J, Engels D, Gerhards R, Lewerenz J, Doppler K, Sommer C, Markewitz R, Falk KK, Rössling R, Pruess H, Finke C, Wickel J, Geis C, Ratuszny D, Pfeffer LK, Bittner S, Piepgras J, Kraft A, Klausewitz J, Nuscher B, Kümpfel T, Thaler FS. Early Neuroaxonal Damage in Neurologic Disorders Associated With GAD65 Antibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200176. [PMID: 37914416 PMCID: PMC10624332 DOI: 10.1212/nxi.0000000000200176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Neurodegeneration is considered a relevant pathophysiologic feature in neurologic disorders associated with antibodies against glutamic acid decarboxylase 65 (GAD65). In this study, we investigate surrogates of neuroaxonal damage in relation to disease duration and clinical presentation. METHODS In a multicentric cohort of 50 patients, we measured serum neurofilament light chain (sNfL) in relation to disease duration and disease phenotypes, applied automated MRI volumetry, and analyzed clinical characteristics. RESULTS In patients with neurologic disorders associated with GAD65 antibodies, we detected elevated sNfL levels early in the disease course. By contrast, this elevation of sNfL levels was less pronounced in patients with long-standing disease. Increased sNfL levels were observed in patients presenting with cerebellar ataxia and limbic encephalitis, but not in those with stiff person syndrome. Using MRI volumetry, we identified atrophy predominantly of the cerebellar cortex, cerebellar superior posterior lobe, and cerebral cortex with similar atrophy patterns throughout all clinical phenotypes. DISCUSSION Together, our data provide evidence for early neuroaxonal damage and support the need for timely therapeutic interventions in GAD65 antibody-associated neurologic disorders.
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Affiliation(s)
- Katharina Eisenhut
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jennifer Faber
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Daniel Engels
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Ramona Gerhards
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jan Lewerenz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kathrin Doppler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Claudia Sommer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Robert Markewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kim K Falk
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Rosa Rössling
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Harald Pruess
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Carsten Finke
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jonathan Wickel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Christian Geis
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Dominica Ratuszny
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Lena K Pfeffer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Stefan Bittner
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Johannes Piepgras
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Andrea Kraft
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jaqueline Klausewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Brigitte Nuscher
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Tania Kümpfel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Franziska S Thaler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys.
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Zhang J, Liu S, Wu Y, Tang Z, Wu Y, Qi Y, Dong F, Wang Y. Enlarged Perivascular Space and Index for Diffusivity Along the Perivascular Space as Emerging Neuroimaging Biomarkers of Neurological Diseases. Cell Mol Neurobiol 2023; 44:14. [PMID: 38158515 DOI: 10.1007/s10571-023-01440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
The existence of lymphatic vessels or similar clearance systems in the central nervous system (CNS) that transport nutrients and remove cellular waste is a neuroscientific question of great significance. As the brain is the most metabolically active organ in the body, there is likely to be a potential correlation between its clearance system and the pathological state of the CNS. Until recently the successive discoveries of the glymphatic system and the meningeal lymphatics solved this puzzle. This article reviews the basic anatomy and physiology of the glymphatic system. Imaging techniques to visualize the function of the glymphatic system mainly including post-contrast imaging techniques, indirect lymphatic assessment by detecting increased perivascular space, and diffusion tensor image analysis along the perivascular space (DTI-ALPS) are discussed. The pathological link between glymphatic system dysfunction and neurological disorders is the key point, focusing on the enlarged perivascular space (EPVS) and the index of diffusivity along the perivascular space (ALPS index), which may represent the activity of the glymphatic system as possible clinical neuroimaging biomarkers of neurological disorders. The pathological link between glymphatic system dysfunction and neurological disorders is the key point, focusing on the enlarged perivascular space (EPVS) and the index for of diffusivity along the perivascular space (ALPS index), which may represent the activity of the glymphatic system as possible clinical neuroimaging biomarkers of neurological disorders.
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Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shengwen Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yaqi Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhijian Tang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yasong Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yiwei Qi
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fangyong Dong
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yu Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Rueb M, Rauen K, Koerte IK, Gersing A, Zetterberg H, Simrén J, Brendel M, Adorjan K. Traumatic Encephalopathy Syndrome and Tauopathy in a 19-Year-Old With Child Abuse. Neurotrauma Rep 2023; 4:857-862. [PMID: 38156074 PMCID: PMC10754342 DOI: 10.1089/neur.2023.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
The majority of traumatic encephalopathy syndrome (TES) cases have been reported in former contact sport athletes. This is the first case with TES in a 19-year-old male patient with progressive cognitive decline after daily domestic physical violence through repeated hits to the head for 15 years. The patient presented with a moderate depressive episode and progressive cognitive decline. Tau positron emission tomography (PET) with 220 MBq of [18F]PI-2620 revealed increased focal signal at the frontal and parietal white/gray matter border. Brain magnetic resonance imaging (MRI) showed a cavum septum pellucidum, reduced left-sided hippocampal volume, and a left midbrain lesion. Cerebrospinal fluid results showed elevated total and p-tau. Neurocognitive testing at admission showed memory deficits clearly below average, and hampered dysfunctions according to the slow processing speed with a low mistake rate, indicating the acquired, thus secondary, attentional deficits. We diagnosed the patient with a TES suggestive of chronic traumatic encephalopathy and classified him as having subtle/mild functional limitation with a most likely transition to mild dementia within the TES criteria. This report underlines child abuse as a relevant criterion in diagnosing TES in cases with repetitive hits to the head. In addition to clinical markers, we show the relevance of fluid tau biomarkers and tau-PET to support the diagnosis of TES according to the recently published diagnosis criteria for TES.
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Affiliation(s)
- Mike Rueb
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU University Hospital, LMU Munich, Munich, Germany
- Center for International Health (CIH LMU), LMU University Hospital, LMU Munich, Munich, Germany
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Inga Katharina Koerte
- Psychiatric Neuroimaging Laboratory, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, LMU University Hospital, Munich, Germany
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Gersing
- Department of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Joel Simrén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Matthias Brendel
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
- Center for International Health (CIH LMU), LMU University Hospital, LMU Munich, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics, LMU University Hospital, Munich, Germany
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Hossain I, Marklund N, Czeiter E, Hutchinson P, Buki A. Blood biomarkers for traumatic brain injury: A narrative review of current evidence. BRAIN & SPINE 2023; 4:102735. [PMID: 38510630 PMCID: PMC10951700 DOI: 10.1016/j.bas.2023.102735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 03/22/2024]
Abstract
Introduction A blood-based biomarker (BBBM) test could help to better stratify patients with traumatic brain injury (TBI), reduce unnecessary imaging, to detect and treat secondary insults, predict outcomes, and monitor treatment effects and quality of care. Research question What evidence is available for clinical applications of BBBMs in TBI and how to advance this field? Material and methods This narrative review discusses the potential clinical applications of core BBBMs in TBI. A literature search in PubMed, Scopus, and ISI Web of Knowledge focused on articles in English with the words "traumatic brain injury" together with the words "blood biomarkers", "diagnostics", "outcome prediction", "extracranial injury" and "assay method" alone-, or in combination. Results Glial fibrillary acidic protein (GFAP) combined with Ubiquitin C-terminal hydrolase-L1(UCH-L1) has received FDA clearance to aid computed tomography (CT)-detection of brain lesions in mild (m) TBI. Application of S100B led to reduction of head CT scans. GFAP may also predict magnetic resonance imaging (MRI) abnormalities in CT-negative cases of TBI. Further, UCH-L1, S100B, Neurofilament light (NF-L), and total tau showed value for predicting mortality or unfavourable outcome. Nevertheless, biomarkers have less role in outcome prediction in mTBI. S100B could serve as a tool in the multimodality monitoring of patients in the neurointensive care unit. Discussion and conclusion Largescale systematic studies are required to explore the kinetics of BBBMs and their use in multiple clinical groups. Assay development/cross validation should advance the generalizability of those results which implicated GFAP, S100B and NF-L as most promising biomarkers in the diagnostics of TBI.
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Affiliation(s)
- Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Niklas Marklund
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Endre Czeiter
- Department of Neurosurgery, Medical School, Neurotrauma Research Group, Szentagothai Research Centre, And HUN-REN-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Peter Hutchinson
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Andras Buki
- Department of Neurosurgery, University of Örebro, Örebro, Sweden
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Hiskens MI, Mengistu TS, Hovinga B, Thornton N, Smith KB, Mitchell G. Epidemiology and management of traumatic brain injury in a regional Queensland Emergency Department. Australas Emerg Care 2023; 26:314-320. [PMID: 37076417 DOI: 10.1016/j.auec.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND There is a paucity of traumatic brain injury (TBI) data in Australia in the regional and rural context. This study aimed to investigate the epidemiology, severity, causes, and management of TBI in a regional north Queensland population to plan acute care, follow up, and prevention strategies. METHODS This retrospective study analysed TBI patients presenting to Mackay Base Hospital Emergency Department (ED) in 2021. We identified patients using head injury SNOMED codes, and analysed patient characteristics with descriptive and multivariable regression analysis. RESULTS There were 1120 head injury presentations, with an overall incidence of 909 per 100,000 people per year. The median (IQR) age was 18 (6-46) years. Falls were the most common injury mechanism (52.4% of presentations). 41.1% of patients had a Computed Tomography (CT) scan, while 16.5% of patients who met criteria had post traumatic amnesia (PTA) testing. Age, being male and Indigenous status were associated with higher odds of moderate to severe TBI. CONCLUSION TBI incidence in this regional population was higher than metropolitan locations. CT scan was undertaken less frequently than in comparative literature, and low rates of PTA testing were undertaken. These data provide insight to assist in planning prevention and TBI-care services.
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Affiliation(s)
- Matthew I Hiskens
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia.
| | - Tesfaye S Mengistu
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia; University of Queensland, School of Public Health, Herston, QLD 4006, Australia
| | - Bauke Hovinga
- Emergency Department, Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Neale Thornton
- Emergency Department, Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Karen B Smith
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Gary Mitchell
- Royal Brisbane and Women's Hospital Emergency and Trauma Centre, Herston, QLD 4006, Australia
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Grijalva C, Mullins VA, Michael BR, Hale D, Wu L, Toosizadeh N, Chilton FH, Laksari K. Neuroimaging, wearable sensors, and blood-based biomarkers reveal hyperacute changes in the brain after sub-concussive impacts. BRAIN MULTIPHYSICS 2023; 5:100086. [PMID: 38292249 PMCID: PMC10827333 DOI: 10.1016/j.brain.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Impacts in mixed martial arts (MMA) have been studied mainly in regard to the long-term effects of concussions. However, repetitive sub-concussive head impacts at the hyperacute phase (minutes after impact), are not understood. The head experiences rapid acceleration similar to a concussion, but without clinical symptoms. We utilize portable neuroimaging technology - transcranial Doppler (TCD) ultrasound and functional near infrared spectroscopy (fNIRS) - to estimate the extent of pre- and post-differences following contact and non-contact sparring sessions in nine MMA athletes. In addition, the extent of changes in neurofilament light (NfL) protein biomarker concentrations, and neurocognitive/balance parameters were determined following impacts. Athletes were instrumented with sensor-based mouth guards to record head kinematics. TCD and fNIRS results demonstrated significantly increased blood flow velocity (p = 0.01) as well as prefrontal (p = 0.01) and motor cortex (p = 0.04) oxygenation, only following the contact sparring sessions. This increase after contact was correlated with the cumulative angular acceleration experienced during impacts (p = 0.01). In addition, the NfL biomarker demonstrated positive correlations with angular acceleration (p = 0.03), and maximum principal and fiber strain (p = 0.01). On average athletes experienced 23.9 ± 2.9 g peak linear acceleration, 10.29 ± 1.1 rad/s peak angular velocity, and 1,502.3 ± 532.3 rad/s2 angular acceleration. Balance parameters were significantly increased following contact sparring for medial-lateral (ML) center of mass (COM) sway, and ML ankle angle (p = 0.01), illustrating worsened balance. These combined results reveal significant changes in brain hemodynamics and neurophysiological parameters that occur immediately after sub-concussive impacts and suggest that the physical impact to the head plays an important role in these changes.
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Affiliation(s)
- Carissa Grijalva
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
| | - Veronica A. Mullins
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Bryce R. Michael
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Dallin Hale
- University of Arizona, Department of Physiology, Tucson, AZ, United States
| | - Lyndia Wu
- Univerisity of British Columbia, Department of Mechanical Engineering, Vancouver, BC, Canada
| | - Nima Toosizadeh
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
- University of Arizona, Department of Medicine, Arizona Center for Aging, Tucson, AZ, United States
| | - Floyd H. Chilton
- University of Arizona, School of Nutritional Sciences and Wellness, Tucson, AZ, United States
| | - Kaveh Laksari
- University of Arizona, Department of Biomedical Engineering, Tucson, AZ, United States
- University of Arizona, Department of Aerospace and Mechanical Engineering, Tucson, AZ, United States
- University of California Riverside, Department of Mechanical Engineering, Riverside, CA, United States
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20
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Lv M, Ma X, Zhang K, Zhang M, Ji Y, Cheng L, Shao X, Guan Z, Cui J, Gao Y, Liu Y, Yang Y, Liu X. The disruption of blood-brain barrier induced by long-term arsenic exposure is associated with the increase of MMP-9 and MMP-2: The characteristics are similar to those caused by senescence. Chem Biol Interact 2023; 385:110743. [PMID: 37802410 DOI: 10.1016/j.cbi.2023.110743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
Accumulating evidence suggests that Matrix metalloproteinase-9 (MMP-9) and -2 (MMP-2) are involved in the neuropathological processes by contributing to breaking the extracellular matrix and the tight junctions that constitute the blood-brain barrier (BBB). However, the influences of arsenic (As) on these two MMPs were inconsistent. In the cross-sectional study of 500 adults, serum MMP-2 and MMP-9 positively correlated with urine arsenic. And the positive correlation between urine tAs and serum MMP-9/2 was found in people older than 59 years. In vivo studies, we found that arsenic exposure or senescence might decrease number of neurons and neuritic density and increase serum and cortical MMP-9/2 levels. Furthermore, arsenic exposure or senescence could disrupt the tight junction of BBB and elevate MMP-9 and MMP-2 expression in the cerebral microvascular endothelium. The MMP-9 and MMP-2 are of particular interest when researching the link between arsenic exposure and nerve damage.
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Affiliation(s)
- Man Lv
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Xinbo Ma
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Kunyu Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Meichen Zhang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Yi Ji
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Lin Cheng
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Xinhua Shao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Ziqiao Guan
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Jia Cui
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Yanhui Gao
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Yang Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China
| | - Yanmei Yang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China.
| | - Xiaona Liu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China; Key Lab of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health of PR China, Harbin Medical University, Baojian Road, Harbin, 150081, Heilongjiang Province, China.
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Bernick C, Shan G, Ritter A, Ashton NJ, Blennow K, Lantero-Rodriguez J, Snellman A, Zetterberg H. Blood biomarkers and neurodegeneration in individuals exposed to repetitive head impacts. Alzheimers Res Ther 2023; 15:173. [PMID: 37828595 PMCID: PMC10571311 DOI: 10.1186/s13195-023-01310-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND It is unknown if fluid biomarkers reflective of brain pathologies are useful in detecting and following a neurodegenerative process in individuals exposed to repetitive head impacts. This study explores the relationship between blood biomarkers and longitudinal change in cognitive function and regional brain volumes in a cohort of professional fighters. METHODS Participants are drawn from a convenience sample of active and retired professional boxers and Mixed Martial Arts fighters and a control group with no prior exposure to head impacts. 3 T MRI brain imaging, plasma samples, and computerized cognitive testing were obtained at baseline and, for a subset, annually. MRI regional volumes were extracted, along with plasma levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), p-tau231, and N-terminal tau (NTA). Statistical analyses were performed to assess the relationship between plasma levels and regional brain volumes and cognitive performance at baseline and longitudinally. RESULTS One hundred forty active boxers (mean age: 31 with standard deviation (SD) of 8), 211 active MMA (mean age of 30 with SD of 5), 69 retired boxers (mean age 49 with SD of 9), and 52 control participants (mean age 36 with SD of 12) were included in the analyses. Baseline GFAP levels were highest in the retired boxers (retired boxers v. active MMA: p = 0.0191), whereas active boxers had higher levels of NfL (active boxers v. MMA: p = 0.047). GFAP showed an increase longitudinally in retired boxers that was associated with decreasing volumes of multiple cortical and subcortical structures (e.g., hippocampus: B = - 1.25, 95% CI, - 1.65 to - 0.85) and increase in lateral ventricle size (B = 1.75, 95% CI, 1.46 to 2.04). Furthermore, performance on cognitive domains including memory, processing speed, psychomotor speed, and reaction time declined over time with increasing GFAP (e.g., processing speed: B = - 0.04, 95% CI, - 0.07 to - 0.02; reaction time: B = 0.52, 95% CI, 0.28 to 0.76). Among active fighters, increasing levels of GFAP were correlated with lower thalamic (B = - 1.42, 95% CI, - 2.34 to -0.49) and corpus callosum volumes, along with worsening scores on psychomotor speed (B = 0.14, 95% CI, 0.01 to 0.27). CONCLUSION Longitudinal plasma GFAP levels may have a role in identifying individuals exposed to repetitive head impacts who are at risk of showing progressive regional atrophy and cognitive decline.
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Affiliation(s)
- Charles Bernick
- Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA.
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Aaron Ritter
- Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Juan Lantero-Rodriguez
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Anniina Snellman
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
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22
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Thomas R, Lynch CE, Debad J, Campbell C, Chidomere O, Kilianski J, Ding K, Madden C, Sandsmark DK, Diaz-Arrastia R, Gatson JW. Plasma von Willebrand Factor Is Elevated Hyperacutely After Mild Traumatic Brain Injury. Neurotrauma Rep 2023; 4:655-662. [PMID: 37908322 PMCID: PMC10615084 DOI: 10.1089/neur.2023.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Each year in the United States, ∼2.7 million persons seek medical attention for traumatic brain injury (TBI), of which ∼85% are characterized as being mild brain injuries. Many different cell types in the brain are affected in these heterogeneous injuries, including neurons, glia, and the brain vasculature. Efforts to identify biomarkers that reflect the injury of these different cell types have been a focus of ongoing investigation. We hypothesized that von Willebrand factor (vWF) is a sensitive biomarker for acute traumatic vascular injury and correlates with symptom severity post-TBI. To address this, blood was collected from professional boxing athletes (n = 17) before and within 30 min after competition. Plasma levels of vWF and neuron-specific enolase were measured using the Meso Scale Discovery, LLC. (MSD) electrochemiluminescence array-based multi-plex format (MSD, Gaithersburg, MD). Additional symptom and outcome data from boxers and patients, such as the Rivermead symptom scores (Rivermead Post Concussion Symptoms Questionnaire [RPQ-3]), were collected. We found that, subsequent to boxing bouts, there was a 1.8-fold increase in vWF levels within 30 min of injury (p < 0.0009). Moreover, fold-change in vWF correlates moderately (r = 0.51; p = 0.03) with the number of head blows. We also found a positive correlation (r = 0.69; p = 0.002) between fold-change in vWF and self-reported post-concussive symptoms, measured by the RPQ-3. The receiver operating curve analysis of vWF plasma levels and RPQ-3 scoring yielded a sensitivity of 94.12% and a specificity of 76.5% with an area under the curve of 83% for boxers after a fight compared to the pre-bout baseline. This study suggests that vWF is a potential blood biomarker measurable in the hyperacute period after blunt mild TBI. This biomarker may prove to be useful in diagnosing and monitoring traumatic vascular injury.
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Affiliation(s)
- Rachel Thomas
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cillian E. Lynch
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jeff Debad
- Meso Scale Diagnostics, LLC, Rockville, Maryland, USA
| | | | - Onyinyechi Chidomere
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph Kilianski
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher Madden
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Danielle K. Sandsmark
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joshua W. Gatson
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
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23
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Mayer AR, Dodd AB, Dodd RJ, Stephenson DD, Ling JM, Mehos CJ, Patton DA, Robertson-Benta CR, Gigliotti AP, Vermillion MS, Noghero A. Head Kinematics, Blood Biomarkers, and Histology in Large Animal Models of Traumatic Brain Injury and Hemorrhagic Shock. J Neurotrauma 2023; 40:2205-2216. [PMID: 37341029 PMCID: PMC10701512 DOI: 10.1089/neu.2022.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Traumatic brain injury (TBI) and severe blood loss resulting in hemorrhagic shock (HS) are each leading causes of mortality and morbidity worldwide, and present additional treatment considerations when they are comorbid (TBI+HS) as a result of competing pathophysiological responses. The current study rigorously quantified injury biomechanics with high precision sensors and examined whether blood-based surrogate markers were altered in general trauma as well as post-neurotrauma. Eighty-nine sexually mature male and female Yucatan swine were subjected to a closed-head TBI+HS (40% of circulating blood volume; n = 68), HS only (n = 9), or sham trauma (n = 12). Markers of systemic (e.g., glucose, lactate) and neural functioning were obtained at baseline, and at 35 and 295 min post-trauma. Opposite and approximately twofold differences existed for both magnitude (device > head) and duration (head > device) of quantified injury biomechanics. Circulating levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and ubiquitin C-terminal hydrolase L1 (UCH-L1) demonstrated differential sensitivity for both general trauma (HS) and neurotrauma (TBI+HS) relative to shams in a temporally dynamic fashion. GFAP and NfL were both strongly associated with changes in systemic markers during general trauma and exhibited consistent time-dependent changes in individual sham animals. Finally, circulating GFAP was associated with histopathological markers of diffuse axonal injury and blood-brain barrier breach, as well as variations in device kinematics following TBI+HS. Current findings therefore highlight the need to directly quantify injury biomechanics with head mounted sensors and suggest that GFAP, NfL, and UCH-L1 are sensitive to multiple forms of trauma rather than having a single pathological indication (e.g., GFAP = astrogliosis).
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Affiliation(s)
- Andrew R. Mayer
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Department of Psychology, and University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew B. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Rebecca J. Dodd
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - David D. Stephenson
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Josef M. Ling
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Carissa J. Mehos
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Declan A. Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cidney R. Robertson-Benta
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Andrew P. Gigliotti
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Meghan S. Vermillion
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Alessio Noghero
- The Mind Research Network/Lovelace Biomedical Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
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24
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Zingaropoli MA, Pasculli P, Barbato C, Petrella C, Fiore M, Dominelli F, Latronico T, Ciccone F, Antonacci M, Liuzzi GM, Talarico G, Bruno G, Galardo G, Pugliese F, Lichtner M, Mastroianni CM, Minni A, Ciardi MR. Biomarkers of Neurological Damage: From Acute Stage to Post-Acute Sequelae of COVID-19. Cells 2023; 12:2270. [PMID: 37759493 PMCID: PMC10526816 DOI: 10.3390/cells12182270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Neurological symptoms (NS) in COVID-19 are related to both acute stage and long-COVID. We explored levels of brain injury biomarkers (NfL and GFAP) and myeloid activation marker (sCD163) and their implications on the CNS. Materials and Methods: In hospitalized COVID-19 patients plasma samples were collected at two time points: on hospital admission (baseline) and three months after hospital discharge (Tpost). Patients were stratified according to COVID-19 severity based on acute respiratory distress syndrome (ARDS) onset (severe and non-severe groups). A further stratification according to the presence of NS (with and without groups) at baseline (requiring a puncture lumbar for diagnostic purposes) and according to NS self-referred at Tpost was performed. Finally, cerebrospinal fluid (CSF) samples were collected from patients with NS present at baseline. Results: We enrolled 144 COVID-19 patients (62 female/82 male; median age [interquartile range, IQR]): 64 [55-77]) and 53 heathy donors (HD, 30 female/23 male; median age [IQR]: 64 [59-69]). At baseline, higher plasma levels of NfL, GFAP and sCD163 in COVID-19 patients compared to HD were observed (p < 0.0001, p < 0.0001 and p < 0.0001, respectively), especially in those with severe COVID-19 (p < 0.0001, p < 0.0001 and p < 0.0001, respectively). Patients with NS showed higher plasma levels of NfL, GFAP and sCD163 compared to those without (p = 0.0023, p < 0.0001 and 0.0370, respectively). At baseline, in COVID-19 patients with NS, positive correlations between CSF levels of sCD163 and CSF levels of NfL (ρ = 0.7536, p = 0.0017) and GFAP were observed (ρ = 0.7036, p = 0.0045). At Tpost, the longitudinal evaluation performed on 77 COVID-19 patients showed a significant reduction in plasma levels of NfL, GFAP and sCD163 compared to baseline (p < 0.0001, p < 0.0001 and p = 0.0413, respectively). Finally, at Tpost, in the severe group, higher plasma levels of sCD163 in patients with NS compared to those without were reported (p < 0.0001). Conclusions: High plasma levels of NfL, GFAP and sCD163 could be due to a proinflammatory systemic and brain response involving microglial activation and subsequent CNS damage. Our data highlight the association between myeloid activation and CNS perturbations.
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Affiliation(s)
- Maria Antonella Zingaropoli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Christian Barbato
- Department of Sense Organs, Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, 00185 Rome, Italy; (C.B.); (C.P.); (M.F.)
| | - Carla Petrella
- Department of Sense Organs, Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, 00185 Rome, Italy; (C.B.); (C.P.); (M.F.)
| | - Marco Fiore
- Department of Sense Organs, Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Sapienza University of Rome, 00185 Rome, Italy; (C.B.); (C.P.); (M.F.)
| | - Federica Dominelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Tiziana Latronico
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, 70121 Bari, Italy; (T.L.); (G.M.L.)
| | - Federica Ciccone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Michele Antonacci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Grazia Maria Liuzzi
- Department of Biosciences, Biotechnologies and Environment, University of Bari Aldo Moro, 70121 Bari, Italy; (T.L.); (G.M.L.)
| | - Giuseppina Talarico
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.T.); (G.B.)
| | - Giuseppe Bruno
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy; (G.T.); (G.B.)
| | - Gioacchino Galardo
- Medical Emergency Unit, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy;
| | - Francesco Pugliese
- Department of Specialist Surgery and Organ Transplantation “Paride Stefanini”, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Miriam Lichtner
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, 00185 Latina, Italy;
- Department of Neurosciences, Mental Health, and Sense Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
| | - Antonio Minni
- Department of Sensory Organs, Sapienza University of Rome, 00185 Rome, Italy;
- Division of Otolaryngology-Head and Neck Surgery, ASL Rieti-Sapienza University, Ospedale San Camillo de Lellis, Viale Kennedy, 02100 Rieti, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (P.P.); (F.D.); (F.C.); (M.A.); (C.M.M.); (M.R.C.)
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25
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Zhao ZA, Yan L, Wen J, Satyanarayanan SK, Yu F, Lu J, Liu YU, Su H. Cellular and molecular mechanisms in vascular repair after traumatic brain injury: a narrative review. BURNS & TRAUMA 2023; 11:tkad033. [PMID: 37675267 PMCID: PMC10478165 DOI: 10.1093/burnst/tkad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/01/2023] [Accepted: 05/26/2023] [Indexed: 09/08/2023]
Abstract
Traumatic brain injury (TBI) disrupts normal brain function and is associated with high morbidity and fatality rates. TBI is characterized as mild, moderate or severe depending on its severity. The damage may be transient and limited to the dura matter, with only subtle changes in cerebral parenchyma, or life-threatening with obvious focal contusions, hematomas and edema. Blood vessels are often injured in TBI. Even in mild TBI, dysfunctional cerebral vascular repair may result in prolonged symptoms and poor outcomes. Various distinct types of cells participate in vascular repair after TBI. A better understanding of the cellular response and function in vascular repair can facilitate the development of new therapeutic strategies. In this review, we analyzed the mechanism of cerebrovascular impairment and the repercussions following various forms of TBI. We then discussed the role of distinct cell types in the repair of meningeal and parenchyma vasculature following TBI, including endothelial cells, endothelial progenitor cells, pericytes, glial cells (astrocytes and microglia), neurons, myeloid cells (macrophages and monocytes) and meningeal lymphatic endothelial cells. Finally, possible treatment techniques targeting these unique cell types for vascular repair after TBI are discussed.
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Affiliation(s)
- Zi-Ai Zhao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
- Department of Neurology, General Hospital of Northern Theater Command, 83# Wen-Hua Road, Shenyang 110840, China
| | - Lingli Yan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
| | - Jing Wen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
| | - Senthil Kumaran Satyanarayanan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
| | - Feng Yu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
| | - Jiahong Lu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
| | - Yong U Liu
- Laboratory of Neuroimmunology in Health and Disease Institute, Guangzhou First People’s Hospital School of Medicine, South China University of Technology, Guangzhou Higher Education Mega Center, Panyu District, Guangzhou 511400, China
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Avenida da Universidade, Taipa, Macau 999078, China
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26
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Newcombe V, Richter S, Whitehouse DP, Bloom BM, Lecky F. Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine. Emerg Med J 2023; 40:671-677. [PMID: 37438096 DOI: 10.1136/emermed-2023-213111] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%-40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome. Owing to the requirement for improved diagnostic and prognostic mechanisms, there has been increasing evidence concerning the utility of both imaging and blood biomarkers.Blood biomarkers offer the potential to better risk stratify patients for requirement of neuroimaging than current clinical decisions rules. However, improved assessment of the clinical utility is required prior to wide adoption. MRI, using clinical sequences and advanced quantitative methods, can detect lesions not visible on CT in up to 30% of patients that may explain, at least in part, some of the ongoing problems. The ability of an acute biomarker (be it imaging, blood or other) to highlight those patients at greater risk of ongoing deficits would allow for greater personalisation of follow-up care and resource allocation.We discuss here both the current evidence and the future potential clinical usage of blood biomarkers and advanced MRI to improve diagnostic pathways and outcome prediction following mild traumatic brain injury.
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Affiliation(s)
- Virginia Newcombe
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sophie Richter
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daniel P Whitehouse
- Emergency and Urgent Care Research in Cambridge (EURECA), PACE Section, Department of Medicine, Cambridge University, Cambridge, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Fiona Lecky
- Health Services Research, The University of Sheffield, Sheffield, South Yorkshire, UK
- Emergency Department /TARN, Salford and Trafford Health Authority, Manchester, UK
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27
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To XV, Donnelly P, Maclachlan L, Mahady K, Apellaniz EM, Cumming P, Winter C, Nasrallah F. Anti-inflammatory interleukin 1 receptor antagonist concentration in plasma correlates with blood-brain barrier integrity in the primary lesion area in traumatic brain injury patients. Brain Behav Immun Health 2023; 31:100653. [PMID: 37415924 PMCID: PMC10320227 DOI: 10.1016/j.bbih.2023.100653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose Blood-brain barrier (BBB) dysregulation and pro-inflammatory signalling molecules are secondary factors that have been associated with injury severity and long-term clinical outcome following traumatic brain injury (TBI). However, the association between BBB permeability and inflammation is unknown in human TBI patients. In this study, we investigated whether BBI integrity as measured by Dynamic Contrast-Enhanced (DCE) Magnetic Resonance Imaging (MRI) correlates with plasma levels of immunological markers following TBI. Methods Thirty-two TBI patients recruited from a neurosurgical unit were included in the study. Structural three-dimensional T1-weighted and DCE-MRI images were acquired on a 3T MRI at the earliest opportunity once the participant was sufficiently stable after patient admission to hospital. Blood sampling was performed on the same day as the MRI. The location and extents of the haemorrhagic and contusional lesions were identified. Immunological biomarkers were quantified from the participants' plasma using a multiplex immunoassay. Demographic and clinical information, including age and Glasgow Coma Scale (GCS) were also collected and the immunological biomarker profiles were compared across controls and the TBI severity sub-groups. Contrast agent leakiness through blood-brain barriers (BBB) in the contusional lesions were assessed by fitting DCE-MRI using Patlak model and BBB leakiness characteristics of the participants were correlated with the immunological biomarker profiles. Results TBI patients showed reduced plasma levels of interleukin (IL)-1β, IFN-γ, IL-13, and chemokine (C-C motif) ligands (CCL)2 compared to controls and significantly higher levels of platelet-derived growth factor (PDGF-BB), IL-6, and IL-8. BBB leakiness of the contusional lesions did not significantly differ across different TBI severity sub-groups. IL-1ra levels significantly and positively correlated with the contusional lesion's BBB integrity as measured with DCE-MRI via an exponential curve relationship. Discussion This is the first study to combine DCE-MRI with plasma markers of inflammation in acute TBI patients. Our finding that plasma levels of the anti-inflammatory cytokine IL-1ra correlated negatively with increased leakiness of the BBB.
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Affiliation(s)
- Xuan Vinh To
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Patrick Donnelly
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liam Maclachlan
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kate Mahady
- Department of Radiology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Craig Winter
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Australia
| | - Fatima Nasrallah
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
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28
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Comeau D, Martin M, Robichaud GA, Chamard-Witkowski L. Neurological manifestations of post-acute sequelae of COVID-19: which liquid biomarker should we use? Front Neurol 2023; 14:1233192. [PMID: 37545721 PMCID: PMC10400889 DOI: 10.3389/fneur.2023.1233192] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Long COVID syndrome, also known as post-acute sequelae of COVID-19 (PASC), is characterized by persistent symptoms lasting 3-12 weeks post SARS-CoV-2 infection. Patients suffering from PASC can display a myriad of symptoms that greatly diminish quality of life, the most frequent being neuropsychiatric. Thus, there is an eminent need to diagnose and treat PASC related neuropsychiatric manifestation (neuro-PASC). Evidence suggests that liquid biomarkers could potentially be used in the diagnosis and monitoring of patients. Undoubtedly, such biomarkers would greatly benefit clinicians in the management of patients; however, it remains unclear if these can be reliably used in this context. In this mini review, we highlight promising liquid (blood and cerebrospinal fluid) biomarkers, namely, neuronal injury biomarkers NfL, GFAP, and tau proteins as well as neuroinflammatory biomarkers IL-6, IL-10, TNF-α, and CPR associated with neuro-PASC and discuss their limitations in clinical applicability.
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Affiliation(s)
- Dominique Comeau
- Dr. Georges-L. Dumont University Hospital Centre, Clinical Research Sector, Vitalité Health Network, Moncton, NB, Canada
| | - Mykella Martin
- Centre de Formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, NB, Canada
| | - Gilles A. Robichaud
- Department of Chemistry and Biochemistry, Université de Moncton, Moncton, NB, Canada
- The New Brunswick Center for Precision Medicine, Moncton, NB, Canada
- The Atlantic Cancer Research Institute, Moncton, NB, Canada
| | - Ludivine Chamard-Witkowski
- Centre de Formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, NB, Canada
- Department of Neurology, Dr. Georges-L. Dumont University Hospital Centre, Moncton, NB, Canada
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29
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Brand J, McDonald SJ, Gawryluk JR, Christie BR, Shultz SR. Stress and traumatic brain injury: An inherent bi-directional relationship with temporal and synergistic complexities. Neurosci Biobehav Rev 2023; 151:105242. [PMID: 37225064 DOI: 10.1016/j.neubiorev.2023.105242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 05/26/2023]
Abstract
Traumatic brain injury (TBI) and stress are prevalent worldwide and can both result in life-altering health problems. While stress often occurs in the absence of TBI, TBI inherently involves some element of stress. Furthermore, because there is pathophysiological overlap between stress and TBI, it is likely that stress influences TBI outcomes. However, there are temporal complexities in this relationship (e.g., when the stress occurs) that have been understudied despite their potential importance. This paper begins by introducing TBI and stress and highlighting some of their possible synergistic mechanisms including inflammation, excitotoxicity, oxidative stress, hypothalamic-pituitary-adrenal axis dysregulation, and autonomic nervous system dysfunction. We next describe different temporal scenarios involving TBI and stress and review the available literature on this topic. In doing so we find initial evidence that in some contexts stress is a highly influential factor in TBI pathophysiology and recovery, and vice versa. We also identify important knowledge gaps and suggest future research avenues that will increase our understanding of this inherent bidirectional relationship and could one day result in improved patient care.
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Affiliation(s)
- Justin Brand
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Sandy R Shultz
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Faculty of Health Sciences, Vancouver Island University, Nanaimo, British Columbia, Canada.
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30
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Michaëlsson I, Skoglund T, Hallén T, Olsson R, Maltese G, Tarnow P, Bhatti-Søfteland M, Zetterberg H, Blennow K, Kölby L. Circulating Brain-Injury Markers After Surgery for Craniosynostosis. World Neurosurg 2023; 173:e593-e599. [PMID: 36863456 DOI: 10.1016/j.wneu.2023.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Historically, there have been few quantitative methods for effectively evaluating outcomes after surgery for craniosynostosis. In this prospective study, we assessed a novel approach for detecting possible postsurgery brain injury in patients with craniosynostosis. METHODS We included consecutive patients operated on for sagittal (pi-plasty or craniotomy combined with springs) or metopic (frontal remodeling) synostosis at the Craniofacial Unit at Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2019 to September 2020. Plasma concentrations of the brain-injury biomarkers neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau were measured immediately before induction of anesthesia, immediately before and after surgery, and on the first and the third postoperative days using single-molecule array assays. RESULTS Of the 74 patients included, 44 underwent craniotomy combined with springs for sagittal synostosis, 10 underwent pi-plasty for sagittal synostosis, and 20 underwent frontal remodeling for metopic synostosis. Compared with baseline, GFAP level showed a maximal significant increase at day 1 after frontal remodeling for metopic synostosis and pi-plasty (P = 0.0004 and P = 0.003, respectively). By contrast, craniotomy combined with springs for sagittal synostosis showed no increase in GFAP. For neurofilament light, we found a maximal significant increase at day 3 after surgery for all procedures, with significantly higher levels observed after frontal remodeling and pi-plasty compared with craniotomy combined with springs (P < 0.001). CONCLUSIONS These represent the first results showing significantly increased plasma levels of brain-injury biomarkers after surgery for craniosynostosis. Furthermore, we found that more extensive cranial vault procedures resulted in higher levels of these biomarkers relative to less extensive procedures.
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Affiliation(s)
- Isak Michaëlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Skoglund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tobias Hallén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Robert Olsson
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Madiha Bhatti-Søfteland
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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Tomaiuolo R, Zibetti M, Di Resta C, Banfi G. Challenges of the Effectiveness of Traumatic Brain Injuries Biomarkers in the Sports-Related Context. J Clin Med 2023; 12:jcm12072563. [PMID: 37048647 PMCID: PMC10095236 DOI: 10.3390/jcm12072563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Traumatic brain injury affects 69 million people every year. One of the main limitations in managing TBI patients is the lack of univocal diagnostic criteria, including the absence of standardized assessment methods and guidelines. Computerized axial tomography is the first-choice examination, despite the limited prevalence of positivity; moreover, its performance is undesirable due to the risk of radiological exposure, prolonged stay in emergency departments, inefficient use of resources, high cost, and complexity. Furthermore, immediacy and accuracy in diagnosis and management of TBIs are critically unmet medical needs. Especially in the context of sports-associated TBI, there is a strong need for prognostic indicators to help diagnose and identify at-risk subjects to avoid their returning to play while the brain is still highly vulnerable. Fluid biomarkers may emerge as new prognostic indicators to develop more accurate prediction models, improving risk stratification and clinical decision making. This review describes the current understanding of the cellular sources, temporal profile, and potential utility of leading and emerging blood-based protein biomarkers of TBI; its focus is on biomarkers that could improve the management of mild TBI cases and can be measured readily and directly in the field, as in the case of sports-related contexts.
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Affiliation(s)
- Rossella Tomaiuolo
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Martina Zibetti
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Chiara Di Resta
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- Correspondence:
| | - Giuseppe Banfi
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- IRCCS Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
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Hernández C, Simó-Servat O, Porta M, Grauslund J, Harding SP, Frydkjaer-Olsen U, García-Arumí J, Ribeiro L, Scanlon P, Cunha-Vaz J, Simó R. Serum glial fibrillary acidic protein and neurofilament light chain as biomarkers of retinal neurodysfunction in early diabetic retinopathy: results of the EUROCONDOR study. Acta Diabetol 2023; 60:837-844. [PMID: 36959506 DOI: 10.1007/s00592-023-02076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
AIMS Neurodegeneration and glial activation are primary events in the pathogenesis of diabetic retinopathy. Serum glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) are biomarkers of underlying neuroinflammatory and neurodegenerative disease processes. The aim of the present study was to assess the usefulness of these serum biomarkers for the identification and monitoring of retinal neurodysfunction in subjects with type 2 diabetes. METHODS A case-control study was designed including 38 patients from the placebo arm of the EUROCONDOR clinical trial: 19 with and 19 without retinal neurodysfunction assessed by multifocal electroretinography. GFAP and NfL were measured by Simoa. RESULTS Serum levels of GFAP and NfL directly correlated with age (r = 0.37, p = 0.023 and r = 0.54, p < 0.001, respectively). In addition, a direct correlation between GFAP and NfL was observed (r = 0.495, p = 0.002). Serum levels of GFAP were significantly higher at baseline in those subjects in whom neurodysfunction progressed after the 2 years of follow-up (139.1 ± 52.5 pg/mL vs. 100.2 ± 54.6 pg/mL; p = 0.04). CONCLUSIONS GFAP could be a useful serum biomarker for retinal neurodysfunction. Monitoring retinal neurodysfunction using blood samples would be of benefit in clinical decision-making. However, further research is needed to validate this result as well as to establish the best cutoff values.
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Affiliation(s)
- Cristina Hernández
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, and St. Paul's Eye Unit. Liverpool University Hospitals, Liverpool, UK
| | - Ulrik Frydkjaer-Olsen
- Research Unit of Ophthalmology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - José García-Arumí
- Department of Ophthalmology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luísa Ribeiro
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Peter Scanlon
- Gloucestershire Hospitals National Health Service Foundation Trust, Cheltenham, UK
| | - José Cunha-Vaz
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal
| | - Rafael Simó
- Diabetes and Metabolism Research Unit and CIBERDEM, Vall d'Hebron Research Institute, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Chaumont H, Kaczorowski F, San-Galli A, Michel PP, Tressières B, Roze E, Quadrio I, Lannuzel A. Cerebrospinal fluid biomarkers in SARS-CoV-2 patients with acute neurological syndromes. Rev Neurol (Paris) 2023; 179:208-217. [PMID: 36610823 PMCID: PMC9708608 DOI: 10.1016/j.neurol.2022.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND PURPOSE Mechanisms underlying acute brain injury in SARS-CoV-2 patients remain poorly understood. A better characterization of such mechanisms remains essential to preventing long-term neurological sequelae. Our present aim was to study a panel of biomarkers of neuroinflammation and neurodegeneration in the cerebrospinal fluid (CSF) of NeuroCOVID patients. METHODS We retrospectively collected clinical and CSF biomarkers data from 24 NeuroCOVID adults seen at the University Hospital of Guadeloupe between March and June 2021. RESULTS Among 24 NeuroCOVID patients, 71% had encephalopathy and 29% meningoencephalitis. A number of these patients also experienced de novo movement disorder (33%) or stroke (21%). The CSF analysis revealed intrathecal immunoglobulin synthesis in 54% of NeuroCOVID patients (two with a type 2 pattern and 11 with a type 3) and elevated neopterin levels in 75% of them (median 9.1nM, IQR 5.6-22.1). CSF neurofilament light chain (NfL) was also increased compared to a control group of non-COVID-19 patients with psychiatric illnesses (2905ng/L, IQR 1428-7124 versus 1222ng/L, IQR 1049-1566). Total-tau was elevated in the CSF of 24% of patients, whereas protein 14-3-3, generally undetectable, reached intermediate levels in two patients. Finally, CSF Aß1-42 was reduced in 52.4% of patients (median 536ng/L, IQR 432-904) with no change in the Aß1-42/Aß1-40 ratio (0.082, IQR 0.060-0.096). CONCLUSIONS We showed an elevation of CSF biomarkers of neuroinflammation in NeuroCOVID patients and a rise of CSF NfL, evocative of neuronal damage. However, longitudinal studies are needed to determine whether NeuroCOVID could evolve into a chronic neurodegenerative condition.
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Affiliation(s)
- H Chaumont
- Service de neurologie, centre hospitalier universitaire de la Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France; Faculté de médecine de l'université des Antilles, French West Indies, Pointe-à-Pitre, France; U 1127, CNRS, unité mixte de recherche (UMR) 7225, faculté de médecine de Sorbonne université, Institut national de la santé et de la recherche médicale, Institut du Cerveau, ICM, Paris, France.
| | - F Kaczorowski
- Laboratory of neurobiology and neurogenetics, department of biochemistry and molecular biology, Lyon university hospital, Bron, France; CNRS UMR 5292, Inserm U1028, BIORAN team, Lyon neuroscience research center, Lyon 1 university, Bron, France
| | - A San-Galli
- Service de neurologie, centre hospitalier universitaire de la Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - P P Michel
- U 1127, CNRS, unité mixte de recherche (UMR) 7225, faculté de médecine de Sorbonne université, Institut national de la santé et de la recherche médicale, Institut du Cerveau, ICM, Paris, France
| | - B Tressières
- Inserm CIC 1424, centre d'investigation Clinique Antilles Guyane, CHU de la Guadeloupe, Pointe-à-Pitre, France
| | - E Roze
- U 1127, CNRS, unité mixte de recherche (UMR) 7225, faculté de médecine de Sorbonne université, Institut national de la santé et de la recherche médicale, Institut du Cerveau, ICM, Paris, France; Département de neurologie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - I Quadrio
- Laboratory of neurobiology and neurogenetics, department of biochemistry and molecular biology, Lyon university hospital, Bron, France; CNRS UMR 5292, Inserm U1028, BIORAN team, Lyon neuroscience research center, Lyon 1 university, Bron, France
| | - A Lannuzel
- Service de neurologie, centre hospitalier universitaire de la Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France; Faculté de médecine de l'université des Antilles, French West Indies, Pointe-à-Pitre, France; U 1127, CNRS, unité mixte de recherche (UMR) 7225, faculté de médecine de Sorbonne université, Institut national de la santé et de la recherche médicale, Institut du Cerveau, ICM, Paris, France; Inserm CIC 1424, centre d'investigation Clinique Antilles Guyane, CHU de la Guadeloupe, Pointe-à-Pitre, France
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Volumetric MRI Findings in Mild Traumatic Brain Injury (mTBI) and Neuropsychological Outcome. Neuropsychol Rev 2023; 33:5-41. [PMID: 33656702 DOI: 10.1007/s11065-020-09474-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Region of interest (ROI) volumetric assessment has become a standard technique in quantitative neuroimaging. ROI volume is thought to represent a coarse proxy for making inferences about the structural integrity of a brain region when compared to normative values representative of a healthy sample, adjusted for age and various demographic factors. This review focuses on structural volumetric analyses that have been performed in the study of neuropathological effects from mild traumatic brain injury (mTBI) in relation to neuropsychological outcome. From a ROI perspective, the probable candidate structures that are most likely affected in mTBI represent the target regions covered in this review. These include the corpus callosum, cingulate, thalamus, pituitary-hypothalamic area, basal ganglia, amygdala, and hippocampus and associated structures including the fornix and mammillary bodies, as well as whole brain and cerebral cortex along with the cerebellum. Ventricular volumetrics are also reviewed as an indirect assessment of parenchymal change in response to injury. This review demonstrates the potential role and limitations of examining structural changes in the ROIs mentioned above in relation to neuropsychological outcome. There is also discussion and review of the role that post-traumatic stress disorder (PTSD) may play in structural outcome in mTBI. As emphasized in the conclusions, structural volumetric findings in mTBI are likely just a single facet of what should be a multimodality approach to image analysis in mTBI, with an emphasis on how the injury damages or disrupts neural network integrity. The review provides an historical context to quantitative neuroimaging in neuropsychology along with commentary about future directions for volumetric neuroimaging research in mTBI.
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Lee D, Lee Y, Lee Y, Kim K. Functional Connectivity in the Mouse Brainstem Represents Signs of Recovery from Concussion. J Neurotrauma 2023; 40:240-249. [PMID: 36103389 DOI: 10.1089/neu.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is one of the most frequent neurological disorders. Diagnostic criteria for mTBI are based on cognitive or neurological symptoms without fully understanding the neuropathological basis for explaining behaviors. From the neuropathological perspective of mTBI, recent neuroimaging studies have focused on structural or functional differences in motor-related cortical regions but did not compare topological network properties between the post-concussion days in the brainstem. We investigated temporal changes in functional connectivity and evaluated network properties of functional networks in the mouse brainstem. We observed a significantly decreased functional connectivity and global and local network properties on post-concussion day 7, which normalized on post-concussion day 14. Functional connectivity and local network properties on post-concussion day 2 were also significantly decreased compared with those on post-concussion day 14, but there were no significant group differences in global network properties between days 2 and 14. We also observed that the local efficiency and clustering coefficient of the brainstem network were significantly correlated with anxiety-like behaviors on post-concussion days 7 and 14. This study suggests that functional connectivity in the mouse brainstem provides vital recovery signs from concussion through functional reorganization.
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Affiliation(s)
- Dongha Lee
- Cognitive Science Research Group and Korea Brain Research Institute, Daegu, Republic of Korea
| | - Yujeong Lee
- Cognitive Science Research Group and Korea Brain Research Institute, Daegu, Republic of Korea
| | - Yoonsang Lee
- Cognitive Science Research Group and Korea Brain Research Institute, Daegu, Republic of Korea
| | - Kipom Kim
- Research Strategy Office, Korea Brain Research Institute, Daegu, Republic of Korea
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36
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To XV, Mohamed AZ, Cumming P, Nasrallah FA. Association of sub-acute changes in plasma amino acid levels with long-term brain pathologies in a rat model of moderate-severe traumatic brain injury. Front Neurosci 2023; 16:1014081. [PMID: 36685246 PMCID: PMC9853432 DOI: 10.3389/fnins.2022.1014081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) induces a cascade of cellular alterations that are responsible for evolving secondary brain injuries. Changes in brain structure and function after TBI may occur in concert with dysbiosis and altered amino acid fermentation in the gut. Therefore, we hypothesized that subacute plasma amino acid levels could predict long-term microstructural outcomes as quantified using neurite orientation dispersion and density imaging (NODDI). Methods Fourteen 8-10-week-old male rats were randomly assigned either to sham (n = 6) or a single moderate-severe TBI (n = 8) procedure targeting the primary somatosensory cortex. Venous blood samples were collected at days one, three, seven, and 60 post-procedure and NODDI imaging were carried out at day 60. Principal Component Regression analysis was used to identify time dependent plasma amino acid concentrations after in the subacute phase post-injury that predicted NODDI metric outcomes at day 60. Results The TBI group had significantly increased plasma levels of glutamine, arginine, alanine, proline, tyrosine, valine, isoleucine, leucine, and phenylalanine at days three-seven post-injury. Higher levels of several neuroprotective amino acids, especially the branched-chain amino acids (valine, isoleucine, leucine) and phenylalanine, as well as serine, arginine, and asparagine at days three-seven post-injury were also associated with lower isotropic diffusion volume fraction measures in the ventricles and thus lesser ventricular dilation at day 60. Discussion In the first such study, we examined the relationship between the long-term post-TBI microstructural outcomes across whole brain and the subacute changes in plasma amino acid concentrations. At days three to seven post-injury, we observed that increased plasma levels of several amino acids, particularly the branched-chain amino acids and phenylalanine, were associated with lesser degrees of ventriculomegaly and hydrocephalus TBI neuropathology at day 60 post-injury. The results imply that altered amino acid fermentation in the gut may mediate neuroprotection in the aftermath of TBI.
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Affiliation(s)
- Xuan Vinh To
- The Queensland Brain Institute, The University of Queensland, Saint Lucia, QLD, Australia
| | - Abdalla Z. Mohamed
- The Queensland Brain Institute, The University of Queensland, Saint Lucia, QLD, Australia,Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Paul Cumming
- Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland,School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Fatima A. Nasrallah
- The Queensland Brain Institute, The University of Queensland, Saint Lucia, QLD, Australia,Centre for Advanced Imaging, The University of Queensland, Saint Lucia, QLD, Australia,*Correspondence: Fatima A. Nasrallah,
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Sahin BE, Celikbilek A, Kocak Y, Ilanbey B, Saltoglu GT, Konar NM, Hizmali L. Neurological symptoms and neuronal damage markers in acute COVID-19: Is there a correlation? A pilot study. J Med Virol 2023; 95:e28240. [PMID: 36262025 PMCID: PMC9874781 DOI: 10.1002/jmv.28240] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 01/27/2023]
Abstract
A wide spectrum of neurological symptoms (NS) has been described in patients with COVID-19. We examined the plasma levels of neuron-specific enolase (NSE) and neurofilament light chain (NFL) together, as neuronal damage markers, and their relationships with clinical severity in patients with NS at acute COVID-19. A total of 20 healthy controls and 59 patients with confirmed COVID-19 were enrolled in this pilot prospective study. Serum NSE and NFL levels were measured by using the enzyme-linked immunoassay method from serum samples. Serum NSE levels were found to be significantly higher in the severe group than in the nonsevere group (p = 0.034). However, serum NFL levels were similar between the control and disease groups (p > 0.05). For the mild group, serum NFL levels were significantly higher in patients with the sampling time ≥5 days than in those with the sampling time <5 days (p = 0.019). However, no significant results for NSE and NFL were obtained in patients with either single or multiple NS across the groups (p > 0.05). Increased serum NSE levels were associated with disease severity regardless of accompanied NS in patients with acute COVID-19 infection. However, serum NFL levels may have a role at the subacute phase of COVID-19.
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Affiliation(s)
- Burc E. Sahin
- Department of NeurologyKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Asuman Celikbilek
- Department of NeurologyKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Yusuf Kocak
- Department of NeurologyKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Bilal Ilanbey
- Department of BiochemistryKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Gamze T. Saltoglu
- Department of BiochemistryKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Naime M. Konar
- Department of Biostatistics and Medical InformaticsKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
| | - Lokman Hizmali
- Department of Clinical Microbiology and Infectious DiseasesKirsehir Ahi Evran University Faculty of MedicineKirsehirTurkey
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O'Brien WT, Wright DK, van Emmerik ALJJ, Bain J, Brkljaca R, Christensen J, Yamakawa GR, Chen Z, Giesler LP, Sun M, O'Brien TJ, Monif M, Shultz SR, McDonald SJ. Serum neurofilament light as a biomarker of vulnerability to a second mild traumatic brain injury. Transl Res 2022; 255:77-84. [PMID: 36402367 DOI: 10.1016/j.trsl.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
A second mild traumatic brain injury (mTBI) sustained prior to neuropathological recovery can lead to exacerbated effects. Without objective indicators of this neuropathology, individuals may return to activities at risk of mTBI when their brain is still vulnerable. With axonal injury recognized as a neuropathological hallmark of mTBI, we hypothesized that serum levels of neurofilament light (NfL), a highly sensitive biomarker of axonal injury, may be predictive of vulnerability to worse outcomes in the event of a second mTBI. Given this hypothesis is difficult to test clinically, we used a two-hit model of mTBI in rats and staggered inter-injury intervals by 1-, 3-, 7-, or 14-days. Repeat-mTBI rats were dichotomized into NfLhigh (NfL>median at the time of re-injury) and NfLlow (NfL<median) groups, with behavior and NfL levels analyzed throughout the 28-days, followed by ex vivo diffusion tensor imaging. NfL levels at the time of the second mTBI were found to be predictive of vulnerability to re-injury, with NfLhigh rats displaying more neurological signs and a greater potentiation of NfL levels after the second mTBI. Importantly, this potentiation phenomenon remained even when limiting analyses to rats with longer inter-injury intervals, providing evidence that vulnerability to re-injury may not be exclusively dependent on inter-injury interval. Finally, NfL levels correlated with, and were predictive of, the severity of neurological signs following the second mTBI. These findings provide evidence that measurement of NfL during mTBI recovery may be reflective of the vulnerability to a second mTBI, and as such may have utility to assist return to sport, duty and work decisions.
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Affiliation(s)
- William T O'Brien
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | | | - Jesse Bain
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | | | | | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Zhibin Chen
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Lauren P Giesler
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia
| | - Mastura Monif
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia; Health and Human Services, Vancouver Island University, Nanaimo, V9R 5S5, Canada
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, 3004, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, 3004, Australia.
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Eratne D, Loi SM, Li QX, Stehmann C, Malpas CB, Santillo A, Janelidze S, Cadwallader C, Walia N, Ney B, Lewis V, Senesi M, Fowler C, McGlade A, Varghese S, Ravanfar P, Kelso W, Farrand S, Keem M, Kang M, Goh AMY, Dhiman K, Gupta V, Watson R, Yassi N, Kaylor-Hughes C, Kanaan R, Perucca P, Dobson H, Vivash L, Ali R, O'Brien TJ, Hansson O, Zetterberg H, Blennow K, Walterfang M, Masters CL, Berkovic SF, Collins S, Velakoulis D. Cerebrospinal fluid neurofilament light chain differentiates primary psychiatric disorders from rapidly progressive, Alzheimer's disease and frontotemporal disorders in clinical settings. Alzheimers Dement 2022; 18:2218-2233. [PMID: 35102694 DOI: 10.1002/alz.12549] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many patients with cognitive and neuropsychiatric symptoms face diagnostic delay and misdiagnosis. We investigated whether cerebrospinal fluid (CSF) neurofilament light (NfL) and total-tau (t-tau) could assist in the clinical scenario of differentiating neurodegenerative (ND) from psychiatric disorders (PSY), and rapidly progressive disorders. METHODS Biomarkers were examined in patients from specialist services (ND and PSY) and a national Creutzfeldt-Jakob registry (Creutzfeldt-Jakob disease [CJD] and rapidly progressive dementias/atypically rapid variants of common ND, RapidND). RESULTS A total of 498 participants were included: 197 ND, 67 PSY, 161 CJD, 48 RapidND, and 20 controls. NfL was elevated in ND compared to PSY and controls, with highest levels in CJD and RapidND. NfL distinguished ND from PSY with 95%/78% positive/negative predictive value, 92%/87% sensitivity/specificity, 91% accuracy. NfL outperformed t-tau in most real-life clinical diagnostic dilemma scenarios, except distinguishing CJD from RapidND. DISCUSSION We demonstrated strong generalizable evidence for the diagnostic utility of CSF NfL in differentiating ND from psychiatric disorders, with high accuracy.
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Affiliation(s)
- Dhamidhu Eratne
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Samantha M Loi
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Qiao-Xin Li
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Christiane Stehmann
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Charles B Malpas
- Department of Medicine, Department of Neurology, Clinical Outcomes Research Unit (CORe), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alexander Santillo
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Shorena Janelidze
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Claire Cadwallader
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nirbaanjot Walia
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Blair Ney
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia.,St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Victoria Lewis
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Matteo Senesi
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Christopher Fowler
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Amelia McGlade
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Shiji Varghese
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Parsa Ravanfar
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Wendy Kelso
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sarah Farrand
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Keem
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Matthew Kang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anita M Y Goh
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Kunal Dhiman
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Veer Gupta
- School of Medicine, Deakin University, Geelong, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosie Watson
- Population Health and Immunity Division, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Nawaf Yassi
- Population Health and Immunity Division, the Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Departments of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Cath Kaylor-Hughes
- Department of General Practice, Integrated Mental Health Team, University of Melbourne, Parkville, Victoria, Australia
| | - Richard Kanaan
- Department of Psychiatry, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Piero Perucca
- Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Comprehensive Epilepsy Program, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Hannah Dobson
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry, Alfred Health, Melbourne, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Rashida Ali
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Oskar Hansson
- Department of Clinical Sciences Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden.,Memory Clinic, Skåne University Hospital, Malmo, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mark Walterfang
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Colin L Masters
- National Dementia Diagnostics Laboratory, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Samuel F Berkovic
- Department of Medicine, Austin Health, Epilepsy Research Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Steven Collins
- Australian National Creutzfeldt-Jakob Disease Registry, Florey Institute of Neuroscience and Mental Health and Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Psychiatry & Melbourne Neuropsychiatry Centre, University of Melbourne, Parkville, Victoria, Australia
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Delaby C, Bousiges O, Bouvier D, Fillée C, Fourier A, Mondésert E, Nezry N, Omar S, Quadrio I, Rucheton B, Schraen-Maschke S, van Pesch V, Vicca S, Lehmann S, Bedel A. Neurofilaments contribution in clinic: state of the art. Front Aging Neurosci 2022; 14:1034684. [PMID: 36389064 PMCID: PMC9664201 DOI: 10.3389/fnagi.2022.1034684] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 07/26/2023] Open
Abstract
Neurological biomarkers are particularly valuable to clinicians as they can be used for diagnosis, prognosis, or response to treatment. This field of neurology has evolved considerably in recent years with the improvement of analytical methods, allowing the detection of biomarkers not only in cerebrospinal fluid (CSF) but also in less invasive fluids like blood. These advances greatly facilitate the repeated quantification of biomarkers, including at asymptomatic stages of the disease. Among the various informative biomarkers of neurological disorders, neurofilaments (NfL) have proven to be of particular interest in many contexts, such as neurodegenerative diseases, traumatic brain injury, multiple sclerosis, stroke, and cancer. Here we discuss these different pathologies and the potential value of NfL assay in the management of these patients, both for diagnosis and prognosis. We also describe the added value of NfL compared to other biomarkers currently used to monitor the diseases described in this review.
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Affiliation(s)
- Constance Delaby
- Université de Montpellier, IRMB, INM, INSERM, CHU de Montpellier, Laboratoire Biochimie-Protéomique clinique, Montpellier, France
- Sant Pau Memory Unit, Hospital de la Santa Creu i Sant Pau—Biomedical Research Institute Sant Pau—Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olivier Bousiges
- Laboratoire de biochimie et biologie moléculaire (LBBM)—Pôle de biologie Hôpital de Hautepierre—CHU de Strasbourg, CNRS, laboratoire ICube UMR 7357 et FMTS (Fédération de Médecine Translationnelle de Strasbourg), équipe IMIS, Strasbourg, France
| | - Damien Bouvier
- Service de Biochimie et Génétique Moléculaire, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Fillée
- Cliniques universitaires Saint-Luc UCLouvain, Service de Biochimie Médicale, Brussels, Belgium
| | - Anthony Fourier
- Biochimie et Biologie Moléculaire—LBMMS, Unité de diagnostic des pathologies dégénératives, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Lyon, France
| | - Etienne Mondésert
- Université de Montpellier, IRMB, INM, INSERM, CHU de Montpellier, Laboratoire Biochimie-Protéomique clinique, Montpellier, France
| | - Nicolas Nezry
- Univ. Lille, Inserm, CHU Lille, UMR-S-U1172, LiCEND, Lille Neuroscience & Cognition, LabEx DISTALZ, Lille, France
| | - Souheil Omar
- Laboratoire de biologie médicale de l’Institut de Neurologie de Tunis, Tunis, Tunisia
| | - Isabelle Quadrio
- Biochimie et Biologie Moléculaire—LBMMS, Unité de diagnostic des pathologies dégénératives, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Lyon, France
| | - Benoit Rucheton
- Laboratoire de Biologie, Institut Bergonié, Bordeaux, France
| | - Susanna Schraen-Maschke
- Univ. Lille, Inserm, CHU Lille, UMR-S-U1172, LiCEND, Lille Neuroscience & Cognition, LabEx DISTALZ, Lille, France
| | - Vincent van Pesch
- Cliniques universitaires Saint-Luc UCLouvain, Service de Neurologie, Brussels, Belgium
| | - Stéphanie Vicca
- Hôpital Necker-Enfants malades, Paris, Laboratoire de Biochimie générale, DMU BioPhyGen, AP-HP.Centre—Université de Paris, Paris, France
| | - Sylvain Lehmann
- Université de Montpellier, IRMB, INM, INSERM, CHU de Montpellier, Laboratoire Biochimie-Protéomique clinique, Montpellier, France
| | - Aurelie Bedel
- Service de Biochimie, CHU Pellegrin, Bordeaux, France
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41
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Hiskens MI, Mengistu TS, Li KM, Fenning AS. Systematic Review of the Diagnostic and Clinical Utility of Salivary microRNAs in Traumatic Brain Injury (TBI). Int J Mol Sci 2022; 23:13160. [PMID: 36361944 PMCID: PMC9654991 DOI: 10.3390/ijms232113160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 07/29/2023] Open
Abstract
Research in traumatic brain injury (TBI) is an urgent priority, as there are currently no TBI biomarkers to assess the severity of injury, to predict outcomes, and to monitor recovery. Small non-coding RNAs (sncRNAs) including microRNAs can be measured in saliva following TBI and have been investigated as potential diagnostic markers. The aim of this systematic review was to investigate the diagnostic or prognostic ability of microRNAs extracted from saliva in human subjects. PubMed, Embase, Scopus, PsycINFO and Web of Science were searched for studies that examined the association of saliva microRNAs in TBI. Original studies of any design involving diagnostic capacity of salivary microRNAs for TBI were selected for data extraction. Nine studies met inclusion criteria, with a heterogeneous population involving athletes and hospital patients, children and adults. The studies identified a total of 188 differentially expressed microRNAs, with 30 detected in multiple studies. MicroRNAs in multiple studies involved expression change bidirectionality. The study design and methods involved significant heterogeneity that precluded meta-analysis. Early data indicates salivary microRNAs may assist with TBI diagnosis. Further research with consistent methods and larger patient populations is required to evaluate the diagnostic and prognostic potential of saliva microRNAs.
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Affiliation(s)
- Matthew I. Hiskens
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, 475 Bridge Road, Mackay, QLD 4740, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Rockhampton, QLD 4702, Australia
| | - Tesfaye S. Mengistu
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, 475 Bridge Road, Mackay, QLD 4740, Australia
- Faculty of Medicine, School of Public Health, University of Queensland, 266 Herston Road, Herston, QLD 4006, Australia
| | - Katy M. Li
- School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Rockhampton, QLD 4702, Australia
| | - Andrew S. Fenning
- School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Rockhampton, QLD 4702, Australia
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42
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Khan NA, Asim M, El-Menyar A, Biswas KH, Rizoli S, Al-Thani H. The evolving role of extracellular vesicles (exosomes) as biomarkers in traumatic brain injury: Clinical perspectives and therapeutic implications. Front Aging Neurosci 2022; 14:933434. [PMID: 36275010 PMCID: PMC9584168 DOI: 10.3389/fnagi.2022.933434] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Developing effective disease-modifying therapies for neurodegenerative diseases (NDs) requires reliable diagnostic, disease activity, and progression indicators. While desirable, identifying biomarkers for NDs can be difficult because of the complex cytoarchitecture of the brain and the distinct cell subsets seen in different parts of the central nervous system (CNS). Extracellular vesicles (EVs) are heterogeneous, cell-derived, membrane-bound vesicles involved in the intercellular communication and transport of cell-specific cargos, such as proteins, Ribonucleic acid (RNA), and lipids. The types of EVs include exosomes, microvesicles, and apoptotic bodies based on their size and origin of biogenesis. A growing body of evidence suggests that intercellular communication mediated through EVs is responsible for disseminating important proteins implicated in the progression of traumatic brain injury (TBI) and other NDs. Some studies showed that TBI is a risk factor for different NDs. In terms of therapeutic potential, EVs outperform the alternative synthetic drug delivery methods because they can transverse the blood–brain barrier (BBB) without inducing immunogenicity, impacting neuroinflammation, immunological responses, and prolonged bio-distribution. Furthermore, EV production varies across different cell types and represents intracellular processes. Moreover, proteomic markers, which can represent a variety of pathological processes, such as cellular damage or neuroinflammation, have been frequently studied in neurotrauma research. However, proteomic blood-based biomarkers have short half-lives as they are easily susceptible to degradation. EV-based biomarkers for TBI may represent the complex genetic and neurometabolic abnormalities that occur post-TBI. These biomarkers are not caught by proteomics, less susceptible to degradation and hence more reflective of these modifications (cellular damage and neuroinflammation). In the current narrative and comprehensive review, we sought to discuss the contemporary knowledge and better understanding the EV-based research in TBI, and thus its applications in modern medicine. These applications include the utilization of circulating EVs as biomarkers for diagnosis, developments of EV-based therapies, and managing their associated challenges and opportunities.
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Affiliation(s)
- Naushad Ahmad Khan
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- *Correspondence: Ayman El-Menyar
| | - Kabir H. Biswas
- Division of Biological and Biomedical Sciences, College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
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Shao X, Liu Z, Mao S, Han L. Unraveling the Mechanobiology Underlying Traumatic Brain Injury with Advanced Technologies and Biomaterials. Adv Healthc Mater 2022; 11:e2200760. [PMID: 35841392 DOI: 10.1002/adhm.202200760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/27/2022] [Indexed: 01/27/2023]
Abstract
Traumatic brain injury (TBI) is a worldwide health and socioeconomic problem, associated with prolonged and complex neurological aftermaths, including a variety of functional deficits and neurodegenerative disorders. Research on the long-term effects has highlighted that TBI shall be regarded as a chronic health condition. The initiation and exacerbation of TBI involve a series of mechanical stimulations and perturbations, accompanied by mechanotransduction events within the brain tissues. Mechanobiology thus offers a unique perspective and likely promising approach to unravel the underlying molecular and biochemical mechanisms leading to neural cells dysfunction after TBI, which may contribute to the discovery of novel targets for future clinical treatment. This article investigates TBI and the subsequent brain dysfunction from a lens of neuromechanobiology. Following an introduction, the mechanobiological insights are examined into the molecular pathology of TBI, and then an overview is given of the latest research technologies to explore neuromechanobiology, with particular focus on microfluidics and biomaterials. Challenges and prospects in the current field are also discussed. Through this article, it is hoped that extensive technical innovation in biomedical devices and materials can be encouraged to advance the field of neuromechanobiology, paving potential ways for the research and rehabilitation of neurotrauma and neurological diseases.
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Affiliation(s)
- Xiaowei Shao
- Institute of Marine Science and Technology, Shandong University, Qingdao, Shandong, 266237, China.,Suzhou Research Institute, Shandong University, Suzhou, Jiangsu, 215123, China
| | - Zhongqian Liu
- Institute of Marine Science and Technology, Shandong University, Qingdao, Shandong, 266237, China
| | - Shijie Mao
- Institute of Marine Science and Technology, Shandong University, Qingdao, Shandong, 266237, China
| | - Lin Han
- Institute of Marine Science and Technology, Shandong University, Qingdao, Shandong, 266237, China
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44
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A review of molecular and genetic factors for determining mild traumatic brain injury severity and recovery. BRAIN DISORDERS 2022. [DOI: 10.1016/j.dscb.2022.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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45
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Arneson D, Zhang G, Ahn IS, Ying Z, Diamante G, Cely I, Palafox-Sanchez V, Gomez-Pinilla F, Yang X. Systems spatiotemporal dynamics of traumatic brain injury at single-cell resolution reveals humanin as a therapeutic target. Cell Mol Life Sci 2022; 79:480. [PMID: 35951114 PMCID: PMC9372016 DOI: 10.1007/s00018-022-04495-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/10/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The etiology of mild traumatic brain injury (mTBI) remains elusive due to the tissue and cellular heterogeneity of the affected brain regions that underlie cognitive impairments and subsequent neurological disorders. This complexity is further exacerbated by disrupted circuits within and between cell populations across brain regions and the periphery, which occur at different timescales and in spatial domains. METHODS We profiled three tissues (hippocampus, frontal cortex, and blood leukocytes) at the acute (24-h) and subacute (7-day) phases of mTBI at single-cell resolution. RESULTS We demonstrated that the coordinated gene expression patterns across cell types were disrupted and re-organized by TBI at different timescales with distinct regional and cellular patterns. Gene expression-based network modeling implied astrocytes as a key regulator of the cell-cell coordination following mTBI in both hippocampus and frontal cortex across timepoints, and mt-Rnr2, which encodes the mitochondrial peptide humanin, as a potential target for intervention based on its broad regional and dynamic dysregulation following mTBI. Treatment of a murine mTBI model with humanin reversed cognitive impairment caused by mTBI through the restoration of metabolic pathways within astrocytes. CONCLUSIONS Our results offer a systems-level understanding of the dynamic and spatial regulation of gene programs by mTBI and pinpoint key target genes, pathways, and cell circuits that are amenable to therapeutics.
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Affiliation(s)
- Douglas Arneson
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Guanglin Zhang
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - In Sook Ahn
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Zhe Ying
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Graciel Diamante
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Ingrid Cely
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Victoria Palafox-Sanchez
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Fernando Gomez-Pinilla
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Brain Injury Research Center, University of California, Los Angeles, Los Angeles, CA 90095 USA
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095 USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA 90095 USA
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46
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Newcombe VFJ, Ashton NJ, Posti JP, Glocker B, Manktelow A, Chatfield DA, Winzeck S, Needham E, Correia MM, Williams GB, Simrén J, Takala RSK, Katila AJ, Maanpää HR, Tallus J, Frantzén J, Blennow K, Tenovuo O, Zetterberg H, Menon DK. Post-acute blood biomarkers and disease progression in traumatic brain injury. Brain 2022; 145:2064-2076. [PMID: 35377407 PMCID: PMC9326940 DOI: 10.1093/brain/awac126] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/09/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
There is substantial interest in the potential for traumatic brain injury to result in progressive neurological deterioration. While blood biomarkers such as glial fibrillary acid protein (GFAP) and neurofilament light have been widely explored in characterizing acute traumatic brain injury (TBI), their use in the chronic phase is limited. Given increasing evidence that these proteins may be markers of ongoing neurodegeneration in a range of diseases, we examined their relationship to imaging changes and functional outcome in the months to years following TBI. Two-hundred and three patients were recruited in two separate cohorts; 6 months post-injury (n = 165); and >5 years post-injury (n = 38; 12 of whom also provided data ∼8 months post-TBI). Subjects underwent blood biomarker sampling (n = 199) and MRI (n = 172; including diffusion tensor imaging). Data from patient cohorts were compared to 59 healthy volunteers and 21 non-brain injury trauma controls. Mean diffusivity and fractional anisotropy were calculated in cortical grey matter, deep grey matter and whole brain white matter. Accelerated brain ageing was calculated at a whole brain level as the predicted age difference defined using T1-weighted images, and at a voxel-based level as the annualized Jacobian determinants in white matter and grey matter, referenced to a population of 652 healthy control subjects. Serum neurofilament light concentrations were elevated in the early chronic phase. While GFAP values were within the normal range at ∼8 months, many patients showed a secondary and temporally distinct elevations up to >5 years after injury. Biomarker elevation at 6 months was significantly related to metrics of microstructural injury on diffusion tensor imaging. Biomarker levels at ∼8 months predicted white matter volume loss at >5 years, and annualized brain volume loss between ∼8 months and 5 years. Patients who worsened functionally between ∼8 months and >5 years showed higher than predicted brain age and elevated neurofilament light levels. GFAP and neurofilament light levels can remain elevated months to years after TBI, and show distinct temporal profiles. These elevations correlate closely with microstructural injury in both grey and white matter on contemporaneous quantitative diffusion tensor imaging. Neurofilament light elevations at ∼8 months may predict ongoing white matter and brain volume loss over >5 years of follow-up. If confirmed, these findings suggest that blood biomarker levels at late time points could be used to identify TBI survivors who are at high risk of progressive neurological damage.
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Affiliation(s)
| | - Nicholas J Ashton
- Wallenberg Centre for Molecular and Translational Medicine, University of
Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and
Physiology, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- King’s College London, Institute of Psychiatry, Psychology and
Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute,
London, UK
- Mental Health and Biomedical Research Unit for Dementia, Maudsley NIHR
Biomedical Research Centre, London, UK
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Ben Glocker
- Biomedical Image Analysis Group, Department of Computing, Imperial College
London, London, UK
| | - Anne Manktelow
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Doris A Chatfield
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Stefan Winzeck
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
- Biomedical Image Analysis Group, Department of Computing, Imperial College
London, London, UK
| | - Edward Needham
- University Division of Anaesthesia, Department of Medicine, University of
Cambridge, Cambridge, UK
| | - Marta M Correia
- MRC (Medical Research Council) Cognition and Brain Sciences Unit,
University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Wolfson Brain Imaging Centre, Department of Clinical
Neurosciences, Cambridge, UK
| | - Joel Simrén
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
| | - Riikka S K Takala
- Perioperative Services, Intensive Care Medicine and Pain Management,
Department of Anesthesiology and Intensive Care, Turku University Hospital, University
of Turku, Turku, Finland
| | - Ari J Katila
- Perioperative Services, Intensive Care Medicine and Pain Management,
Department of Anesthesiology and Intensive Care, Turku University Hospital, University
of Turku, Turku, Finland
| | - Henna Riikka Maanpää
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Jussi Tallus
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Janek Frantzén
- Neurocenter, Department of Neurosurgery, Turku University Hospital and
University of Turku, Turku, Finland
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
| | - Olli Tenovuo
- Turku Brain Injury Center, Turku University Hospital and University of
Turku, Turku, Finland
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and
Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg,
Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University
Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of
Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, University College
London, London, UK
- Hong Kong Center for Neurodegenerative Disease,
Hong Kong, China
| | - David K Menon
- Correspondence to: David Menon University Division of Anaesthesia
University of Cambridge Box 93, Addenbrooke’s Hospital Hills Road, Cambridge CB2 0QQ, UK
E-mail:
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47
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Sahin BE, Celikbilek A, Kocak Y, Saltoglu GT, Konar NM, Hizmali L. Plasma biomarkers of brain injury in COVID-19 patients with neurological symptoms. J Neurol Sci 2022; 439:120324. [PMID: 35752131 PMCID: PMC9212259 DOI: 10.1016/j.jns.2022.120324] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
Objective Neurological symptoms (NS) were often reported in COVID-19 infection. We examined the plasma levels of glial fibrillary acidic protein (GFAP) and S100B together, as brain injury biomarkers, in relation to persistent NS in a cohort of patients with COVID-19 during the acute phase of the disease. Methods A total of 20 healthy controls and 58 patients with confirmed COVID-19 were enrolled in this prospective study. Serum GFAP and S100B levels were measured by using enzymle linked immunoassay method from blood samples. Results Serum GFAP levels were found to be significantly higher in the severe group than in the controls (p = 0.007). However, serum S100B levels were similar between control and disease groups (p > 0.05). No significant results for GFAP and S100B were obtained between the disease groups depending on whether the sampling time was below or above 5 days (p > 0.05). We did not find a correlation between serum GFAP and S100B levels and the presence of NS (p > 0.05). However, serum S100B levels were slightly higher in patients with multiple NS than in those with a single symptom (p = 0.044). Conclusions Elevated GFAP was associated with disease severity but not with NS in COVID-19 patients. Whereas, high serum S100B was associated with the multipl NS in these patients. Our data suggest that GFAP and S100B may be of limited value currently in order to represent the neuronal damage, though serving a basis for the future work.
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Affiliation(s)
- B E Sahin
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Neurology, Kirsehir, Turkey.
| | - A Celikbilek
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Neurology, Kirsehir, Turkey
| | - Y Kocak
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Neurology, Kirsehir, Turkey
| | - G T Saltoglu
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Biochemistry, Kirsehir, Turkey
| | - N M Konar
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Biostatistics and Medical Informatics, Kirsehir, Turkey
| | - L Hizmali
- Kirsehir Ahi Evran University Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Kirsehir, Turkey
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48
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Cell-Derived Exosomes as Therapeutic Strategies and Exosome-Derived microRNAs as Biomarkers for Traumatic Brain Injury. J Clin Med 2022; 11:jcm11113223. [PMID: 35683610 PMCID: PMC9181755 DOI: 10.3390/jcm11113223] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) is a complex, life-threatening condition that causes mortality and disability worldwide. No effective treatment has been clinically verified to date. Achieving effective drug delivery across the blood–brain barrier (BBB) presents a major challenge to therapeutic drug development for TBI. Furthermore, the field of TBI biomarkers is rapidly developing to cope with the many aspects of TBI pathology and enhance clinical management of TBI. Exosomes (Exos) are endogenous extracellular vesicles (EVs) containing various biological materials, including lipids, proteins, microRNAs, and other nucleic acids. Compelling evidence exists that Exos, such as stem cell-derived Exos and even neuron or glial cell-derived Exos, are promising TBI treatment strategies because they pass through the BBB and have the potential to deliver molecules to target lesions. Meanwhile, Exos have decreased safety risks from intravenous injection or orthotopic transplantation of viable cells, such as microvascular occlusion or imbalanced growth of transplanted cells. These unique characteristics also create Exos contents, especially Exos-derived microRNAs, as appealing biomarkers in TBI. In this review, we explore the potential impact of cell-derived Exos and exosome-derived microRNAs on the diagnosis, therapy, and prognosis prediction of TBI. The associated challenges and opportunities are also discussed.
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49
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Edlow BL, Bodien YG, Baxter T, Belanger H, Cali R, Deary K, Fischl B, Foulkes AS, Gilmore N, Greve DN, Hooker JM, Huang SY, Kelemen JN, Kimberly WT, Maffei C, Masood M, Perl D, Polimeni JR, Rosen BR, Tromly S, Tseng CEJ, Yao EF, Zurcher NR, Mac Donald CL, Dams-O'Connor K. Long-Term Effects of Repeated Blast Exposure in United States Special Operations Forces Personnel: A Pilot Study Protocol. J Neurotrauma 2022; 39:1391-1407. [PMID: 35620901 PMCID: PMC9529318 DOI: 10.1089/neu.2022.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Emerging evidence suggests that repeated blast exposure (RBE) is associated with brain injury in military personnel. United States (U.S.) Special Operations Forces (SOF) personnel experience high rates of blast exposure during training and combat, but the effects of low-level RBE on brain structure and function in SOF have not been comprehensively characterized. Further, the pathophysiological link between RBE-related brain injuries and cognitive, behavioral, and physical symptoms has not been fully elucidated. We present a protocol for an observational pilot study, Long-Term Effects of Repeated Blast Exposure in U.S. SOF Personnel (ReBlast). In this exploratory study, 30 active-duty SOF personnel with RBE will participate in a comprehensive evaluation of: 1) brain network structure and function using Connectome magnetic resonance imaging (MRI) and 7 Tesla MRI; 2) neuroinflammation and tau deposition using positron emission tomography; 3) blood proteomics and metabolomics; 4) behavioral and physical symptoms using self-report measures; and 5) cognition using a battery of conventional and digitized assessments designed to detect subtle deficits in otherwise high-performing individuals. We will identify clinical, neuroimaging, and blood-based phenotypes that are associated with level of RBE, as measured by the Generalized Blast Exposure Value. Candidate biomarkers of RBE-related brain injury will inform the design of a subsequent study that will test a diagnostic assessment battery for detecting RBE-related brain injury. Ultimately, we anticipate that the ReBlast study will facilitate the development of interventions to optimize the brain health, quality of life, and battle readiness of U.S. SOF personnel.
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Affiliation(s)
- Brian L Edlow
- Harvard Medical School, 1811, 175 Cambridge Street - Suite 300, Boston, Massachusetts, United States, 02115.,Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Yelena G Bodien
- Massachusetts General Hospital, 2348, Department of Neurology, 101 Merrimac, Boston, Massachusetts, United States, 02114;
| | - Timothy Baxter
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Heather Belanger
- University of South Florida, 7831, Department of Psychiatry and Behavioral Neurosciences, Tampa, Florida, United States;
| | - Ryan Cali
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Katryna Deary
- Navy SEAL Foundation, Virginia Beach, Virginia, United States;
| | - Bruce Fischl
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Room 2301, 149 13th Street, Charlestown, Massachusetts, United States, 02129-2020.,Massachusetts General Hospital;
| | - Andrea S Foulkes
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Natalie Gilmore
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Douglas N Greve
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jacob M Hooker
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Susie Y Huang
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Jessica N Kelemen
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - W Taylor Kimberly
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Chiara Maffei
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Maryam Masood
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States;
| | - Daniel Perl
- Uniformed Services University of the Health Sciences, 1685, Pathology, 4301 Jones Bridge Road, Room B3138, Bethesda, Maryland, United States, 20814;
| | - Jonathan R Polimeni
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Bruce R Rosen
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown, Massachusetts, United States;
| | - Samantha Tromly
- University of South Florida, 7831, Institute for Applied Engineering, Tampa, Florida, United States;
| | - Chieh-En J Tseng
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Eveline F Yao
- United States Special Operations Command, Office of the Surgeon General, MacDill Air Force Base, United States;
| | - Nicole R Zurcher
- Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| | - Christine L Mac Donald
- University of Washington, 7284, Department of Neurological Surgery, Seattle, Washington, United States;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
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50
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Tyagi M, Kapoor I, Mahajan C, Gupta N, Prabhakar H. Brain Biomarkers in Patients with COVID-19 and Neurological Manifestations: A Narrative Review. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1744395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractAcute hyperinflammatory response (cytokine storm) and immunosuppression are responsible for critical illness in patients infected with coronavirus disease 2019 (COVID-19). It is a serious public health crisis that has affected millions of people worldwide. The main clinical manifestations are mostly by respiratory tract involvement and have been extensively researched. Increasing numbers of evidence from emerging studies point out the possibility of neurological involvement by COVID-19 highlighting the need for developing technology to diagnose, manage, and treat brain injury in such patients. Here, we aimed to discuss the rationale for the use of an emerging spectrum of blood biomarkers to guide future diagnostic strategies to mitigate brain injury-associated morbidity and mortality risks in COVID-19 patients, their use in clinical practice, and prediction of neurological outcomes.
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Affiliation(s)
- Mayank Tyagi
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Gupta
- Department of Neuroanesthesia, Indraprastha Apollo Hospital, New Delhi, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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