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Beard K, Gauff AK, Pennington AM, Marion DW, Smith J, Sloley S. Biofluid, Imaging, Physiological, and Functional Biomarkers of Mild Traumatic Brain Injury and Subconcussive Head Impacts. J Neurotrauma 2024. [PMID: 38943278 DOI: 10.1089/neu.2024.0136] [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: 07/01/2024] Open
Abstract
Post-concussive symptoms are frequently reported by individuals who sustain mild traumatic brain injuries (mTBIs) and subconcussive head impacts, even when evidence of intracranial pathology is lacking. Current strategies used to evaluate head injuries, which primarily rely on self-report, have a limited ability to predict the incidence, severity, and duration of post-concussive symptoms that will develop in an individual patient. In addition, these self-report measures have little association with the underlying mechanisms of pathology that may contribute to persisting symptoms, impeding advancement in precision treatment for TBI. Emerging evidence suggests that biofluid, imaging, physiological, and functional biomarkers associated with mTBI and subconcussive head impacts may address these shortcomings by providing more objective measures of injury severity and underlying pathology. Interest in the use of biomarker data has rapidly accelerated, which is reflected by the recent efforts of organizations such as the National Institute of Neurological Disorders and Stroke and the National Academies of Sciences, Engineering, and Medicine to prioritize the collection of biomarker data during TBI characterization in acute-care settings. Thus, this review aims to describe recent progress in the identification and development of biomarkers of mTBI and subconcussive head impacts and to discuss important considerations for the implementation of these biomarkers in clinical practice.
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Affiliation(s)
- Kryshawna Beard
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Amina K Gauff
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Ashley M Pennington
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Xynergie Federal, LLC, San Juan, United States Minor Outlying Islands
| | - Donald W Marion
- General Dynamics Information Technology Fairfax, Falls Church, Virginia, USA
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Johanna Smith
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
| | - Stephanie Sloley
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
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Janković T, Pilipović K. Single Versus Repetitive Traumatic Brain Injury: Current Knowledge on the Chronic Outcomes, Neuropathology and the Role of TDP-43 Proteinopathy. Exp Neurobiol 2023; 32:195-215. [PMID: 37749924 PMCID: PMC10569144 DOI: 10.5607/en23008] [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: 02/16/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the most important causes of death and disability in adults and thus an important public health problem. Following TBI, secondary pathophysiological processes develop over time and condition the development of different neurodegenerative entities. Previous studies suggest that neurobehavioral changes occurring after a single TBI are the basis for the development of Alzheimer's disease, while repetitive TBI is considered to be a contributing factor for chronic traumatic encephalopathy development. However, pathophysiological processes that determine the evolvement of a particular chronic entity are still unclear. Human post-mortem studies have found combinations of amyloid, tau, Lewi bodies, and TAR DNA-binding protein 43 (TDP-43) pathologies after both single and repetitive TBI. This review focuses on the pathological changes of TDP-43 after single and repetitive brain traumas. Numerous studies have shown that TDP-43 proteinopathy noticeably occurs after repetitive head trauma. A relatively small number of available preclinical research on single brain injury are not in complete agreement with the results from the human samples, which makes it difficult to draw specific conclusions. Also, as TBI is considered a heterogeneous type of injury, different experimental trauma models and injury intensities may cause differences in the cascade of secondary injury, which should be considered in future studies. Experimental and post-mortem studies of TDP-43 pathobiology should be carried out, preferably in the same laboratories, to determine its involvement in the development of neurodegenerative conditions after one and repetitive TBI, especially in the context of the development of new therapeutic options.
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Affiliation(s)
- Tamara Janković
- Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Kristina Pilipović
- Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
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Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
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Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
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Pierre K, Molina V, Shukla S, Avila A, Fong N, Nguyen J, Lucke-Wold B. Chronic traumatic encephalopathy: Diagnostic updates and advances. AIMS Neurosci 2022; 9:519-535. [PMID: 36660076 PMCID: PMC9826753 DOI: 10.3934/neuroscience.2022030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease that occurs secondary to repetitive mild traumatic brain injury. Current clinical diagnosis relies on symptomatology and structural imaging findings which often vary widely among those with the disease. The gold standard of diagnosis is post-mortem pathological examination. In this review article, we provide a brief introduction to CTE, current diagnostic workup and the promising research on imaging and fluid biomarker diagnostic techniques. For imaging, we discuss quantitative structural analyses, DTI, fMRI, MRS, SWI and PET CT. For fluid biomarkers, we discuss p-tau, TREM2, CCL11, NfL and GFAP.
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Affiliation(s)
- Kevin Pierre
- University of Florida Department of Radiology, Gainesville 32603, Florida, USA
| | - Vanessa Molina
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Shil Shukla
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Anthony Avila
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Nicholas Fong
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Jessica Nguyen
- Sam Houston State University of Osteopathic Medicine, Conroe 77304, Texas, USA
| | - Brandon Lucke-Wold
- University of Florida Department of Neurosurgery, Gainesville 32603, Florida, USA,* Correspondence:
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Dodd WS, Panther EJ, Pierre K, Hernandez JS, Patel D, Lucke-Wold B. Traumatic Brain Injury and Secondary Neurodegenerative Disease. TRAUMA CARE 2022; 2:510-522. [PMID: 36211982 PMCID: PMC9541088 DOI: 10.3390/traumacare2040042] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023] Open
Abstract
Traumatic brain injury (TBI) is a devastating event with severe long-term complications. TBI and its sequelae are one of the leading causes of death and disability in those under 50 years old. The full extent of secondary brain injury is still being intensely investigated; however, it is now clear that neurotrauma can incite chronic neurodegenerative processes. Chronic traumatic encephalopathy, Parkinson's disease, and many other neurodegenerative syndromes have all been associated with a history of traumatic brain injury. The complex nature of these pathologies can make clinical assessment, diagnosis, and treatment challenging. The goal of this review is to provide a concise appraisal of the literature with focus on emerging strategies to improve clinical outcomes. First, we review the pathways involved in the pathogenesis of neurotrauma-related neurodegeneration and discuss the clinical implications of this rapidly evolving field. Next, because clinical evaluation and neuroimaging are essential to the diagnosis and management of neurodegenerative diseases, we analyze the clinical investigations that are transforming these areas of research. Finally, we briefly review some of the preclinical therapies that have shown the most promise in improving outcomes after neurotrauma.
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Affiliation(s)
- William S. Dodd
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Eric J. Panther
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kevin Pierre
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jairo S. Hernandez
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Devan Patel
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Alongi P, Laudicella R, Panasiti F, Stefano A, Comelli A, Giaccone P, Arnone A, Minutoli F, Quartuccio N, Cupidi C, Arnone G, Piccoli T, Grimaldi LME, Baldari S, Russo G. Radiomics Analysis of Brain [ 18F]FDG PET/CT to Predict Alzheimer's Disease in Patients with Amyloid PET Positivity: A Preliminary Report on the Application of SPM Cortical Segmentation, Pyradiomics and Machine-Learning Analysis. Diagnostics (Basel) 2022; 12:diagnostics12040933. [PMID: 35453981 PMCID: PMC9030037 DOI: 10.3390/diagnostics12040933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early in-vivo diagnosis of Alzheimer's disease (AD) is crucial for accurate management of patients, in particular, to select subjects with mild cognitive impairment (MCI) that may evolve into AD, and to define other types of MCI non-AD patients. The application of artificial intelligence to functional brain [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography(CT) aiming to increase diagnostic accuracy in the diagnosis of AD is still undetermined. In this field, we propose a radiomics analysis on advanced imaging segmentation method Statistical Parametric Mapping (SPM)-based completed with a Machine-Learning (ML) application to predict the diagnosis of AD, also by comparing the results with following Amyloid-PET and final clinical diagnosis. METHODS From July 2016 to September 2017, 43 patients underwent PET/CT scans with FDG and Florbetaben brain PET/CT and at least 24 months of clinical/instrumental follow-up. Patients were retrospectively evaluated by a multidisciplinary team (MDT = Neurologist, Psychologist, Radiologist, Nuclear Medicine Physician, Laboratory Clinic) at the G. Giglio Institute in Cefalù, Italy. Starting from the cerebral segmentations applied by SPM on the main cortical macro-areas of each patient, Pyradiomics was used for the feature extraction process; subsequently, an innovative descriptive-inferential mixed sequential approach and a machine learning algorithm (i.e., discriminant analysis) were used to obtain the best diagnostic performance in prediction of amyloid deposition and the final diagnosis of AD. RESULTS A total of 11 radiomics features significantly predictive of cortical beta-amyloid deposition (n = 6) and AD (n = 5) were found. Among them, two higher-order features (original_glcm_Idmn and original_glcm_Id), extracted from the limbic enthorinal cortical area (ROI-1) in the FDG-PET/CT images, predicted the positivity of Amyloid-PET/CT scans with maximum values of sensitivity (SS), specificity (SP), precision (PR) and accuracy (AC) of 84.92%, 75.13%, 73.75%, and 79.56%, respectively. Conversely, for the prediction of the clinical-instrumental final diagnosis of AD, the best performance was obtained by two higher-order features (original_glcm_MCC and original_glcm_Maximum Probability) extracted from ROI-2 (frontal cortex) with a SS, SP, PR and AC of 75.16%, 80.50%, 77.68%, and 78.05%, respectively, and by one higher-order feature (original_glcm_Idmn) extracted from ROI-3 (medial Temporal cortex; SS = 80.88%, SP = 76.85%, PR = 75.63%, AC = 78.76%. CONCLUSIONS The results obtained in this preliminary study support advanced segmentation of cortical areas typically involved in early AD on FDG PET/CT brain images, and radiomics analysis for the identification of specific high-order features to predict Amyloid deposition and final diagnosis of AD.
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Affiliation(s)
- Pierpaolo Alongi
- Nuclear Medicine Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, 90133 Palermo, Italy; (N.Q.); (G.A.)
- Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy;
- Correspondence:
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra Pisciotto, 90015 Cefalù, Italy;
- Department of Nuclear Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging Nuclear Medicine Unit, University of Messina, 98122 Messina, Italy; (F.P.); (F.M.); (S.B.)
- Ri.Med Foundation, Via Bandiera 11, 90133 Palermo, Italy; (A.C.); (P.G.)
| | - Francesco Panasiti
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging Nuclear Medicine Unit, University of Messina, 98122 Messina, Italy; (F.P.); (F.M.); (S.B.)
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (G.R.)
| | - Albert Comelli
- Ri.Med Foundation, Via Bandiera 11, 90133 Palermo, Italy; (A.C.); (P.G.)
| | - Paolo Giaccone
- Ri.Med Foundation, Via Bandiera 11, 90133 Palermo, Italy; (A.C.); (P.G.)
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Annachiara Arnone
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Fabio Minutoli
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging Nuclear Medicine Unit, University of Messina, 98122 Messina, Italy; (F.P.); (F.M.); (S.B.)
| | - Natale Quartuccio
- Nuclear Medicine Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, 90133 Palermo, Italy; (N.Q.); (G.A.)
| | - Chiara Cupidi
- Neurology Unit, Fondazione Istituto G. Giglio, 90015 Cefalù, Italy; (C.C.); (L.M.E.G.)
| | - Gaspare Arnone
- Nuclear Medicine Unit, ARNAS Ospedali Civico, Di Cristina e Benfratelli, 90133 Palermo, Italy; (N.Q.); (G.A.)
| | - Tommaso Piccoli
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90127 Palermo, Italy;
| | | | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging Nuclear Medicine Unit, University of Messina, 98122 Messina, Italy; (F.P.); (F.M.); (S.B.)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), 90015 Cefalù, Italy; (A.S.); (G.R.)
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Echlin HV, Rahimi A, Wojtowicz M. Systematic Review of the Long-Term Neuroimaging Correlates of Mild Traumatic Brain Injury and Repetitive Head Injuries. Front Neurol 2021; 12:726425. [PMID: 34659091 PMCID: PMC8514830 DOI: 10.3389/fneur.2021.726425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To systematically review the literature on the long-term neuroimaging findings (≥10 years from exposure) for exposure in adulthood to mild traumatic brain injury (mTBI) and repetitive head impacts (RHIs) using neuroimaging across all available populations. Data sources: Four electronic databases: MEDLINE, SPORTDiscus, PsycINFO, and EMBASE. Study selection: All articles were original research and published in English. Studies examined adults with remote exposure to mTBI and/or RHIs from ten or more years ago in addition to any associated neuroimaging findings. Data extraction: Parameters mainly included participants' population, age, years since head injury, race, sex, education level, and any neuroimaging findings. Scores for the level of evidence and risk of bias were calculated independently by two authors. Results: 5,521 studies were reviewed, of which 34 met inclusion criteria and were included in this study. The majority of adults in these studies showed positive neuroimaging findings one or more decades following mTBI/RHI exposure. This was consistent across study populations (i.e., veterans, athletes, and the general population). There was evidence for altered protein deposition patterns, micro- and macro-structural, functional, neurochemical, and blood flow-related differences in the brain for those with remote mTBI/RHI exposure. Conclusion: Findings from these studies suggest that past mTBI/RHI exposure may be associated with neuroimaging findings. However, given the methodological constraints related to relatively small sample sizes and the heterogeneity in injury types/exposure and imaging techniques used, conclusions drawn from this review are limited. Well-designed longitudinal studies with multimodal imaging and in-depth health and demographic information will be required to better understand the potential for having positive neuroimaging findings following remote mTBI/RHI.
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Sharma HS, Muresanu DF, Castellani RJ, Nozari A, Lafuente JV, Buzoianu AD, Sahib S, Tian ZR, Bryukhovetskiy I, Manzhulo I, Menon PK, Patnaik R, Wiklund L, Sharma A. Alzheimer's disease neuropathology is exacerbated following traumatic brain injury. Neuroprotection by co-administration of nanowired mesenchymal stem cells and cerebrolysin with monoclonal antibodies to amyloid beta peptide. PROGRESS IN BRAIN RESEARCH 2021; 265:1-97. [PMID: 34560919 DOI: 10.1016/bs.pbr.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Military personnel are prone to traumatic brain injury (TBI) that is one of the risk factors in developing Alzheimer's disease (AD) at a later stage. TBI induces breakdown of the blood-brain barrier (BBB) to serum proteins into the brain and leads to extravasation of plasma amyloid beta peptide (ΑβP) into the brain fluid compartments causing AD brain pathology. Thus, there is a need to expand our knowledge on the role of TBI in AD. In addition, exploration of the novel roles of nanomedicine in AD and TBI for neuroprotection is the need of the hour. Since stem cells and neurotrophic factors play important roles in TBI and in AD, it is likely that nanodelivery of these agents exert superior neuroprotection in TBI induced exacerbation of AD brain pathology. In this review, these aspects are examined in details based on our own investigations in the light of current scientific literature in the field. Our observations show that TBI exacerbates AD brain pathology and TiO2 nanowired delivery of mesenchymal stem cells together with cerebrolysin-a balanced composition of several neurotrophic factors and active peptide fragments, and monoclonal antibodies to amyloid beta protein thwarted the development of neuropathology following TBI in AD, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia; Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Igor Manzhulo
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia; Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Preeti K Menon
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Asken BM, Rabinovici GD. Identifying degenerative effects of repetitive head trauma with neuroimaging: a clinically-oriented review. Acta Neuropathol Commun 2021; 9:96. [PMID: 34022959 PMCID: PMC8141132 DOI: 10.1186/s40478-021-01197-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND SCOPE OF REVIEW Varying severities and frequencies of head trauma may result in dynamic acute and chronic pathophysiologic responses in the brain. Heightened attention to long-term effects of head trauma, particularly repetitive head trauma, has sparked recent efforts to identify neuroimaging biomarkers of underlying disease processes. Imaging modalities like structural magnetic resonance imaging (MRI) and positron emission tomography (PET) are the most clinically applicable given their use in neurodegenerative disease diagnosis and differentiation. In recent years, researchers have targeted repetitive head trauma cohorts in hopes of identifying in vivo biomarkers for underlying biologic changes that might ultimately improve diagnosis of chronic traumatic encephalopathy (CTE) in living persons. These populations most often include collision sport athletes (e.g., American football, boxing) and military veterans with repetitive low-level blast exposure. We provide a clinically-oriented review of neuroimaging data from repetitive head trauma cohorts based on structural MRI, FDG-PET, Aβ-PET, and tau-PET. We supplement the review with two patient reports of neuropathology-confirmed, clinically impaired adults with prior repetitive head trauma who underwent structural MRI, FDG-PET, Aβ-PET, and tau-PET in addition to comprehensive clinical examinations before death. REVIEW CONCLUSIONS Group-level comparisons to controls without known head trauma have revealed inconsistent regional volume differences, with possible propensity for medial temporal, limbic, and subcortical (thalamus, corpus callosum) structures. Greater frequency and severity (i.e., length) of cavum septum pellucidum (CSP) is observed in repetitive head trauma cohorts compared to unexposed controls. It remains unclear whether CSP predicts a particular neurodegenerative process, but CSP presence should increase suspicion that clinical impairment is at least partly attributable to the individual's head trauma exposure (regardless of underlying disease). PET imaging similarly has not revealed a prototypical metabolic or molecular pattern associated with repetitive head trauma or predictive of CTE based on the most widely studied radiotracers. Given the range of clinical syndromes and neurodegenerative pathologies observed in a subset of adults with prior repetitive head trauma, structural MRI and PET imaging may still be useful for differential diagnosis (e.g., assessing suspected Alzheimer's disease).
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Affiliation(s)
- Breton M. Asken
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
| | - Gil D. Rabinovici
- Departments of Neurology, Radiology & Biomedical Imaging, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, 675 Nelson Rising Lane, Suite 190, San Francisco, CA 94143 USA
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Pierre K, Dyson K, Dagra A, Williams E, Porche K, Lucke-Wold B. Chronic Traumatic Encephalopathy: Update on Current Clinical Diagnosis and Management. Biomedicines 2021; 9:biomedicines9040415. [PMID: 33921385 PMCID: PMC8069746 DOI: 10.3390/biomedicines9040415] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Chronic traumatic encephalopathy is a disease afflicting individuals exposed to repetitive neurotrauma. Unfortunately, diagnosis is made by postmortem pathologic analysis, and treatment options are primarily symptomatic. In this clinical update, we review clinical and pathologic diagnostic criteria and recommended symptomatic treatments. We also review animal models and recent discoveries from pre-clinical studies. Furthermore, we highlight the recent advances in diagnosis using diffusor tensor imaging, functional magnetic resonance imaging, positron emission tomography, and the fluid biomarkers t-tau, sTREM2, CCL11, NFL, and GFAP. We also provide an update on emerging pharmaceutical treatments, including immunotherapies and those that target tau acetylation, tau phosphorylation, and inflammation. Lastly, we highlight the current literature gaps and guide future directions to further improve clinical diagnosis and management of patients suffering from this condition.
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Affiliation(s)
- Kevin Pierre
- College of Medicine, University of Florida, Gainesville, FL 32611, USA; (K.P.); (K.D.); (A.D.); (E.W.)
| | - Kyle Dyson
- College of Medicine, University of Florida, Gainesville, FL 32611, USA; (K.P.); (K.D.); (A.D.); (E.W.)
| | - Abeer Dagra
- College of Medicine, University of Florida, Gainesville, FL 32611, USA; (K.P.); (K.D.); (A.D.); (E.W.)
| | - Eric Williams
- College of Medicine, University of Florida, Gainesville, FL 32611, USA; (K.P.); (K.D.); (A.D.); (E.W.)
| | - Ken Porche
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA;
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA;
- Correspondence:
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Marklund N, Vedung F, Lubberink M, Tegner Y, Johansson J, Blennow K, Zetterberg H, Fahlström M, Haller S, Stenson S, Larsson EM, Wall A, Antoni G. Tau aggregation and increased neuroinflammation in athletes after sports-related concussions and in traumatic brain injury patients - A PET/MR study. NEUROIMAGE-CLINICAL 2021; 30:102665. [PMID: 33894460 PMCID: PMC8091173 DOI: 10.1016/j.nicl.2021.102665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/11/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) leads to axonal injury and an inflammatory response. Repeated sports-related concussions (rSRC) are linked to neurodegeneration. We studied tau aggregation and neuroinflammation in rSRC and TBI using PET/MRI. In young rSRC and TBI patients, tau aggregation and neuroinflammation was increased. PET useful when studying the long-term consequences of rSRC and TBI.
Traumatic brain injury (TBI) and repeated sports-related concussions (rSRCs) are associated with an increased risk for neurodegeneration. Autopsy findings of selected cohorts of long-term TBI survivors and rSRC athletes reveal increased tau aggregation and a persistent neuroinflammation. To assess in vivo tau aggregation and neuroinflammation in young adult TBI and rSRC cohorts, we evaluated 9 healthy controls (mean age 26 ± 5 years; 4 males, 5 females), 12 symptomatic athletes (26 ± 7 years; 6 males, 6 females) attaining ≥3 previous SRCs, and 6 moderate-to severe TBI patients (27 ± 7 years; 4 males, 2 females) in a combined positron emission tomography (PET)/magnetic resonance (MR) scanner ≥6 months post-injury. Dual PET tracers, [18F]THK5317 for tau aggregation and [11C]PK11195 for neuroinflammation/microglial activation, were investigated on the same day. The Repeated Battery Assessment of Neurological Status (RBANS) scores, used for cognitive evaluation, were lower in both the rSRC and TBI groups (p < 0.05). Neurofilament-light (NF-L) levels were increased in plasma and cerebrospinal fluid (CSF; p < 0.05), and serum tau levels lower, in TBI although not in rSRC. In rSRC athletes, PET imaging showed increased neuroinflammation in the hippocampus and tau aggregation in the corpus callosum. In TBI patients, tau aggregation was observed in thalami, temporal white matter and midbrain; widespread neuroinflammation was found e.g. in temporal white matter, hippocampus and corpus callosum. In mixed-sex cohorts of young adult athletes with persistent post-concussion symptoms and in TBI patients, increased tau aggregation and neuroinflammation are observed at ≥6 months post-injury using PET. Studies with extended clinical follow-up, biomarker examinations and renewed PET imaging are needed to evaluate whether these findings progress to a neurodegenerative disorder or if spontaneous resolution is possible.
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Affiliation(s)
- Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden; Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden.
| | - Fredrik Vedung
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Sweden
| | - Jakob Johansson
- Department of Surgical Sciences, Anesthesiology, Uppsala University, Sweden
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; UK Dementia Research Institute at UCL, London, United Kingdom; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Sven Haller
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden; CIMC - Centre d'Imagerie Médicale de Cornavin, Place de Cornavin 18, 1201 Genève, Switzerland
| | - Staffan Stenson
- Department of Neuroscience, Rehabilitation Medicine PET Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Anders Wall
- Department of Surgical Sciences, Nuclear Medicine and PET, Uppsala University, Sweden; Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
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The Relations Among Depression, Cognition, and Brain Volume in Professional Boxers: A Preliminary Examination Using Brief Clinical Measures. J Head Trauma Rehabil 2020; 34:E29-E39. [PMID: 31033751 DOI: 10.1097/htr.0000000000000495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression, neuropathology, and cognitive decline are commonly observed with repetitive head injuries (RHIs). We examined whether in boxers (a) clinically significant depression is associated with structural brain changes and cognition; (b) minimal symptoms of depression moderate the relations among RHI and brain volumes and cognition; and (c) baseline depression is associated with longitudinal cognitive changes. SETTING Clinical Research Center. PARTICIPANTS A total of 205 male professional boxers. DESIGN Cross-sectional and longitudinal (subsample: n = 45; first visit to follow-up range = 1-6 years; mean = 2.61 years). MAIN MEASURES Patient Health Questionnaire-9 depression; CNS Vital Signs cognitive battery; brain imaging. RESULTS Clinically significant depression was associated with smaller regional volumes in insula, cingulate, orbitofrontal cortex, thalami, and middle corpus-callosum subregions; and with poorer verbal memory and psychomotor speed performance. Depression symptoms moderated the relations between RHI and bilateral thalami, left hippocampus, left medial orbitofrontal cortex, and bilateral insula volumes; but not cognition. Baseline depression was associated with poorer psychomotor speed and reaction time longitudinally and improved verbal memory performance longitudinally. CONCLUSION Clinical depression is associated with volumetric and cognitive changes occasioning RHI exposure, and even minimal depressive symptoms may moderate the relations between exposure and brain volumes in key regions. Longitudinally, there is preliminary evidence that depression precedes cognitive changes.
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Edwards KA, Leete JJ, Tschiffely AE, Moore CY, Dell KC, Statz JK, Carr W, Walker PB, LoPresti ML, Ahlers ST, Yarnell AM, Gill J. Blast exposure results in tau and neurofilament light chain changes in peripheral blood. Brain Inj 2020; 34:1213-1221. [DOI: 10.1080/02699052.2020.1797171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Katie A. Edwards
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Henry M. Jackson Foundation, Bethesda, MD, USA
| | - Jacqueline J. Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Anna E. Tschiffely
- Department of Neurotrauma, Naval Medical Research Center, Silver Spring, MD, USA
| | - Candace Y. Moore
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - Kristine C. Dell
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Jonathan K. Statz
- Henry M. Jackson Foundation, Bethesda, MD, USA
- Department of Neurotrauma, Naval Medical Research Center, Silver Spring, MD, USA
| | - Walter Carr
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Peter B. Walker
- Joint Artificial Intelligence Center, Arlington, VA, USA
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
- Military Emergency Medicine Department, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Matthew L. LoPresti
- Center for Military Psychiatry & Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Stephen T. Ahlers
- Operational & Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Angela M. Yarnell
- Operational & Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Jessica Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Bryant BR, Narapareddy BR, Bray MJC, Richey LN, Krieg A, Shan G, Peters ME, Bernick CB. The effect of age of first exposure to competitive fighting on cognitive and other neuropsychiatric symptoms and brain volume. Int Rev Psychiatry 2020; 32:89-95. [PMID: 31587599 DOI: 10.1080/09540261.2019.1665501] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It has long been established that fighting sports such as boxing and mixed martial arts can lead to head injury. Prior work from this group on the Professional Fighters Brain Health Study found that exposure to repetitive head impacts is associated with lower brain volumes and decreased processing speed in fighters. Current and previously licensed professional fighters were recruited, divided into active and retired cohorts, and matched with a control group that had no prior experience in sports with likely head trauma. This study examined the relationship between age of first exposure (AFE) to fighting sports and brain structure (MRI regional volume), cognitive performance (CNS Vital Signs, iComet C3), and clinical neuropsychiatric symptoms (PHQ-9, Barratt Impulsiveness Scale). Brain MRI data showed significant correlations between earlier AFE and smaller bilateral hippocampal and posterior corpus callosum volumes for both retired and active fighters. Earlier AFE in active fighters was correlated with decreased processing speed and decreased psychomotor speed. Retired fighters showed a correlation between earlier AFE and higher measures of depression and impulsivity. Overall, the results help to inform clinicians, governing bodies, parents, and athletes of the risks associated with beginning to compete in fighting sports at a young age.
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Affiliation(s)
- Barry R Bryant
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J C Bray
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa N Richey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Akshay Krieg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guogen Shan
- Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Matthew E Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles B Bernick
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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Filley CM, Arciniegas DB, Brenner LA, Anderson CA, Kelly JP. Chronic Traumatic Encephalopathy: A Clinical Perspective. J Neuropsychiatry Clin Neurosci 2019; 31:170-172. [PMID: 31012827 DOI: 10.1176/appi.neuropsych.18100223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Christopher M Filley
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - David B Arciniegas
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - Lisa A Brenner
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - C Alan Anderson
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
| | - James P Kelly
- From the Departments of Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly); the Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, Colo. (Filley, Arciniegas, Anderson, Kelly); and Rocky Mountain Mental Illness, Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Marcus Institute for Brain Health, Aurora, Colo. (Filley, Arciniegas, Brenner, Anderson, Kelly)
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[ 18F]-AV-1451 binding profile in chronic traumatic encephalopathy: a postmortem case series. Acta Neuropathol Commun 2019; 7:164. [PMID: 31661038 PMCID: PMC6816221 DOI: 10.1186/s40478-019-0808-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/08/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Chronic traumatic encephalopathy (CTE) is a tauopathy associated to repetitive head trauma. There are no validated in vivo biomarkers of CTE and a definite diagnosis can only be made at autopsy. Recent studies have shown that positron emission tomography (PET) tracer AV-1451 (Flortaucipir) exhibits high binding affinity for paired helical filament (PHF)-tau aggregates in Alzheimer (AD) brains but relatively low affinity for tau lesions in other tauopathies like temporal lobal degeneration (FTLD)-tau, progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD). Little is known, however, about the binding profile of this ligand to the tau-containing lesions of CTE. OBJECTIVE To study the binding properties of [18F]-AV-1451 on pathologically confirmed CTE postmortem brain tissue samples. METHODS We performed [18F]-AV-1451 phosphor screen and high resolution autoradiography, quantitative tau measurements by immunohistochemistry and Western blot and tau seeding activity assays in brain blocks containing hippocampus, superior temporal cortex, superior frontal cortex, inferior parietal cortex and occipital cortex from 5 cases of CTE, across the stages of disease: stage II-III (n = 1), stage III (n = 3), and stage IV (n = 1). Importantly, low or no concomitant classic AD pathology was present in these brains. RESULTS Despite the presence of abundant tau aggregates in multiple regions in all CTE brains, only faint or no [18F]-AV-1451 binding signal could be detected by autoradiography. The only exception was the presence of a strong signal confined to the region of the choroid plexus and the meninges in two of the five cases. Tau immunostaining and Thioflavin-S staining ruled out the presence of tau aggregates in those regions. High resolution nuclear emulsion autoradiography revealed the presence of leptomeningeal melanocytes as the histologic source of this off-target binding. Levels of abnormally hyperphosphorylated tau species, as detected by Western Blotting, and tau seeding activity were both found to be lower in extracts from cases CTE when compared to AD. CONCLUSION AV-1451 may have limited utility for in vivo selective and reliable detection of tau aggregates in CTE. The existence of disease-specific tau conformations may likely explain the differential binding affinity of this tracer for tau lesions in different tauopathies.
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Dallmeier JD, Meysami S, Merrill DA, Raji CA. Emerging advances of in vivo detection of chronic traumatic encephalopathy and traumatic brain injury. Br J Radiol 2019; 92:20180925. [PMID: 31287716 PMCID: PMC6732918 DOI: 10.1259/bjr.20180925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 07/04/2019] [Accepted: 07/07/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder that is of epidemic proportions in contact sports athletes and is linked to subconcussive and concussive repetitive head impacts (RHI). Although postmortem analysis is currently the only confirmatory method to diagnose CTE, there has been progress in early detection techniques of fluid biomarkers as well as in advanced neuroimaging techniques. Specifically, promising new methods of diffusion MRI and radionucleotide PET scans could aid in the early detection of CTE.The authors examine early detection methods focusing on various neuroimaging techniques. Advances in structural and diffusion MRI have demonstrated the ability to measure volumetric and white matter abnormalities associated with CTE. Recent studies using radionucleotides such as flortaucipir and 18F-FDDNP have shown binding patterns that are consistent with the four stages of neurofibrillary tangle (NFT) distribution postmortem. Additional research undertakings focusing on fMRI, MR spectroscopy, susceptibility-weighted imaging, and singlephoton emission CT are also discussed as are advanced MRI methods such as diffusiontensor imaging and arterial spin labeled. Neuroimaging is fast becoming a key instrument in early detection and could prove essential for CTE quantification. This review explores a global approach to in vivo early detection.Limited data of in vivo CTE biomarkers with postmortem confirmation are available. While some data exist, they are limited by selection bias. It is unlikely that a single test will be sufficient to properly diagnosis and distinguish CTE from other neurodegenerative diseases such as Alzheimer disease or Frontotemporal Dementia. However, with a combination of fluid biomarkers, neuroimaging, and genetic testing, early detection may become possible.
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Affiliation(s)
- Julian D. Dallmeier
- Department of Neuroscience, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - Somayeh Meysami
- Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - David A. Merrill
- Psychiatry and Biobehavioral Sciences and Pacific Brain Health Center, UCLA and Pacific Neuroscience Institute, Los Angeles, California, United States
| | - Cyrus A. Raji
- Radiology, Washington University Mallinckrodt Institute of Radiology, St. Louis, Missouri, United States
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Srivastava AK, Pittman JM, Zerweck J, Venkata BS, Moore PC, Sachleben JR, Meredith SC. β-Amyloid aggregation and heterogeneous nucleation. Protein Sci 2019; 28:1567-1581. [PMID: 31276610 PMCID: PMC6699094 DOI: 10.1002/pro.3674] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/26/2019] [Accepted: 07/03/2019] [Indexed: 01/09/2023]
Abstract
In this article, we consider the role of heterogeneous nucleation in β-amyloid aggregation. Heterogeneous nucleation is more common and occurs at lower levels of supersaturation than homogeneous nucleation. The nucleation period is also the stage at which most of the polymorphism of amyloids arises, this being one of the defining features of amyloids. We focus on several well-known heterogeneous nucleators of β-amyloid, including lipid surfaces, especially those enriched in gangliosides and cholesterol, and divalent metal ions. These two broad classes of nucleators affect β-amyloid particularly in light of the amphiphilicity of these peptides: the N-terminal region, which is largely polar and charged, contains the metal binding site, whereas the C-terminal region is aliphatic and is important in lipid binding. Notably, these two classes of nucleators can interact cooperatively, aggregation begetting greater aggregation.
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Affiliation(s)
- Atul K. Srivastava
- Department of PathologyThe University of ChicagoChicagoIllinois
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIllinois
| | - Jay M. Pittman
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIllinois
| | - Jonathan Zerweck
- Department of PathologyThe University of ChicagoChicagoIllinois
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIllinois
| | - Bharat S. Venkata
- Department of PathologyThe University of ChicagoChicagoIllinois
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIllinois
| | | | | | - Stephen C. Meredith
- Department of PathologyThe University of ChicagoChicagoIllinois
- Department of Biochemistry and Molecular BiologyThe University of ChicagoChicagoIllinois
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Tang Y, Liu HL, Min LX, Yuan HS, Guo L, Han PB, Lu YX, Zhong JF, Wang DL. Serum and cerebrospinal fluid tau protein level as biomarkers for evaluating acute spinal cord injury severity and motor function outcome. Neural Regen Res 2019; 14:896-902. [PMID: 30688276 PMCID: PMC6375043 DOI: 10.4103/1673-5374.249238] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promising biomarker to reflect the degree of spinal cord injury and prognosis of motor function. In this study, 160 female Sprague-Dawley rats were randomly divided into a sham group, and mild, moderate, and severe spinal cord injury groups. A laminectomy was performed at the T8 level to expose the spinal cord in all groups. A contusion lesion was made with the NYU-MASCIS impactor by dropping a 10 g rod from heights of 12.5 mm (mild), 25 mm (moderate) and 50 mm (severe) upon the exposed dorsal surface of the spinal cord. Tau protein levels were measured in serum and cerebrospinal fluid samples at 1, 6, 12, 24 hours, 3, 7, 14 and 28 days after operation. Locomotor function of all rats was assessed using the Basso, Beattie and Bresnahan locomotor rating scale. Tau protein concentration in the three spinal cord injury groups (both in serum and cerebrospinal fluid) rapidly increased and peaked at 12 hours after spinal cord injury. Statistically significant positive linear correlations were found between tau protein level and spinal cord injury severity in the three spinal cord injury groups, and between the tau protein level and Basso, Beattie, and Bresnahan locomotor rating scale scores. The tau protein level at 12 hours in the three spinal cord injury groups was negatively correlated with Basso, Beattie, and Bresnahan locomotor rating scale scores at 28 days (serum: r = −0.94; cerebrospinal fluid: r = −0.95). Our data suggest that tau protein levels in serum and cerebrospinal fluid might be a promising biomarker for predicting the severity and functional outcome of traumatic spinal cord injury.
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Affiliation(s)
- Ying Tang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Hong-Liang Liu
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ling-Xia Min
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hao-Shi Yuan
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Lei Guo
- Department of Orthopedics, Chinese PLA Beijing Army General Hospital, Beijing, China
| | - Peng-Bo Han
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Yu-Xin Lu
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Jian-Feng Zhong
- Department of Spine Surgery, Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shanxi Province, China
| | - Dong-Lin Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
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Tharmaratnam T, Iskandar MA, Tabobondung TC, Tobbia I, Gopee-Ramanan P, Tabobondung TA. Chronic Traumatic Encephalopathy in Professional American Football Players: Where Are We Now? Front Neurol 2018; 9:445. [PMID: 29971037 PMCID: PMC6018081 DOI: 10.3389/fneur.2018.00445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/28/2018] [Indexed: 12/14/2022] Open
Abstract
Repetitive head trauma provides a favorable milieu for the onset of inflammatory and neurodegenerative processes. The result of long-lasting head trauma is chronic traumatic encephalopathy (CTE), a disease process well-recognized in boxers, military personnel, and more recently, in American football players. CTE is a chronic neurodegenerative disease with hallmarks of hyperphosphorylated tau (p-tau) aggregates and intercellular lesions of neurofibrillary tangles. The criteria for CTE diagnosis requires at least 1-2 focal perivascular lesions of p-tau in the cerebral cortex, at the depth of the sulci. These pathognomonic lesions aggregate within neurons and glial cells such as astrocytes, and cell processes within the vicinity of small blood vessels. CTE presents in a distinct topographical distribution pattern compared to other tauopathies such as AD and other age-related astrogliopathies. CTE also has an insidious onset, years after repetitive head trauma. The disease course of CTE is characterized by cognitive dysfunction, behavioral changes, and can progress to altered motor function with parkinsonian-like manifestations in later stages. This short review aims to summarize CTE in professional football, epidemiology, diagnosis based on neuroanatomical abnormalities, cognitive degeneration, and adverse mental health effects, as well as gaps in the literature and future directions in diagnostics, therapeutics, and preventive measures.
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Affiliation(s)
- Tharmegan Tharmaratnam
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Al Muharraq, Bahrain
| | - Mina A. Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tyler C. Tabobondung
- Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Brantford General Hospital, Hamilton, ON, Canada
| | - Iqdam Tobbia
- Department of Pathology and Clinical Microbiology, School of Medicine, Royal College of Surgeons in Ireland-Bahrain, Adliya, Bahrain
| | - Prasaanthan Gopee-Ramanan
- Hamilton Health Sciences Centre, Department of Radiology, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Taylor A. Tabobondung
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON, Canada
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