1
|
Mokbel AY, Burns MP, Main BS. The contribution of the meningeal immune interface to neuroinflammation in traumatic brain injury. J Neuroinflammation 2024; 21:135. [PMID: 38802931 PMCID: PMC11131220 DOI: 10.1186/s12974-024-03122-7] [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: 02/17/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide, particularly among the elderly, yet our mechanistic understanding of what renders the post-traumatic brain vulnerable to poor outcomes, and susceptible to neurological disease, is incomplete. It is well established that dysregulated and sustained immune responses elicit negative consequences after TBI; however, our understanding of the neuroimmune interface that facilitates crosstalk between central and peripheral immune reservoirs is in its infancy. The meninges serve as the interface between the brain and the immune system, facilitating important bi-directional roles in both healthy and disease settings. It has been previously shown that disruption of this system exacerbates neuroinflammation in age-related neurodegenerative disorders such as Alzheimer's disease; however, we have an incomplete understanding of how the meningeal compartment influences immune responses after TBI. In this manuscript, we will offer a detailed overview of the holistic nature of neuroinflammatory responses in TBI, including hallmark features observed across clinical and animal models. We will highlight the structure and function of the meningeal lymphatic system, including its role in immuno-surveillance and immune responses within the meninges and the brain. We will provide a comprehensive update on our current knowledge of meningeal-derived responses across the spectrum of TBI, and identify new avenues for neuroimmune modulation within the neurotrauma field.
Collapse
Affiliation(s)
- Alaa Y Mokbel
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA
| | - Mark P Burns
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA
| | - Bevan S Main
- Department of Neuroscience, Georgetown University Medical Center, New Research Building-EG11, 3970 Reservoir Rd, NW, Washington, DC, 20057, USA.
| |
Collapse
|
2
|
Smith AM, Taylor EB, Brooks RJ, Dos Santos e Santos C, Grayson BE. Cerebral and Peripheral Immune Cell Changes following Rodent Juvenile Traumatic Brain Injury. Brain Sci 2024; 14:398. [PMID: 38672047 PMCID: PMC11048136 DOI: 10.3390/brainsci14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of death and disability. TBI is associated with neuroinflammation, but temporal changes in immune and inflammatory signaling following TBI have not been fully elucidated. Furthermore, there have been no previous studies on changes in immune cell populations following TBI via the Closed Head Injury Model of Engineered Rotational Acceleration (CHIMERA). The current study aimed to determine the time course changes to inflammatory marker mRNA expression in the acute period following TBI in juvenile rats and to determine acute changes to brain and circulating immune cell populations. For this study, post-natal day (PND)-30 male Long Evans rats sustained a TBI or Sham TBI and were euthanized at 0, 3, 6, 12, 24, or 96 h post-injury. Prefrontal cortex and hippocampus samples were used to determine mRNA expression changes of inflammatory factors. The mRNA expression of the pro-inflammatory cytokine TNF-α was significantly elevated at 6 h post-injury in both regions evaluated. To evaluate immune cell populations, male Long Evans rats were euthanized at 48 h post-injury, and brain and blood samples were used for cell sorting by marker-specific antibodies. In the peripheral blood, there was an elevation in CD3+ total T cells, CD45R+ total B cells, and CD3+CD4+ helper T cells in the TBI subjects. However, there were no changes to natural killer cells or CD3+CD8+ cytotoxic T cell populations. In the brain, there was a reduction in CD11b/c+ monocytes/macrophages, but no changes in other immune cell populations. At 48 h post-injury, the TBI subjects also demonstrated expansion of the thymic medulla. These changes in the cerebral and blood immune cell populations and thymic medulla expansion may implicate the subacute recovery timeframe as a vulnerable window for the immune system in the pediatric population.
Collapse
Affiliation(s)
- Allie M. Smith
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.S.); (R.J.B.); (C.D.S.e.S.)
| | - Erin B. Taylor
- Department Physiology and Biophysics Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Ruth J. Brooks
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.S.); (R.J.B.); (C.D.S.e.S.)
| | - Christiano Dos Santos e Santos
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.S.); (R.J.B.); (C.D.S.e.S.)
| | - Bernadette E. Grayson
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (A.M.S.); (R.J.B.); (C.D.S.e.S.)
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| |
Collapse
|
3
|
Ryan AK, Rahman S, Williams RM. An optical aptamer-based cytokine nanosensor detects macrophage activation by bacterial toxins. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.05.588290. [PMID: 38617274 PMCID: PMC11014583 DOI: 10.1101/2024.04.05.588290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Overactive or dysregulated cytokine expression is hallmark of many acute and chronic inflammatory diseases. This is true for acute or chronic infection, neurodegenerative diseases, autoimmune diseases, cardiovascular disease, cancer, and others. Cytokines such as interleukin-6 (IL-6) are known therapeutic targets and biomarkers for such inflammatory diseases. Platforms for cytokine detection are therefore desirable tools for both research and clinical applications. Single-walled carbon nanotubes (SWCNT) are versatile nanomaterials with near-infrared fluorescence that can serve as transducers for optical sensors. When functionalized with an analyte-specific recognition element, SWCNT emission may become sensitive and selective towards the desired target. SWCNT-aptamer sensors are easily assembled, inexpensive, and biocompatible. In this work, we introduced a nanosensor design based on SWCNT and a DNA aptamer specific to IL-6. We first evaluated several SWCNT-aptamer constructs based on this simple direct complexation method, wherein the aptamer both solubilizes the SWCNT and confers sensitivity to IL-6. The sensor limit of detection, 105 ng/mL, lies in the relevant range for pathological IL-6 levels. Upon investigation of sensor kinetics, we found rapid response within seconds of antigen addition which continued over the course of three hours. We found that this sensor construct is stable, and the aptamer is not displaced from the nanotube surface during IL-6 detection. Finally, we investigated the ability of this sensor construct to detect macrophage activation caused by bacterial lipopolysaccharides (LPS) in an in vitro model of disease, finding rapid and sensitive detection of macrophage-expressed IL-6. We are confident further development of this sensor will have novel implications for diagnosis of acute and chronic inflammatory diseases, in addition to contributing to the understanding of the role of cytokines in these diseases.
Collapse
Affiliation(s)
- Amelia K. Ryan
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031
| | - Syeda Rahman
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031
| | - Ryan M. Williams
- The City College of New York, Department of Biomedical Engineering, New York, NY 10031
- PhD Program in Chemistry, Graduate Center, City University of New York, New York, NY 10016
| |
Collapse
|
4
|
Hennigan K, Lavik E. Nature vs. Manmade: Comparing Exosomes and Liposomes for Traumatic Brain Injury. AAPS J 2023; 25:83. [PMID: 37610471 DOI: 10.1208/s12248-023-00849-8] [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: 03/30/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Traumatic brain injury (TBI) of all severities is a significant public health burden, causing a range of effects that can lead to death or a diminished quality of life. Liposomes and mesenchymal stem cell-derived exosomes are two drug delivery agents with potential to be leveraged in the treatment of TBI by increasing the efficacy of drug therapies as well as having additional therapeutic effects. They exhibit several physical similarities, but key differences affect their performances as nanocarriers. Liposomes can be produced commercially at scale, and liposomes achieve higher encapsulation efficiency. Meanwhile, the intrinsic cargo and targeting moieties of exosomes, which liposomes lack, give exosomes a greater ability to facilitate neural regeneration, and exosomes do not trigger the infusion reactions that liposomes can. However, there are concerns about both exosomes and liposomes regarding interactions with tumors. The same routes of administration can be used for both exosomes and liposomes, resulting in somewhat different distribution throughout the body. While the effect of the nanocarrier type on accumulation in the brain is not concrete, targeting leads to increased accumulation of both exosomes and liposomes in the brain, upon which on-demand release can be used for both drug deliverers. Although neither have been applied to TBI in humans, preclinical trials have shown their immense potential, as have clinical trials pertaining to other brain injuries and conditions. While questions remain, research thus far shows that the various differences make exosomes a better choice of nanocarrier for TBI.
Collapse
Affiliation(s)
- Kate Hennigan
- Marriotts Ridge High School, Ellicott City, Maryland, 21042, USA
| | - Erin Lavik
- University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, Maryland, 21250, USA.
| |
Collapse
|
5
|
Tsitsipanis C, Miliaraki M, Paflioti E, Lazarioti S, Moustakis N, Ntotsikas K, Theofanopoulos A, Ilia S, Vakis A, Simos P, Venihaki M. Inflammation biomarkers IL‑6 and IL‑10 may improve the diagnostic and prognostic accuracy of currently authorized traumatic brain injury tools. Exp Ther Med 2023; 26:364. [PMID: 37408863 PMCID: PMC10318605 DOI: 10.3892/etm.2023.12063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/04/2023] [Indexed: 07/07/2023] Open
Abstract
Traumatic brain injury (TBI) is currently one of the leading causes of mortality and disability worldwide. At present, no reliable inflammatory or specific molecular neurobiomarker exists in any of the standard models proposed for TBI classification or prognostication. Therefore, the present study was designed to assess the value of a group of inflammatory mediators for evaluating acute TBI, in combination with clinical, laboratory and radiological indices and prognostic clinical scales. In the present single-centre, prospective observational study, 109 adult patients with TBI, 20 adult healthy controls and a pilot group of 17 paediatric patients with TBI from a Neurosurgical Department and two intensive care units of University General Hospital of Heraklion, Greece were recruited. Blood measurements using the ELISA method, of cytokines IL-6, IL-8 and IL-10, ubiquitin C-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein, were performed. Compared with those in healthy control individuals, elevated IL-6 and IL-10 but reduced levels of IL-8 were found on day 1 in adult patients with TBI. In terms of TBI severity classifications, higher levels of IL-6 (P=0.001) and IL-10 (P=0.009) on day 1 in the adult group were found to be associated with more severe TBI according to widely used clinical and functional scales. Moreover, elevated IL-6 and IL-10 in adults were found to be associated with more serious brain imaging findings (rs<0.442; P<0.007). Subsequent multivariate logistic regression analysis in adults revealed that early-measured (day 1) IL-6 [odds ratio (OR)=0.987; P=0.025] and UCH-L1 (OR=0.993; P=0.032) are significant independent predictors of an unfavourable outcome. In conclusion, results from the present study suggest that inflammatory molecular biomarkers may prove to be valuable diagnostic and prognostic tools for TBI.
Collapse
Affiliation(s)
- Christos Tsitsipanis
- Department of Neurosurgery, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Marianna Miliaraki
- Pediatric Intensive Care Unit, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Elina Paflioti
- Department of Clinical Chemistry, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Sofia Lazarioti
- Department of Neurosurgery, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Nikolaos Moustakis
- Department of Neurosurgery, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Konstantinos Ntotsikas
- Department of Neurosurgery, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | | | - Stavroula Ilia
- Pediatric Intensive Care Unit, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Antonis Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Maria Venihaki
- Department of Clinical Chemistry, School of Medicine, University of Crete, 70013 Heraklion, Greece
| |
Collapse
|
6
|
Wang D, Wang S, Zhu Q, Shen Z, Yang G, Chen Y, Luo C, Du Y, Hu Y, Wang W, Yang J. Prospects for Nerve Regeneration and Gene Therapy in the Treatment of Traumatic Brain Injury. J Mol Neurosci 2023; 73:578-586. [PMID: 37458921 DOI: 10.1007/s12031-023-02144-9] [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: 05/26/2023] [Accepted: 07/12/2023] [Indexed: 09/24/2023]
Abstract
Traumatic brain injury (TBI) is a prevalent neurological disorder and a leading cause of death and disability worldwide. The high mortality rates result in a tremendous burden on society and families in terms of public health and economic costs. Despite advances in biomedical research, treatment options for TBI still remain limited, and there is no effective therapy to restore the structure and function of the injured brain. Regrettably, due to the excessive heterogeneity of TBI and the lack of objective and reliable efficacy evaluation indicators, no proven therapeutic drugs or drugs with clear benefits on functional outcomes have been successfully developed to date. Therefore, it is urgent to explore new therapeutic approaches to protect or regenerate the injured brain from different perspectives. In this review, we first provide a brief overview of the causes and current status of TBI and then summarize the preclinical and clinical research status of cutting-edge treatment methods, including nerve regeneration therapy and gene therapy, with the aim of providing valuable references for effective therapeutic strategies for TBI.
Collapse
Affiliation(s)
- Daliang Wang
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Shengguo Wang
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Qunchao Zhu
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Zhe Shen
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Guohuan Yang
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Yanfei Chen
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Chen Luo
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Yanglin Du
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China
| | - Yelang Hu
- Biological Medicine Research and Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, Zhejiang, China
| | - Wenmin Wang
- Biological Medicine Research and Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, Zhejiang, China
| | - Jie Yang
- Department of Critical Care Medicine, The First People Hospital of Jiashan, Jiaxing, 314199, Zhejiang, China.
| |
Collapse
|
7
|
Doğanyiğit Z, Erbakan K, Akyuz E, Polat AK, Arulsamy A, Shaikh MF. The Role of Neuroinflammatory Mediators in the Pathogenesis of Traumatic Brain Injury: A Narrative Review. ACS Chem Neurosci 2022; 13:1835-1848. [PMID: 35732021 DOI: 10.1021/acschemneuro.2c00196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Traumatic brain injury (TBI) is a debilitating acquired neurological disorder that afflicts nearly 74 million people worldwide annually. TBI has been classified as more than just a single insult because of its associated risk toward various long-term neurological and neurodegenerative disorders. This risk may be triggered by a series of postinjury secondary molecular and cellular pathology, which may be dependent on the severity of the TBI. Among the secondary injury mechanisms, neuroinflammation may be the most crucial as it may exacerbate brain damage and lead to fatal consequences when prolonged. This Review aimed to elucidate the influence of neuroinflammatory mediators on the TBI functional and pathological outcomes, particularly focusing on inflammatory cytokines which were associated with neuronal dysfunctions in the acute and chronic stages of TBI. These cytokines include interleukins (IL) such as IL-1(beta)β, IL-4, IL-6, IL8, IL-10, IL-18, IL-33 and tumor necrosis factor alpha (TNF-α), which have been extensively studied. Apart from these, IL-2, interferon gamma (IFN-γ), and transforming growth factor-beta (TGF-β) may also play a significant role in the pathogenesis of TBI. These neuroinflammatory mediators may trigger a series of pathological events such as cell death, microglial suppression, and increased catecholaminergic activity. Interestingly, in the acute phase of TBI, most of these mediators may also play a neuroprotective role by displaying anti-inflammatory properties, which may convert to a pro-inflammatory action in the chronic stages post TBI. Early identification and treatment of these mediators may help the development of more effective treatment options for TBI.
Collapse
Affiliation(s)
- Züleyha Doğanyiğit
- Department of Histology and Embryology, Faculty of Medicine, Yozgat Bozok University, Yozgat 66100, Turkey
| | - Kaan Erbakan
- Ordu University, Faculty of Medicine, Ordu 52200, Turkey
| | - Enes Akyuz
- University of Health Sciences, Hamidiye International Faculty of Medicine, Department of Biophysics, Istanbul 34668, Turkey
| | | | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia
| |
Collapse
|
8
|
Ooi SZY, Spencer RJ, Hodgson M, Mehta S, Phillips NL, Preest G, Manivannan S, Wise MP, Galea J, Zaben M. Interleukin-6 as a prognostic biomarker of clinical outcomes after traumatic brain injury: a systematic review. Neurosurg Rev 2022; 45:3035-3054. [PMID: 35790656 PMCID: PMC9256073 DOI: 10.1007/s10143-022-01827-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/12/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. There are currently no early biomarkers for prognosis in routine clinical use. Interleukin-6 (IL-6) is a potential biomarker in the context of the established role of neuroinflammation in TBI recovery. Therefore, a systematic review of the literature was performed to assess and summarise the evidence for IL-6 secretion representing a useful biomarker for clinical outcomes. A multi-database literature search between January 1946 and July 2021 was performed. Studies were included if they reported adult TBI patients with IL-6 concentration in serum, cerebrospinal fluid (CSF) and/or brain parenchyma analysed with respect to functional outcome and/or mortality. A synthesis without meta-analysis is reported. Fifteen studies were included, reporting 699 patients. Most patients were male (71.7%), and the pooled mean age was 40.8 years; 78.1% sustained severe TBI. Eleven studies reported IL-6 levels in serum, six in CSF and one in the parenchyma. Five studies on serum demonstrated higher IL-6 concentrations were associated with poorer outcomes, and five showed no signification association. In CSF studies, one found higher IL-6 levels were associated with poorer outcomes, one found them to predict better outcomes and three found no association. Greater parenchymal IL-6 was associated with better outcomes. Despite some inconsistency in findings, it appears that exaggerated IL-6 secretion predicts poor outcomes after TBI. Future efforts require standardisation of IL-6 measurement practices as well as assessment of the importance of IL-6 concentration dynamics with respect to clinical outcomes, ideally within large prospective studies. Prospero registration number: CRD42021271200
Collapse
Affiliation(s)
| | - Robert James Spencer
- Brain Research and Intracranial Neurotherapeutics (BRAIN) Unit, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK.,Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Megan Hodgson
- Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - Samay Mehta
- University of Birmingham Medical School, Birmingham, UK
| | | | | | - Susruta Manivannan
- Department of Neurosurgery, Southampton General Hospital, Southampton, UK
| | - Matt P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - James Galea
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Malik Zaben
- Brain Research and Intracranial Neurotherapeutics (BRAIN) Unit, Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK. .,Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
| |
Collapse
|
9
|
The role of IL-6 in TBI and PTSD, a potential therapeutic target? Clin Neurol Neurosurg 2022; 218:107280. [PMID: 35567833 DOI: 10.1016/j.clineuro.2022.107280] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/15/2022] [Accepted: 05/02/2022] [Indexed: 01/14/2023]
Abstract
This literature review focuses on the role of IL-6 in TBI or PTSD-induced neuroinflammation. While TBI and PTSD are widely prevalent, these diagnoses are particularly common amongst veterans. Given the role of IL-6 in neuroprotection acutely, compared to detrimental chronically, targeting this cytokine at specific time points may be beneficial in modulating neuroinflammation. Current treatments for TBI or PTSD are variably affective. By reviewing the role of IL-6 in these two diagnoses, future studies can focus on therapeutics to treat neuroinflammation and ultimately reduce the devastating impacts of neuroinflammation on cognition in PTSD and TBI.
Collapse
|
10
|
Roggero EG, Rocchetti NS, Torresán GV, Quintana RM, Gattino SP, Settecase CJ, Bagilet DH. Serum interleukin-6 may predict brain death development after severe traumatic brain injury. Clin Transplant 2022; 36:e14653. [PMID: 35320586 DOI: 10.1111/ctr.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Eliana Guadalupe Roggero
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Nicolás Sebastián Rocchetti
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Gabriela Verónica Torresán
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Rosana Maris Quintana
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Silvana Paola Gattino
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Claudio Jesús Settecase
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| | - Daniel Horacio Bagilet
- Intensive Care Unit, Granadero Baigorria, "Eva Perón" University Hospital, Santa Fe, Argentina.,School of Medicine, Rosario, Rosario National University, Santa Fe, Argentina
| |
Collapse
|
11
|
Forensic biomarkers of lethal traumatic brain injury. Int J Legal Med 2022; 136:871-886. [PMID: 35226180 PMCID: PMC9005436 DOI: 10.1007/s00414-022-02785-2] [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: 08/20/2021] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
AbstractTraumatic brain injury (TBI) is a major cause of death and its accurate diagnosis is an important concern of daily forensic practice. However, it can be challenging to diagnose TBI in cases where macroscopic signs of the traumatic head impact are lacking and little is known about the circumstances of death. In recent years, several post-mortem studies investigated the possible use of biomarkers for providing objective evidence for TBIs as the cause of death or to estimate the survival time and time since death of the deceased. This work systematically reviewed the available scientific literature on TBI-related biomarkers to be used for forensic purposes. Post-mortem TBI-related biomarkers are an emerging and promising resource to provide objective evidence for cause of death determinations as well as survival time and potentially even time since death estimations. This literature review of forensically used TBI-biomarkers revealed that current markers have low specificity for TBIs and only provide limited information with regards to survival time estimations and time since death estimations. Overall, TBI fatality-related biomarkers are largely unexplored in compartments that are easily accessible during autopsies such as urine and vitreous humor. Future research on forensic biomarkers requires a strict distinction of TBI fatalities from control groups, sufficient sample sizes, combinations of currently established biomarkers, and novel approaches such as metabolomics and mi-RNAs.
Collapse
|
12
|
Plasma biomarkers associated with deployment trauma and its consequences in post-9/11 era veterans: initial findings from the TRACTS longitudinal cohort. Transl Psychiatry 2022; 12:80. [PMID: 35217643 PMCID: PMC8881445 DOI: 10.1038/s41398-022-01853-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 11/28/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is among the most common injuries sustained by post-9/11 veterans; however, these injuries often occur within the context of psychological trauma. Blast exposure, even in the absence of a diagnosable TBI, leads to changes in neural connectivity and congitive functioning. Therefore, considering clinical comorbidities and injury characteristics is critical to understanding the long-term effects of mTBI. Research is moving towards identifying diagnostic and prognostic blood-based biomarkers for TBI; however, few studies include other prevalent clinical and medical comorbidities related to deployment. Here, we present the initial cross-sectional relationships between plasma biomarkers, clinical, and medical comorbidities in a well-characterized longitudinal sample of 550 post-9/11 veteran men and women. We examined biomarkers associated with inflammation (interleukin 6 and 10, tumor necrosis factor α, and eotaxin) and neurodegeneration (neurofilament light, glial fibrillary acidic protein (GFAP), tau, brain derived neurotrophic factor, amyloid ß 40 and 42, phosphorylated neurofilament heavy chain, and neuron specific enolase). Univariate analyses of covariance (ANCOVA) were conducted to determine mean level differences between close blast (blasts that occur within 0-10 meters) and mTBI groups. Our primary findings were twofold: (1) Inflammatory markers were consistently higher in participants exposed to close blasts and were strongly related to deployment-related psychopathology. (2) GFAP was consistently lower in participants exposed to blast and mTBI and lower GFAP was associated with more severe psychological symptoms. More research is clearly needed; however, our findings indicate that chronic increased inflammation and decreased GFAP may be related to close blast exposure.
Collapse
|
13
|
Meier TB, Guedes VA, Smith EG, Sass D, Mithani S, Vorn R, Savitz J, Teague TK, McCrea MA, Gill JM. Extracellular vesicle-associated cytokines in sport-related concussion. Brain Behav Immun 2022; 100:83-87. [PMID: 34848337 PMCID: PMC8895755 DOI: 10.1016/j.bbi.2021.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/21/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023] Open
Abstract
Growing evidence suggests that sport-related concussion results in a robust inflammatory response that can be measured in serum or plasma and is predictive of symptom recovery. Recently, extracellular vesicles (EV) derived from serum or plasma have emerged as a promising source of biomarkers for neurological disorders like concussion because they may better reflect central immunological activity. However, the association of acute concussion with EV-associated cytokines has not yet been systematically studied in humans. We tested the hypothesis that EV-associated cytokines are elevated acutely and predictive of symptom duration following concussion in a cohort of high-school and collegiate football players. Players were enrolled and provided serum samples at a preseason baseline visit (N = 857). An additional blood draw was obtained in players that subsequently suffered a concussion (N = 23) within 6-hours post-injury and in matched, uninjured players (N = 44). Concentrations of Interleukin-6 (IL-6), IL-1β, IL-1 receptor antagonist (IL-1RA), IL-10, and tumor necrosis factor were measured in EV and EV-depleted serum samples. EV-associated IL-6 was significantly elevated post-injury relative to baseline levels and controls (ps < 0.01). In EV-depleted samples, IL-1RA was significantly elevated post-injury relative to baseline levels and controls (ps < 0.01). Time-to-event analyses showed that post-injury EV-associated IL-6 levels were positively associated with the number of days that injured athletes reported symptoms (p < 0.05). These results highlight the potential of EV-associated cytokines as biomarkers of concussion.
Collapse
Affiliation(s)
- Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Ethan G Smith
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Dilorom Sass
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Sara Mithani
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Rany Vorn
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jonathan Savitz
- Laureate Institute for Brain Research, Tulsa, OK, United States; Oxley College of Health Sciences, Tulsa, OK, United States
| | - T Kent Teague
- Departments of Surgery and Psychiatry, The University of Oklahoma School of Community Medicine, Tulsa, OK, United States; Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, Tulsa, OK, United States; Department of Biochemistry and Microbiology, Oklahoma State University Center for Health Sciences, United States
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
14
|
Chhiber SS, Gul A, Arif S, Wani AA, Ramzan AU. Serum Progesterone Levels as Predictor of Outcome in Severe Traumatic Brain Injury: Analysis of Cohort of 100 Patients. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractDespite advances in research and improved neurological intensive care in recent years, the clinical outcome of severely head injured patients is still poor. Primary insult is followed by a complex cascade of molecular and biochemical events that lead to neuroinflammation, brain edema, and delayed neuronal death. No specific pharmacological therapy is currently available which prevents the development of secondary brain injuries, and most therapeutic strategies have failed in translation from bench to bedside. There are limitations of clinical and radiological methods in delineating the exact severity and prognosis of traumatic brain injury (TBI). A myriad complex biochemical markers are under investigation to delineate the extent of brain tissue damage and to independently predict the outcome, but a search for simple biomarker still eludes the research. Progesterone, a gonadal hormone and a neurosteroid, although controversial as a neuroprotective agent, may hold promise as a simple biochemical marker of the outcome in severe TBI.
Collapse
Affiliation(s)
- Sarbjit Singh Chhiber
- Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Adfer Gul
- Department of Plastic Surgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Sajad Arif
- Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Abrar Ahad Wani
- Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| | - Altaf Umar Ramzan
- Department of Neurosurgery, Sher-e-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
15
|
Zwirner J, Bohnert S, Franke H, Garland J, Hammer N, Möbius D, Tse R, Ondruschka B. Assessing Protein Biomarkers to Detect Lethal Acute Traumatic Brain Injuries in Cerebrospinal Fluid. Biomolecules 2021; 11:biom11111577. [PMID: 34827575 PMCID: PMC8615532 DOI: 10.3390/biom11111577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (p = 0.002; R2 = 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.
Collapse
Affiliation(s)
- Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
- Institute of Legal Medicine, University of Leipzig, 04103 Leipzig, Germany
- Correspondence: (J.Z.); (B.O.); Tel.: +49-178-3551783 (J.Z.)
| | - Simone Bohnert
- Institute of Forensic Medicine, University of Wuerzburg, 97078 Wuerzburg, Germany;
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, University of Leipzig, 04107 Leipzig, Germany;
| | - Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, Lidcombe 2141, Australia;
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, 8010 Graz, Austria;
- Department of Orthopedic and Trauma Surgery, University of Leipzig, 04103 Leipzig, Germany
- Fraunhofer IWU, 47720 Dresden, Germany
| | - Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand;
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
- Correspondence: (J.Z.); (B.O.); Tel.: +49-178-3551783 (J.Z.)
| |
Collapse
|
16
|
Serum Biomarkers of Regeneration and Plasticity are Associated with Functional Outcome in Pediatric Neurocritical Illness: An Exploratory Study. Neurocrit Care 2021; 35:457-467. [PMID: 33665769 PMCID: PMC9344468 DOI: 10.1007/s12028-021-01199-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVE Pediatric neurocritical care survivorship is frequently accompanied by functional impairments. Lack of prognostic biomarkers is a barrier to early identification and management of impairment. We explored the association between blood biomarkers and functional impairment in children with acute acquired brain injury. METHODS This study is a secondary analysis of a randomized control trial evaluating early versus usual care rehabilitation in the pediatric intensive care unit (PICU). Forty-four children (17 [39%] female, median age 11 [interquartile range 6-13] years) with acute acquired brain injury admitted to the PICU were studied. A single center obtained serum samples on admission days 0, 1, 3, 5, and the day closest to hospital discharge. Biomarkers relevant to brain injury (neuron specific enolase [NSE], S100b), inflammation (interleukin [IL-6], C-reactive protein), and regeneration (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF]) were collected. Biomarkers were analyzed using a Luminex® bioassay. Functional status scale (FSS) scores were abstracted from the medical record. New functional impairment was defined as a (worse) FSS score at hospital discharge compared to pre-PICU (baseline). Individual biomarker fluorescence index (FI) values for each sample collection day were correlated with new functional impairment using Spearman rank correlation coefficient (ρ). Trends in repeated measures of biomarker FI over time were explored graphically, and the association between repeated measures of biomarker FI and new functional impairment was analyzed using covariate adjusted linear mixed-effect models. RESULTS Functional impairment was inversely correlated with markers of regeneration and plasticity including BDNF at day 3 (ρ = - 0.404, p = .015), day 5 (ρ = - 0.549, p = 0.005) and hospital discharge (ρ = - 0.420, p = 0.026) and VEGF at day 1 (ρ = - 0.282, p = 0.008) and hospital discharge (ρ = - 0.378, p = 0.047), such that lower levels of both markers at each time point were associated with greater impairment. Similarly, repeated measures of BDNF and VEGF were inversely correlated with new functional impairment (B = - 0.001, p = 0.001 and B = - 0.001, p = 0.003, respectively). NSE, a biomarker of acute brain injury, showed a positive correlation between day 0 levels and new functional impairment (ρ = 0.320, p = 0.044). CONCLUSIONS Blood-based biomarkers of regeneration and plasticity may hold prognostic utility for functional impairment among pediatric patients with neurocritical illness and warrant further investigation.
Collapse
|
17
|
Lassarén P, Lindblad C, Frostell A, Carpenter KLH, Guilfoyle MR, Hutchinson PJA, Helmy A, Thelin EP. Systemic inflammation alters the neuroinflammatory response: a prospective clinical trial in traumatic brain injury. J Neuroinflammation 2021; 18:221. [PMID: 34563211 PMCID: PMC8464153 DOI: 10.1186/s12974-021-02264-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/30/2021] [Indexed: 01/31/2023] Open
Abstract
Background Neuroinflammation following traumatic brain injury (TBI) has been shown to be associated with secondary injury development; however, how systemic inflammatory mediators affect this is not fully understood. The aim of this study was to see how systemic inflammation affects markers of neuroinflammation, if this inflammatory response had a temporal correlation between compartments and how different compartments differ in cytokine composition. Methods TBI patients recruited to a previous randomised controlled trial studying the effects of the drug anakinra (Kineret®), a human recombinant interleukin-1 receptor antagonist (rhIL1ra), were used (n = 10 treatment arm, n = 10 control arm). Cytokine concentrations were measured in arterial and jugular venous samples twice a day, as well as in microdialysis-extracted brain extracellular fluid (ECF) following pooling every 6 h. C-reactive protein level (CRP), white blood cell count (WBC), temperature and confirmed systemic clinical infection were used as systemic markers of inflammation. Principal component analyses, linear mixed-effect models, cross-correlations and multiple factor analyses were used. Results Jugular and arterial blood held similar cytokine information content, but brain-ECF was markedly different. No clear arterial to jugular gradient could be seen. No substantial delayed temporal associations between blood and brain compartments were detected. The development of a systemic clinical infection resulted in a significant decrease of IL1-ra, G-CSF, PDGF-ABBB, MIP-1b and RANTES (p < 0.05, respectively) in brain-ECF, even if adjusting for injury severity and demographic factors, while an increase in several cytokines could be seen in arterial blood. Conclusions Systemic inflammation, and infection in particular, alters cytokine levels with different patterns seen in brain and in blood. Cerebral inflammatory monitoring provides independent information from arterial and jugular samples, which both demonstrate similar information content. These findings could present potential new treatment options in severe TBI patients, but novel prospective trials are warranted to confirm these associations. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02264-2.
Collapse
Affiliation(s)
- Philipp Lassarén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Lindblad
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Frostell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Keri L H Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mathew R Guilfoyle
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter J A Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Eric Peter Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. .,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|
18
|
Impact of Age on Plasma Inflammatory Biomarkers in the 6 Months Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2021; 35:324-331. [PMID: 32881766 DOI: 10.1097/htr.0000000000000606] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare plasma inflammatory biomarker concentrations to 6 months in young and older adults with and without mild traumatic brain injury (TBI). SETTING Level 1 trauma center. PARTICIPANTS Younger (21-54 years) and older (55+) adults diagnosed with mild TBI along with age-/sex-matched noninjured controls (n = 313). DESIGN Prospective cohort study. MAIN MEASURES Multiplex assays were used to quantify concentrations of selected plasma inflammatory markers at day 0, months 1 and 6. RESULTS Persistent aging-related differences were found between control groups in concentrations of 4 cytokines up to 6 months. At day 0, interleukin-6 (IL-6), IL-8, and fractalkine were higher in the older TBI compared with older control as well as the younger TBI groups, while IL-10 was higher in older TBI compared with controls. At month 1, significantly higher concentrations of IL-8, fractalkine, and tumor necrosis factor-α (TNF-α) were seen. At 6 months postinjury, significantly higher concentrations of IL-6 and IL-8 were seen, while a lower concentration of IL-7 was found in older versus younger TBI groups. CONCLUSION The neuroinflammatory signature that accompanies mild TBI in older adults differs from that of younger adults. The differences seen are notable for their roles in neutrophil attraction (IL-8), neuronal-microglial-immune cell interactions (fractalkine), and chronic inflammation (IL-6).
Collapse
|
19
|
Bao W, Lin Y, Chen Z. The Peripheral Immune System and Traumatic Brain Injury: Insight into the role of T-helper cells. Int J Med Sci 2021; 18:3644-3651. [PMID: 34790036 PMCID: PMC8579286 DOI: 10.7150/ijms.46834] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/17/2021] [Indexed: 12/15/2022] Open
Abstract
Emerging evidence suggests that immune-inflammatory processes are key elements in the physiopathological events associated with traumatic brain injury (TBI). TBI is followed by T-cell-specific immunological changes involving several subsets of T-helper cells and the cytokines they produce; these processes can have opposite effects depending on the disease course and cytokine concentrations. Efforts are underway to identify the T-helper cells and cytokine profiles associated with prognosis. These predictors may eventually serve as effective treatment targets to decrease morbidity and mortality and to improve the management of TBI patients. Here, we review the immunological response to TBI, the possible molecular mechanisms of this response, and therapeutic strategies to address it.
Collapse
Affiliation(s)
| | | | - Zuobing Chen
- Department of Rehabilitation Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
20
|
do Espírito Santo MP, Faria CS, Solla DJF, Pipek LZ, Belon AR, Jeng BP, de Andrade AF, Teixeira MJ, Paiva WS. Inflammatory markers assessment in an animal model of intracranial hypertension: a randomized trial. Intensive Care Med Exp 2021; 9:42. [PMID: 34423394 PMCID: PMC8380614 DOI: 10.1186/s40635-021-00408-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intracranial hypertension (ICH) is a common final pathway of most neurosurgical pathologies and leads to poor prognosis if not detected and treated properly. Inflammatory markers have been assessed in clinical scenarios of neurological injuries, in which systemic and brain tissue aggressions may introduce bias. There is a lack of studies under controlled settings to isolate the ICH effect on inflammation. This study aims to evaluate the effects of ICH on the serum concentration of cytokines as biomarkers of neuroinflammation in an experimental model which isolates ICH from potential confounding variables.
Methods An established model of ICH using an intracerebral pediatric bladder catheter and a multisensor intraparenchymal catheter was used in adult pigs (Sus domesticus). The animals were randomly allocated to 2 groups based on the catheter balloon volume used to simulate the ICP increase (4 ml or 7 ml). Cytokines were measured in 4 timepoints during the experiment: (1) 15 min before balloon insufflation; (2) 5 min after insufflation; (3) 125 min after insufflation; (4) 60 min after deflation. The following cytokines were measured IL-1α; IL-1β; IL–1ra; IL-2; IL-4; IL-6; IL-8; IL-10; IL-12; IL-18; TNFα. Generalized estimating equations were modeled to compare the ICP and cytokines values between the groups along the experiment. The study sample size was powered to detect interactions between the groups and the study moments with an effect size (f) of at least 0.3. The ARRIVE checklist was followed. Results A total of 20 animals were studied (10 in each group, 4 ml or 7 ml balloon volume insufflation). The animal model was successful in increasing the ICP along the moments of the experiment (p < 0,001) and in creating an ICP gradient between the groups (p = 0,004). The interaction term (moment × group) was also significant (p < 0,001). There was a significant association between ICP elevation and most cytokines variation. The cytokines IL-1α, IL-1β, IL1-ra, IL-6, IL-12, and IL-18 increased, whereas IL-2, IL-4, and TNF-α decreased. IL-10 did not vary significantly in response to the ICP elevation. Conclusion The serum concentration of cytokines varied in response to intracranial hypertension. The study demonstrated the specific changes in each cytokine after intracranial hypertension and provides key information to guide neuroinflammation clinical research. The proposed experiment was successful as an animal model to the study of neuroinflammation biomarkers Supplementary Information The online version contains supplementary material available at 10.1186/s40635-021-00408-5.
Collapse
Affiliation(s)
| | | | | | | | | | - Brasil Ping Jeng
- Division of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | |
Collapse
|
21
|
Zwirner J, Anders S, Bohnert S, Burkhardt R, Da Broi U, Hammer N, Pohlers D, Tse R, Ondruschka B. Screening for Fatal Traumatic Brain Injuries in Cerebrospinal Fluid Using Blood-Validated CK and CK-MB Immunoassays. Biomolecules 2021; 11:1061. [PMID: 34356685 PMCID: PMC8301791 DOI: 10.3390/biom11071061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 12/13/2022] Open
Abstract
A single, specific, sensitive biochemical biomarker that can reliably diagnose a traumatic brain injury (TBI) has not yet been found, but combining different biomarkers would be the most promising approach in clinical and postmortem settings. In addition, identifying new biomarkers and developing laboratory tests can be time-consuming and economically challenging. As such, it would be efficient to use established clinical diagnostic assays for postmortem biochemistry. In this study, postmortem cerebrospinal fluid samples from 45 lethal TBI cases and 47 controls were analyzed using commercially available blood-validated assays for creatine kinase (CK) activity and its heart-type isoenzyme (CK-MB). TBI cases with a survival time of up to two hours showed an increase in both CK and CK-MB with moderate (CK-MB: AUC = 0.788, p < 0.001) to high (CK: AUC = 0.811, p < 0.001) diagnostic accuracy. This reflected the excessive increase of the brain-type CK isoenzyme (CK-BB) following a TBI. The results provide evidence that CK immunoassays can be used as an adjunct quantitative test aid in diagnosing acute TBI-related fatalities.
Collapse
Affiliation(s)
- Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
- Institute of Legal Medicine, University of Leipzig, 04103 Leipzig, Germany
| | - Sven Anders
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| | - Simone Bohnert
- Institute of Forensic Medicine, University of Wuerzburg, 97078 Wuerzburg, Germany;
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Ugo Da Broi
- Department of Medicine, Forensic Medicine, University of Udine, 33100 Udine, Italy;
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, 8010 Graz, Austria;
- Department of Trauma, Orthopedic and Plastic Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany
- Fraunhofer Institute for Machine Tools and Forming Technology, 09126 Dresden, Germany
| | - Dirk Pohlers
- Center of Diagnostics, Klinikum Chemnitz, 09116 Chemnitz, Germany;
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1023, New Zealand;
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany;
| |
Collapse
|
22
|
Shi W, Dong P, Kuss MA, Gu L, Kievit F, Kim HJ, Duan B. Design and Evaluation of an In Vitro Mild Traumatic Brain Injury Modeling System Using 3D Printed Mini Impact Device on the 3D Cultured Human iPSC Derived Neural Progenitor Cells. Adv Healthc Mater 2021; 10:e2100180. [PMID: 33890428 PMCID: PMC8222191 DOI: 10.1002/adhm.202100180] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/15/2021] [Indexed: 12/13/2022]
Abstract
Despite significant progress in understanding the disease mechanism of traumatic brain injury (TBI), promising preclinical therapeutics have seldom been translated into successful clinical outcomes, partially because the model animals have physiological and functional differences in the central nervous system (CNS) compared to humans. Human relevant models are thus urgently required. Here, an in vitro mild TBI (mTBI) modeling system is reported based on 3D cultured human induced pluripotent stem cells (iPSC) derived neural progenitor cells (iPSC-NPCs) to evaluate consequences of single and repetitive mTBI using a 3D printed mini weight-drop impact device. Computational simulation is performed to understand the single/cumulative effects of weight-drop impact on the NPC differentiated neurospheres. Experimental results reveal that neurospheres show reactive astrogliosis and glial scar formation after repetitive (10 hits) mild impacts, while no astrocyte activation is found after one or two mild impacts. A 3D co-culture model of human microglia cells with neurospheres is further developed. It is found that astrocyte response is promoted even after two mild impacts, possibly caused by the chronic neuroinflammation after microglia activation. The in vitro mTBI modeling system recapitulates several hallmarks of the brain impact injury and might serve as a good platform for future drug screening.
Collapse
Affiliation(s)
- Wen Shi
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
| | - Pengfei Dong
- Department of Biomedical and Chemical Engineering and Science, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Mitchell A Kuss
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
| | - Linxia Gu
- Department of Biomedical and Chemical Engineering and Science, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Forrest Kievit
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68583, USA
| | - Hyung Joon Kim
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
- Eppley Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska, Medical Center, Omaha, NE, 68198, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| |
Collapse
|
23
|
Evaluation of cytokines and structural proteins to analyze the pathology of febrile central nervous system disease. Leg Med (Tokyo) 2021; 51:101864. [PMID: 33798967 DOI: 10.1016/j.legalmed.2021.101864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
This study was designed to examine the pathophysiological differences in interleukin (IL) and structural protein levels between central nervous system (CNS) disorders associated with heat stroke and CNS stimulants. We measured the concentrations of IL-6, IL-8, neuron-specific enolase (NSE), and myelin basic protein (MBP) in blood and cerebrospinal fluid (CSF) from 87 autopsy cases. In addition, to examine changes in each marker, we cultured nerve cells at 40 °C as a heat stroke model and administered 4-aminopyridine and ephedrine in cultured cells as a CNS stimulant model. IL-6 levels in blood and CSF were significantly higher in the stimulant compared with the heat stroke group. IL-8 levels in blood and CSF were relatively high in the stimulant, heat stroke, and psychotropic addiction groups. NSE levels in blood were high in the stimulant and heat stroke groups, while those in CSF were significantly higher in the heat stroke group. MBP levels in blood were markedly higher in the stimulant and heat stroke groups, but no differences were seen in CSF. Compared with the CNS stimulant model, the heat stroke model with cultured human nerve cells showed high values for each marker. The results of the autopsy and laboratory tests in the present cases and those of cultured cell experiments indicated that CNS disorders caused by CNS stimulants such as amphetamines led to changes in IL-6 as an immune response, which suggests that IL-8 may help protect nerve cells in cases involving heat stroke and stimulants.
Collapse
|
24
|
Sikora JP, Sobczak J, Zawadzki D, Przewratil P, Wysocka A, Burzyńska M. Respiratory Burst and TNF-α Receptor Expression of Neutrophils after Sepsis and Severe Injury-Induced Inflammation in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042187. [PMID: 33672270 PMCID: PMC7926345 DOI: 10.3390/ijerph18042187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022]
Abstract
Systemic inflammatory response syndrome (SIRS) is defined as the systemic host response to infection or a non-infectious factor. The purpose of this study was to evaluate the involvement of reactive oxygen species (ROS) in severe inflammation and to assess the discrimination strength of the neutrophil BURSTTEST assay regarding its etiology in three groups of patients (sepsis, burns, and bone fractures) who met the SIRS criteria. The neutrophil activation (respiratory burst of granulocytes as well as p55 and p75 tumor necrosis factor (TNF-α) receptor expression) was evaluated twice using flow cytometry, and the results were compared with healthy controls and among SIRS subjects. A decreased oxygen metabolism in neutrophils after E.coli stimulation and increased TNF-α receptor expression were found in septic and burned patients on admission, while ROS production augmented and TNF-α receptor expression diminished with the applied therapy. The significant differences in neutrophil respiratory burst intensity among septic and burned patients and those with sepsis and bone fractures were found (however, there were not any such differences between patients with thermal and mechanical injuries). This study indicates that the neutrophil BURSTTEST evaluation might be a clinically reliable marker for differentiating the SIRS etiology.
Collapse
Affiliation(s)
- Janusz P. Sikora
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
- Correspondence: ; Tel.: +48-698861043
| | - Jarosław Sobczak
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
- Department of Management and Logistics in Healthcare, Medical University of Łódź, 6 Lindleya St., 90-131 Łódź, Poland
| | - Dariusz Zawadzki
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (J.S.); (D.Z.)
| | - Przemysław Przewratil
- Department of Pediatric Surgery and Oncology, Chair of Surgical Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (P.P.); (A.W.)
| | - Anna Wysocka
- Department of Pediatric Surgery and Oncology, Chair of Surgical Pediatrics, Central Clinical Hospital, Medical University of Łódź, 36/50 Sporna St., 91-738 Łódź, Poland; (P.P.); (A.W.)
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Chair of Social and Preventive Medicine, Medical University of Łódź, 7/9 Żeligowskiego St., 90-752 Łódź, Poland;
| |
Collapse
|
25
|
Abstract
INTRODUCTION Traumatic brain injury (TBI) is associated with secondary injury to the central nervous system (CNS) via inflammatory mechanisms. The combination of polytrauma and TBI further exacerbates the inflammatory response to injury; however, combined injury phenomena have not been thoroughly studied. In this study, we examined the inflammatory differences between patients with TBI versus patients with polytrauma, but no TBI (polytrauma). We hypothesize that patients with TBI have a heightened early inflammatory response compared with polytrauma. METHODS We conducted a single-center retrospective study of a cohort of patients with polytrauma, who were enrolled in the PROPPR study. These patients had blood samples prospectively collected at eight time points in the first 3 days of admission. Using radiological data to determine TBI, our polytrauma cohort was dichotomized into TBI (n = 30) or polytrauma (n = 54). Inflammatory biomarkers were measured using ELISA. Data across time were compared for TBI versus polytrauma groups using Wilcoxon rank-sum test. Network analysis techniques were used to systematically characterize the inflammatory responses at admission. RESULTS Patients with TBI (51.6%) had a higher 30-day mortality compared with polytrauma (16.9%) (P <0.001). Expression levels of IL6, IL8, and CCL2 were elevated from the 2-h through 24-h time points, becoming significant at the 6-h time point (IL6, IL8, and CCL2; P <0.05) (). CSF3 showed a similar pattern, but did not attain significance. TBI and polytrauma networks underwent diverging trends from admission to the 6-h time point. CONCLUSION Patients with TBI demonstrated upregulations in proinflammatory cytokines IL6, IL8, and CCL2. Utilizing informatics methods, we were able to identify temporal differences in network trends, as well as uncharacterized cytokines and chemokines in TBI. These data suggest TBI induces a distinct inflammatory response and pathologically heightened inflammatory response in the presence of polytrauma and may propagate worsened patient outcomes including mortality.
Collapse
|
26
|
Popovitz J, Mysore SP, Adwanikar H. Neural Markers of Vulnerability to Anxiety Outcomes after Traumatic Brain Injury. J Neurotrauma 2020; 38:1006-1022. [PMID: 33050836 DOI: 10.1089/neu.2020.7320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Anxiety outcomes after traumatic brain injury (TBI) are complex, and the underlying neural mechanisms are poorly understood. Here, we developed a multi-dimensional behavioral profiling approach to investigate anxiety-like outcomes in mice that takes into account individual variability. Departing from the tradition of comparing outcomes in TBI versus sham groups, we identified a subgroup within the TBI group that is vulnerable to anxiety dysfunction, and present increased exploration of the anxiogenic zone compared to sham controls or resilient injured animals, by applying dimensionality reduction, clustering, and post hoc validation to behavioral data obtained from multiple assays for anxiety at several post-injury time points. These vulnerable animals expressed distinct molecular profiles in the corticolimbic network, with downregulation in gamma-aminobutyric acid and glutamate and upregulation in neuropeptide Y markers. Indeed, among vulnerable animals, not resilient or sham controls, severity of anxiety-related outcomes correlated strongly with expression of molecular markers. Our results establish a foundational approach, with predictive power, for reliably identifying maladaptive anxiety outcomes after TBI and uncovering neural signatures of vulnerability to anxiety.
Collapse
Affiliation(s)
- Juliana Popovitz
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shreesh P Mysore
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neuroscience, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hita Adwanikar
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
27
|
Hoffman J, Yu J, Kirstein C, Kindy MS. Combined Effects of Repetitive Mild Traumatic Brain Injury and Alcohol Drinking on the Neuroinflammatory Cytokine Response and Cognitive Behavioral Outcomes. Brain Sci 2020; 10:brainsci10110876. [PMID: 33228251 PMCID: PMC7699568 DOI: 10.3390/brainsci10110876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
The relationship between alcohol consumption and traumatic brain injury (TBI) often focuses on alcohol consumption increasing the likelihood of incurring a TBI, rather than alcohol use outcomes after TBI. However, patients without a history of an alcohol use disorder can also show increased problem drinking after single or multiple TBIs. Alcohol and mild TBI share diffuse deleterious neurological impacts and cognitive impairments; therefore, the purpose of these studies was to determine if an interaction on brain and behavior outcomes occurs when alcohol is consumed longitudinally after TBI. To examine the impact of mild repetitive TBI (rmTBI) on voluntary alcohol consumption, mice were subjected to four mild TBI or sham procedures over a 2 week period, then offered alcohol (20% v/v) for 2 weeks using the two-bottle choice, drinking in the dark protocol. Following the drinking period, mice were evaluated for neuroinflammatory cytokine response or tested for cognitive and behavioral deficits. Results indicate no difference in alcohol consumption or preference following rmTBI as compared to sham; however, increases in the neuroinflammatory cytokine response due to alcohol consumption and some mild cognitive behavioral deficits after rmTBI and alcohol consumption were observed. These data suggest that the cytokine response to alcohol drinking and rmTBI + alcohol drinking is not necessarily aggregate, but the combination does result in an exacerbation of cognitive behavioral outcomes.
Collapse
Affiliation(s)
- Jessica Hoffman
- Department of Psychiatry, Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: (J.H.); (M.S.K.); Tel.: +1-919-843-4389 (J.H.)
| | - Jin Yu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA;
| | - Cheryl Kirstein
- Department of Psychology, College of Arts and Sciences, University of South Florida, Tampa, FL 33612, USA;
| | - Mark S. Kindy
- Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL 33612, USA;
- James A. Haley VA Medical Center, Tampa, FL 33612, USA
- Shriners Hospital for Children, Tampa, FL 33612, USA
- Correspondence: (J.H.); (M.S.K.); Tel.: +1-919-843-4389 (J.H.)
| |
Collapse
|
28
|
Neuroinflammatory Biomarkers Associated With Mild Traumatic Brain Injury History in Special Operations Forces Combat Soldiers. J Head Trauma Rehabil 2020; 35:300-307. [DOI: 10.1097/htr.0000000000000598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
29
|
Vedantam A, Brennan J, Levin HS, McCarthy JJ, Dash PK, Redell JB, Yamal JM, Robertson CS. Early versus Late Profiles of Inflammatory Cytokines after Mild Traumatic Brain Injury and Their Association with Neuropsychological Outcomes. J Neurotrauma 2020; 38:53-62. [PMID: 32600167 DOI: 10.1089/neu.2019.6979] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Despite pre-clinical evidence for the role of inflammation in traumatic brain injury (TBI), there is limited data on inflammatory biomarkers in mild TBI (mTBI). In this study, we describe the profile of plasma inflammatory cytokines and explore associations between these cytokines and neuropsychological outcomes after mTBI. Patients with mTBI with negative computed tomography and orthopedic injury (OI) controls without mTBI were prospectively recruited from emergency rooms at three trauma centers. Plasma inflammatory cytokine levels were measured from venous whole-blood samples that were collected at enrollment (within 24 h of injury) and at 6 months after injury. Neuropsychological tests were performed at 1 week, 1 month, 3 months, and 6 months after the injury. Multivariate regression analysis was performed to identify associations between inflammatory cytokines and neuropsychological outcomes. A total of 53 mTBI and 24 OI controls were included in this study. The majority of patients were male (62.3%), and injured in motor vehicle accidents (37.7%). Plasma interleukin (IL)-2 (p = 0.01) and IL-6 (p = 0.01) within 24 h post-injury were significantly higher for mTBI patients compared with OI controls. Elevated plasma IL-2 at 24 h was associated with more severe 1-week post-concussive symptoms (p = 0.001). At 6 months, elevated plasma IL-10 was associated with greater depression scores (p = 0.004) and more severe post-traumatic stress disorder (PTSD) symptoms (p = 0.001). Plasma cytokine levels (within 24 h and at 6 months post-injury) were significantly associated with early and late post-concussive symptoms, PTSD, and depression scores after mTBI. These results highlight the potential role of inflammation in the pathophysiology of post-traumatic symptoms after mTBI.
Collapse
Affiliation(s)
- Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey Brennan
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - James J McCarthy
- Department of Emergency Medicine, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, University of Texas Health Sciences Center, Houston, Texas, USA
| | - John B Redell
- Department of Neurobiology and Anatomy, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | | |
Collapse
|
30
|
Rodney T, Taylor P, Dunbar K, Perrin N, Lai C, Roy M, Gill J. High IL-6 in military personnel relates to multiple traumatic brain injuries and post-traumatic stress disorder. Behav Brain Res 2020; 392:112715. [DOI: 10.1016/j.bbr.2020.112715] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/04/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
|
31
|
Guedes VA, Devoto C, Leete J, Sass D, Acott JD, Mithani S, Gill JM. Extracellular Vesicle Proteins and MicroRNAs as Biomarkers for Traumatic Brain Injury. Front Neurol 2020; 11:663. [PMID: 32765398 PMCID: PMC7378746 DOI: 10.3389/fneur.2020.00663] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous condition, associated with diverse etiologies, clinical presentations and degrees of severity, and may result in chronic neurobehavioral sequelae. The field of TBI biomarkers is rapidly evolving to address the many facets of TBI pathology and improve its clinical management. Recent years have witnessed a marked increase in the number of publications and interest in the role of extracellular vesicles (EVs), which include exosomes, cell signaling, immune responses, and as biomarkers in a number of pathologies. Exosomes have a well-defined lipid bilayer with surface markers that reflect the cell of origin and an aqueous core that contains a variety of biological material including proteins (e.g., cytokines and growth factors) and nucleic acids (e.g., microRNAs). The presence of proteins associated with neurodegenerative changes such as amyloid-β, α-synuclein and phosphorylated tau in exosomes suggests a role in the initiation and propagation of neurological diseases. However, mechanisms of cell communication involving exosomes in the brain and their role in TBI pathology are poorly understood. Exosomes are promising TBI biomarkers as they can cross the blood-brain barrier and can be isolated from peripheral fluids, including serum, saliva, sweat, and urine. Exosomal content is protected from enzymatic degradation by exosome membranes and reflects the internal environment of their cell of origin, offering insights into tissue-specific pathological processes. Challenges in the clinical use of exosomal cargo as biomarkers include difficulty in isolating pure exosomes, variable yields of the isolation processes, quantification of vesicles, and lack of specificity of exosomal markers. Moreover, there is no consensus regarding nomenclature and characteristics of EV subtypes. In this review, we discuss current technical limitations and challenges of using exosomes and other EVs as blood-based biomarkers, highlighting their potential as diagnostic and prognostic tools in TBI.
Collapse
Affiliation(s)
- Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jacqueline Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Delia Sass
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jedidiah D Acott
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Sara Mithani
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
32
|
Treble-Barna A, Pilipenko V, Wade SL, Jegga AG, Yeates KO, Taylor HG, Martin LJ, Kurowski BG. Cumulative Influence of Inflammatory Response Genetic Variation on Long-Term Neurobehavioral Outcomes after Pediatric Traumatic Brain Injury Relative to Orthopedic Injury: An Exploratory Polygenic Risk Score. J Neurotrauma 2020; 37:1491-1503. [PMID: 32024452 PMCID: PMC7307697 DOI: 10.1089/neu.2019.6866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The addition of genetic factors to prognostic models of neurobehavioral recovery following pediatric traumatic brain injury (TBI) may account for unexplained heterogeneity in outcomes. The present study examined the cumulative influence of candidate genes involved in the inflammatory response on long-term neurobehavioral recovery in children with early childhood TBI relative to children with orthopedic injuries (OI). Participants were drawn from a prospective, longitudinal study evaluating outcomes of children who sustained TBI (n = 67) or OI (n = 68) between the ages of 3 and 7 years. Parents completed ratings of child executive function and behavior at an average of 6.8 years after injury. Exploratory unweighted and weighted polygenic risk scores (PRS) were constructed from single nucleotide polymorphisms (SNPs) across candidate inflammatory response genes (i.e., angiotensin converting enzyme [ACE], brain-derived neurotrophic factor [BDNF], interleukin-1 receptor antagonist [IL1RN], and 5'-ectonucleotidase [NT5E]) that showed nominal (p ≤ 0.20) associations with outcomes in the TBI group. Linear regression models tested the PRS × injury group (TBI vs. OI) interaction term and post-hoc analyses examined the effect of PRS within each injury group. Higher inflammatory response PRS were associated with more executive dysfunction and behavior problems in children with TBI but not in children with OI. The cumulative influence of inflammatory response genes as measured by PRS explained additional variance in long-term neurobehavioral outcomes, over and above well-established predictors and single candidate SNPs tested individually. The results suggest that some of the unexplained heterogeneity in long-term neurobehavioral outcomes following pediatric TBI may be attributable to a child's genetic predisposition to a greater or lesser inflammatory response to TBI.
Collapse
Affiliation(s)
- Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennslvania, USA
| | - Valentina Pilipenko
- Division of Human Genetics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L. Wade
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anil G. Jegga
- Division of Biomedical Informatics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - H. Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Lisa J. Martin
- Division of Human Genetics, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brad G. Kurowski
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
33
|
Hassan SA, Arbab MA, Abdelrahman SF, Aldeaf SH, Gassoum AF, Musa HH. The Significance of Mutation in IL-1β Gene and Circulatory Level for Prediction of Trauma Severity and Outcome in Traumatic Cerebral Hemorrhagic Contusion. J Acute Med 2020; 10:70-76. [PMID: 32995158 PMCID: PMC7517881 DOI: 10.6705/j.jacme.202003_10(2).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Traumatic brain injuries (TBIs) is a leading cause of death, disability, and resources consumption. Cerebral hemorrhagic contusions are primary brain lesion and often one of the most visible lesions following TBIs. Interleukin-one beta (IL-1 β) is pro-inflammatory cytokines it is circulatory level and gene have been implicated in secondary brain injury and worse outcome following TBIs. This study is to determine the significance role of IL-1 β gene polymorphism (-511C/T) and circulatory level for prediction trauma severity and outcome in traumatic cerebral hemorrhagic contusion. METHODS The study population includes 90 Sudanese patients with traumatic cerebral hemorrhagic and 90 apparently healthy individuals as control. IL-1β serum concentration was measured using enzyme-linked immunosorbent assay and IL-1β gene was genotyped using restriction fragment length polymorphism-polymerase chain reaction. RESULTS Significant elevation of IL-1β level was seen among trauma patients compared to control (p-value < 0.001). Although there was no significant association between IL-1β level with trauma severity or death; IL-1β level was higher in severe brain injures compared with moderate and mild one, and the mean concentration of IL-1β was high (18.75 pg/mL) among patient developed poor outcome compared to survivals (15.17 pg/mL). T recessive allele of IL-1 β gene was detected in 13.3% of participant. The highest circulatory level of IL-1β (17.8 pg/mL) was observed among patients with TT homozygous alleles. IL-1 β gene polymorphism was not associated with trauma severity and death. CONCLUSIONS IL-1β circulatory level was varied according to trauma severity and highly levels were seen among patients developed unfavorable outcome. IL-1β -511C/T gene was not associated with trauma severity and outcome.
Collapse
Affiliation(s)
- Samah Abdelrahman Hassan
- Almugtaribeen University Department of Medical Microbiology, Faculty of Medicine Khartoum Sudan
- National Center for Neurological Sciences Khartoum Sudan
| | - Mohamed Abdelrahman Arbab
- National Center for Neurological Sciences Khartoum Sudan
- Faculty of Medicine, University of Khartoum Department of Surgery Khartoum Sudan
| | | | | | | | - Hassan Hussein Musa
- University of Khartoum Department of Medical Microbiology, Faculty of Medical Laboratory Sciences Khartoum Sudan
- Darfur College Biomedical Research Institute Nyala Sudan
| |
Collapse
|
34
|
Edwards KA, Gill JM, Pattinson CL, Lai C, Brière M, Rogers NJ, Milhorn D, Elliot J, Carr W. Interleukin-6 is associated with acute concussion in military combat personnel. BMC Neurol 2020; 20:209. [PMID: 32450801 PMCID: PMC7249335 DOI: 10.1186/s12883-020-01760-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Concussion is the most common type of TBI, yet reliable objective measures related to these injuries and associated recovery processes remain elusive, especially in military personnel. The purpose of this study was to characterize the relationship between cytokines and recovery from acute brain injury in active duty service members. Inflammatory cytokines (IL-6, IL-10, and TNFα) were measured acutely in blood samples within 8 h following a medically diagnosed concussion and then 24 h later. METHODS Participants (n = 94) were categorized into two groups: 1) military personnel who sustained provider-diagnosed concussion, without other major medical diagnosis (n = 45) and 2) healthy control participants in the same deployment environment who did not sustain concussion or other illness or injuries (n = 49). IL-6, IL-10, and TNFα concentrations were measured using an ultrasensitive single-molecule enzyme-linked immunosorbent assay. Differences in cytokine levels between concussed and healthy groups were evaluated at two time points (time point 1 ≤ 8 h after injury; time point 2 = 24 h following time point 1). RESULTS At time point 1, IL-6 median (IQR) concentrations were 2.62 (3.62) in the concussed group, which was greater compared to IL-6 in the healthy control group (1.03 (0.90); U = 420.00, z = - 5.12, p < 0.001). Compared to healthy controls, the concussed group did not differ at time point 1 in IL-10 or TNFα concentrations (p's > 0.05). At time point 2, no differences were detected between concussed and healthy controls for IL-6, IL-10, or TNFα (p's > 0.05). The median difference between time points 1 and 2 were compared between the concussed and healthy control groups for IL-6, IL-10, and TNFα. Change in IL-6 across time was greater for the concussed group than healthy control (- 1.54 (3.12); U = 315.00, z = - 5.96, p < 0.001), with no differences between groups in the change of IL-10 or TNFα (p's > 0.05). CONCLUSION Reported here is a significant elevation of IL-6 levels in concussed military personnel less than 8 h following injury. Future studies may examine acute and chronic neurological symptomology associated with inflammatory cytokine levels, distinguish individuals at high risk for developing neurological complications, and identify underlying biological pathways to mitigate inflammation and improve outcomes.
Collapse
Affiliation(s)
- Katie A Edwards
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 26E, Bethesda, MD, 20892, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Dr, Bethesda, MD, 20817, USA.
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 26E, Bethesda, MD, 20892, USA.,CNRM Co-Director Biomarkers Core, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Cassandra L Pattinson
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 26E, Bethesda, MD, 20892, USA
| | - Chen Lai
- National Institute of Nursing Research, National Institutes of Health, 3 Center Drive, Building 3, Room 26E, Bethesda, MD, 20892, USA
| | - Misha Brière
- 87th Medical Group, Joint Base McGuire-Dix-Lakehurst, 3458 Neely Road, Trenton, NJ, 08641, USA
| | - Nicholas J Rogers
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Denise Milhorn
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Jonathan Elliot
- USS Gerald R. Ford (CVN78), FPO, AE, Norfolk, VA, 09523, USA
| | - Walter Carr
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.,Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| |
Collapse
|
35
|
Edwards KA, Pattinson CL, Guedes VA, Peyer J, Moore C, Davis T, Devoto C, Turtzo LC, Latour L, Gill JM. Inflammatory Cytokines Associate With Neuroimaging After Acute Mild Traumatic Brain Injury. Front Neurol 2020; 11:348. [PMID: 32508732 PMCID: PMC7248260 DOI: 10.3389/fneur.2020.00348] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/08/2020] [Indexed: 01/03/2023] Open
Abstract
Introduction: Elevated levels of blood-based proinflammatory cytokines are linked to acute moderate to severe traumatic brain injuries (TBIs), yet less is known in acute mild (m)TBI cohorts. The current study examined whether blood-based cytokines can differentiate patients with mTBI, with and without neuroimaging findings (CT and MRI). Material and Methods: Within 24 h of a mTBI, determined by a Glasgow Coma Scale (GCS) between 13 and 15, participants (n = 250) underwent a computed tomography (CT) and magnetic resonance imaging (MRI) scan and provided a blood sample. Participants were classified into three groups according to imaging findings; (1) CT+, (2) MRI+ (CT–), (3) Controls (CT– MRI–). Plasma levels of circulating cytokines (IL-6, IL-10, TNFα), and vascular endothelial growth factor (VEGF) were measured using an ultra-sensitive immunoassay. Results: Concentrations of inflammatory cytokines (IL-6, TNFα) and VEGF were elevated in CT+, as well as MRI+ groups (p < 0.001), compared to controls, even after controlling for age, sex and cardiovascular disease (CVD)-related risk factors; hypertension, and hyperlipidemia. Post-concussive symptoms were associated with imaging groupings, but not inflammatory cytokines in this cohort. Levels of VEGF, IL-6, and TNFα differentiated patients with CT+ findings from controls, with the combined biomarker model (VEGF, IL-6, TNFα, and IL-10) showing good discriminatory power (AUC 0.92, 95% CI 0.87–0.97). IL-6 was a fair predictor of MRI+ findings compared to controls (AUC 0.70, 95% CI 0.60–0.78). Finally, the combined biomarker model discriminated patients with MRI+ from CT+ with an AUC of 0.71 (95% CI 0.62–0.80). Conclusions: When combined, IL-6, TNFα, and VEGF may provide a promising biomarker cytokine panel to differentiate mTBI patients with CT+ imaging vs. controls. Singularly, IL-6 was a fair discriminator between each of the imaging groups. Future research directions may help elucidate mechanisms related to injury severity and potentially, recovery following an mTBI.
Collapse
Affiliation(s)
- Katie A Edwards
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Cassandra L Pattinson
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Vivian A Guedes
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Jordan Peyer
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Candace Moore
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States
| | - Tara Davis
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States.,Johns Hopkins Suburban Hospital, Bethesda, MD, United States
| | - Christina Devoto
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - L Christine Turtzo
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Lawrence Latour
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Jessica M Gill
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, United States.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Biomarker Core, Bethesda, MD, United States
| |
Collapse
|
36
|
Gao C, Wang H, Wang T, Luo C, Wang Z, Zhang M, Chen X, Tao L. Platelet regulates neuroinflammation and restores blood-brain barrier integrity in a mouse model of traumatic brain injury. J Neurochem 2020; 154:190-204. [PMID: 32048302 DOI: 10.1111/jnc.14983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 01/14/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
Neuroinflammation accompanied by microglial activation triggers multiple cell death after traumatic brain injury (TBI). The secondary injury caused by inflammation may persist for a long time. Recently, platelet C-type lectin-like 2 receptor (CLEC-2) has been shown to regulate inflammation in certain diseases. However, its possible effects on TBI remain poorly understood. Here, we aimed to investigate the role of platelet CLEC-2 in the pathological process of neuroinflammation after TBI. In this study, mice were subjected to sham or controlled cortical impact injury, and arbitrarily received recombinant platelet CLEC-2. In parallel, BV2 cells were treated with lipopolysaccharide (LPS) to mimic microglial activation after TBI. Primary endothelial cells were also subjected to LPS in order to replicate the inflammatory damage caused by TBI. We used western blot analysis, reverse transcription polymerase chain reaction (RT-PCR), and immunostaining to evaluate the role of platelet CLEC-2 in TBI. In conditional knock out platelet CLEC-2 mice, trauma worsened the integrity of the blood-brain barrier and amplified the release of inflammatory cytokines. In wild type mice subjected to controlled cortical impact injury, recombinant platelet CLEC-2 administration altered the secretion of inflammatory cytokines, reduced brain edema, and improved neurological function. In vitro, the polarization phenotype of microglia induced by LPS was transformed by recombinant platelet CLEC-2, and this conversion depended on the mammalian target of rapamycin (mTOR) pathway. Endothelial cell injury by LPS was ameliorated when microglia expressed mostly M2 phenotype markers. In conclusion, platelet CLEC-2 regulates trauma-induced neuroinflammation and restores blood-brain barrier integrity.
Collapse
Affiliation(s)
- Cheng Gao
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Haochen Wang
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Tao Wang
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Chengliang Luo
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Zufeng Wang
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Mingyang Zhang
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Xiping Chen
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| | - Luyang Tao
- Department of Forensic Medicine, Medical School of Soochow University, Suzhou, China
| |
Collapse
|
37
|
Xie XK, Xu ZK, Xu K, Xiao YX. DUSP19 mediates spinal cord injury-induced apoptosis and inflammation in mouse primary microglia cells via the NF-kB signaling pathway. Neurol Res 2019; 42:31-38. [PMID: 31813339 DOI: 10.1080/01616412.2019.1685068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective: Spinal cord injury (SCI) is a common injury that seriously threatens human health. NF-κB may be involved in the secondary injury of SCI that is mediated by inflammation and aggravates damage. Our study was aimed to investigate the role of NF-κB signaling in DUSP19-mediated cleaved Caspase-3 expression and the release of inflammatory factors in vivo and in vitro.Materials and Methods: DUSP19 mRNA expression and the content of IL-6 and IL-8 in patients with traumatic SCI (TSCI) were measured by real-time PCR and ELISA, respectively. The levels of p-NF-κBp65, NF-κBp65 and cleaved Caspase-3 expression and the concentrations of IL-6 and IL-8 were measured by western blotting and ELISA, respectively.Results: Patients with TSCI showed lower DUSP19 expression and higher concentration of IL-6 and IL-8 compared with healthy controls. DUSP19 overexpression inhibited p-NF-κBp65 level, cleaved Caspase-3 expression, and production of IL-8 and IL-6 in the mice induced by TSCI. DUSP19 silencing increased p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells. DUSP19 overexpression had an inverse effect. Importantly, DUSP19 silencing and overexpression mediated p-NF-κBp65 level, cleaved Caspase-3 expression, and concentration of IL-6 and IL-8 in mouse primary microglia cells were reversed by NF-κB inhibitor pyrrolidine dithiocarbamate (PDTC) and NF-κB activator 12-myristate 13-acetate (PMA), respectively.Conclusion: These results suggested that DUSP19-mediated SCI-induced apoptosis and inflammation via NF-κB signaling and might therefore serve as a potential therapeutic target for SCI.
Collapse
Affiliation(s)
- Xian-Kuan Xie
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hang Zhou, Zhejiang, PR China
| | - Zheng-Kuan Xu
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hang Zhou, Zhejiang, PR China
| | - Kan Xu
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hang Zhou, Zhejiang, PR China
| | - Yu-Xiang Xiao
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hang Zhou, Zhejiang, PR China
| |
Collapse
|
38
|
Lewis CT, Savarraj JP, McGuire MF, Hergenroeder GW, Alex Choi H, Kitagawa RS. Elevated inflammation and decreased platelet activity is associated with poor outcomes after traumatic brain injury. J Clin Neurosci 2019; 70:37-41. [DOI: 10.1016/j.jocn.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/07/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
|
39
|
Kany S, Vollrath JT, Relja B. Cytokines in Inflammatory Disease. Int J Mol Sci 2019; 20:ijms20236008. [PMID: 31795299 PMCID: PMC6929211 DOI: 10.3390/ijms20236008] [Citation(s) in RCA: 858] [Impact Index Per Article: 171.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022] Open
Abstract
This review aims to briefly discuss a short list of a broad variety of inflammatory cytokines. Numerous studies have implicated that inflammatory cytokines exert important effects with regard to various inflammatory diseases, yet the reports on their specific roles are not always consistent. They can be used as biomarkers to indicate or monitor disease or its progress, and also may serve as clinically applicable parameters for therapies. Yet, their precise role is not always clearly defined. Thus, in this review, we focus on the existing literature dealing with the biology of cytokines interleukin (IL)-6, IL-1, IL-33, tumor necrosis factor-alpha (TNF-α), IL-10, and IL-8. We will briefly focus on the correlations and role of these inflammatory mediators in the genesis of inflammatory impacts (e.g., shock, trauma, immune dysregulation, osteoporosis, and/or critical illness).
Collapse
Affiliation(s)
- Shinwan Kany
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany;
- Department of Cardiology with Emphasis on Electrophysiology, University Heart Centre, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jan Tilmann Vollrath
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University, 60590 Frankfurt, Germany
| | - Borna Relja
- Experimental Radiology, Department of Radiology and Nuclear Medicine, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
- Correspondence: ; Tel.: +49-391-6721395
| |
Collapse
|
40
|
Geniposide Alleviates Traumatic Brain Injury in Rats Via Anti-Inflammatory Effect and MAPK/NF-kB Inhibition. Cell Mol Neurobiol 2019; 40:511-520. [PMID: 31677006 DOI: 10.1007/s10571-019-00749-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/19/2019] [Indexed: 12/12/2022]
Abstract
We aimed to investigate whether geniposide, a main component extracted from Gardenia jasminoides Ellis fruit, could exert neuroprotective functions against traumatic brain injury (TBI). Enzyme-linked immunosorbent assay (ELISA) was used for detection of plasma cytokines. Real-time polymerase chain reaction (RT-PCR) was employed for measurements of mRNA levels of cytokines. Neurological outcomes were evaluated by modified neurological severity score (mNSS) and Rota-Rod. Blood-brain barrier (BBB) integrity and brain edema were assessed. Protein expression was tested by Western blot. The plasma levels of interleukin (IL)-1β, IL-6, IL-8 and IL-10 were all elevated in patients with TBI compared to those of healthy controls. TBI rats treated with geniposide showed lower mNSS and longer fall latency time than untreated TBI rats. BBB integrity was maintained and brain edema was reduced by geniposide treatment in TBI rats. Plasma levels of IL-1β, IL-6 and IL-8 were significantly repressed by geniposide treatment in TBI rats, whereas IL-10 level was upregulated. mRNA expression levels of these cytokines in the brain tissues of TBI rats exhibited the same trends of changes. By testing p38 mitogen-activated protein kinase and NF-κB p65 activities, it was observed that phosphorylated (p)-p38 and p-p65 were dramatically inhibited by geniposide. In conclusion, geniposide exerts neuroprotective functions against TBI by inhibiting p-p38 and p-p65.
Collapse
|
41
|
Kanefsky R, Motamedi V, Mithani S, Mysliwiec V, Gill JM, Pattinson CL. Mild traumatic brain injuries with loss of consciousness are associated with increased inflammation and pain in military personnel. Psychiatry Res 2019; 279:34-39. [PMID: 31280036 DOI: 10.1016/j.psychres.2019.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 02/01/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
Mild traumatic brain injuries (mTBI) are a pervasive concern for military personnel. Determining the impact of injury severity, including loss of consciousness (LOC) may provide important insights into the risk of psychological symptoms and inflammation commonly witnessed in military personnel and veterans following mTBI. US military personnel and veterans were categorized into three groups; TBI with LOC (n = 36), TBI without LOC (n = 25), Controls (n = 82). Participants reported their history of mTBI, psychological symptoms (post-traumatic stress disorder [PTSD] and depression), health-related quality of life (HRQOL), and underwent a blood draw. ANCOVA models which controlled for insomnia status and combat exposure indicated that both mTBI groups (with/without LOC) reported significantly greater depression and PTSD symptoms compared to controls; however, they did not differ from each other. The mTBI with LOC did report greater pain than both controls and mTBI without LOC. The TBI with LOC group also had significantly elevated IL-6 concentrations than both TBI without LOC and control groups. Within the mTBI groups, increased TNFα concentrations were associated with greater PTSD symptoms. These findings indicate that sustaining an mTBI, with or without LOC is detrimental for psychological wellbeing. However, LOC may be involved in perceptions of pain and concentrations of IL-6.
Collapse
Affiliation(s)
- Rebekah Kanefsky
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Court, Bldg 60, Bethesda, MD 20892, USA
| | - Vida Motamedi
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Court, Bldg 60, Bethesda, MD 20892, USA
| | - Sara Mithani
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Court, Bldg 60, Bethesda, MD 20892, USA
| | - Vincent Mysliwiec
- San Antonio Military Medical Center, Department of Sleep Medicine, 1100 Wilford Hall Loop, Bldg 4554, JBSA-Lackland, TX 78236, USA
| | - Jessica M Gill
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Court, Bldg 60, Bethesda, MD 20892, USA
| | - Cassandra L Pattinson
- National Institutes of Health, National Institute of Nursing Research, 1 Cloister Court, Bldg 60, Bethesda, MD 20892, USA.
| |
Collapse
|
42
|
Houck KL, Yuan H, Tian Y, Solomon M, Cramer D, Liu K, Zhou Z, Wu X, Zhang J, Oehler V, Dong JF. Physical proximity and functional cooperation of glycoprotein 130 and glycoprotein VI in platelet membrane lipid rafts. J Thromb Haemost 2019; 17:1500-1510. [PMID: 31145836 DOI: 10.1111/jth.14525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Clinical and laboratory studies have demonstrated that platelets become hyperactive and prothrombotic in conditions of inflammation. We have previously shown that the proinflammatory cytokine interleukin (IL)-6 forms a complex with soluble IL-6 receptor α (sIL-6Rα) to prime platelets for activation by subthreshold concentrations of collagen. Upon being stimulated with collagen, the transcription factor signal transducer and activator of transcription (STAT) 3 in platelets is phosphorylated and dimerized to act as a protein scaffold to facilitate the catalytic action between the kinase Syk and the substrate phospholipase Cγ2 (PLCγ2) in collagen-induced signaling. However, it remains unknown how collagen induces phosphorylation and dimerization of STAT3. METHODS AND RESULTS We conducted complementary in vitro experiments to show that the IL-6 receptor subunit glycoprotein 130 (GP130) was in physical proximity to the collagen receptor glycoprotein VI (GPVI in membrane lipid rafts of platelets. This proximity allows collagen to induce STAT3 activation and dimerization, and the IL-6-sIL-6Rα complex to activate the kinase Syk and the substrate PLCγ2 in the GPVI signal pathway, resulting in an enhanced platelet response to collagen. Disrupting lipid rafts or blocking GP130-Janus tyrosine kinase (JAK)-STAT3 signaling abolished the cross-activation and reduced platelet reactivity to collagen. CONCLUSION These results demonstrate cross-talk between collagen and IL-6 signal pathways. This cross-talk could potentially provide a novel mechanism for inflammation-induced platelet hyperactivity, so the IL-6-GP130-JAK-STAT3 pathway has been identified as a potential target to block this hyperactivity.
Collapse
Affiliation(s)
| | - Hengjie Yuan
- Tianjin Neurological Institute, General Hospital, Tianjin Medical University, Tianjin, China
| | - Ye Tian
- Tianjin Neurological Institute, General Hospital, Tianjin Medical University, Tianjin, China
| | | | - Drake Cramer
- Bloodworks Research Institute, Seattle, Washington
| | - Kitty Liu
- Bloodworks Research Institute, Seattle, Washington
| | - Zhou Zhou
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China
| | - Xiaoping Wu
- Bloodworks Research Institute, Seattle, Washington
| | - Jianning Zhang
- Tianjin Neurological Institute, General Hospital, Tianjin Medical University, Tianjin, China
| | - Vivian Oehler
- Clinical Research Division, Hutchison Cancer Center, Seattle, Washington
- Seattle Cancer Alliances, Seattle, Washington
- Division of Hematology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| | - Jing-Fei Dong
- Bloodworks Research Institute, Seattle, Washington
- Division of Hematology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
43
|
Trautz F, Franke H, Bohnert S, Hammer N, Müller W, Stassart R, Tse R, Zwirner J, Dreßler J, Ondruschka B. Survival-time dependent increase in neuronal IL-6 and astroglial GFAP expression in fatally injured human brain tissue. Sci Rep 2019; 9:11771. [PMID: 31417126 PMCID: PMC6695416 DOI: 10.1038/s41598-019-48145-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/30/2019] [Indexed: 01/31/2023] Open
Abstract
Knowledge on trauma survival time prior to death following a lethal traumatic brain injury (TBI) may be essential for legal purposes. Immunohistochemistry studies might allow to narrow down this survival interval. The biomarkers interleukin-6 (IL-6) and glial fibrillary acidic protein (GFAP) are well known in the clinical setting for their usability in TBI prediction. Here, both proteins were chosen in forensics to determine whether neuronal or glial expression in various brain regions may be associated with the cause of death and the survival time prior to death following TBI. IL-6 positive neurons, glial cells and GFAP positive astrocytes all concordantly increase with longer trauma survival time, with statistically significant changes being evident from three days post-TBI (p < 0.05) in the pericontusional zone, irrespective of its definite cortical localization. IL-6 staining in neurons increases significantly in the cerebellum after trauma, whereas increasing GFAP positivity is also detected in the cortex contralateral to the focal lesion. These systematic chronological changes in biomarkers of pericontusional neurons and glial cells allow for an estimation of trauma survival time. Higher numbers of IL-6 and GFAP-stained cells above threshold values in the pericontusional zone substantiate the existence of fatal traumatic changes in the brain with reasonable certainty.
Collapse
Affiliation(s)
- Florian Trautz
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Heike Franke
- Rudolf Boehm Institute of Pharmacology and Toxicology, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Simone Bohnert
- Institute of Forensic Medicine, University of Würzburg, Würzburg, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.,Department of Orthopedic and Trauma Surgery, University Hospital of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Wolf Müller
- Department of Neuropathology, University Hospital of Leipzig, Leipzig, Germany
| | - Ruth Stassart
- Department of Neuropathology, University Hospital of Leipzig, Leipzig, Germany
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jan Dreßler
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, Medical Faculty University of Leipzig, Leipzig, Germany.
| |
Collapse
|
44
|
Nitta ME, Savitz J, Nelson LD, Teague TK, Hoelzle JB, McCrea MA, Meier TB. Acute elevation of serum inflammatory markers predicts symptom recovery after concussion. Neurology 2019; 93:e497-e507. [PMID: 31270219 DOI: 10.1212/wnl.0000000000007864] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To test the hypothesis that acute elevations in serum inflammatory markers predict symptom recovery after sport-related concussion (SRC). METHODS High school and collegiate football players (n = 857) were prospectively enrolled. Forty-one athletes with concussion and 43 matched control athletes met inclusion criteria. Serum levels of interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor, C-reactive protein, interferon-γ, and IL-1 receptor antagonist and Sport Concussion Assessment Tool, 3rd edition (SCAT3) symptom severity scores were collected at a preinjury baseline, 6 and 24-48 hours postinjury, and approximately 8, 15, and 45 days following concussion. The number of days that athletes were symptomatic following SRC (i.e., duration of symptoms) was the primary outcome variable. RESULTS IL-6 and IL-1RA were significantly elevated in athletes with concussion at 6 hours relative to preinjury and other postinjury visits, as well as compared to controls (ps ≤ 0.001). IL-6 and IL-1RA significantly discriminated concussed from control athletes at 6 hours postconcussion (IL-6 area under receiver operating characteristic curve 0.79 [95% confidence interval (CI) 0.65-0.92], IL-1RA AUC 0.79 [95% CI 0.67-0.90]). Further, IL-6 levels at 6 hours postconcussion were significantly associated with the duration of symptoms (hazard ratio for symptom recovery = 0.61 [95% CI 0.38-0.96], p = 0.031). CONCLUSIONS Results support the potential utility of IL-6 and IL-1RA as serum biomarkers of SRC and demonstrate the potential of these markers in identifying athletes at risk for prolonged recovery after SRC. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that serum levels of IL-6 and IL-1RA 6 hours postconcussion significantly discriminated concussed from control athletes.
Collapse
Affiliation(s)
- Morgan E Nitta
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - Jonathan Savitz
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - Lindsay D Nelson
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - T Kent Teague
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - James B Hoelzle
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - Michael A McCrea
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa
| | - Timothy B Meier
- From the Departments of Neurosurgery (M.E.N., L.D.N., M.A.M., T.B.M.), Neurology (L.D.N., M.A.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin; Department of Psychology (M.E.N., J.B.H.), Marquette University, Milwaukee, WI; Laureate Institute for Brain Research (J.S.), Tulsa; Oxley College of Health Sciences (J.S.), The University of Tulsa; Departments of Surgery (T.K.T.) and Psychiatry (T.K.T.), University of Oklahoma School of Community Medicine; Department of Pharmaceutical Sciences (T.K.T.), University of Oklahoma College of Pharmacy; and Department of Biochemistry and Microbiology (T.K.T.), Oklahoma State University Center for Health Sciences, Tulsa.
| |
Collapse
|
45
|
Di Battista AP, Churchill N, Rhind SG, Richards D, Hutchison MG. Evidence of a distinct peripheral inflammatory profile in sport-related concussion. J Neuroinflammation 2019; 16:17. [PMID: 30684956 PMCID: PMC6347801 DOI: 10.1186/s12974-019-1402-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Inflammation is considered a hallmark of concussion pathophysiology in experimental models, yet is understudied in human injury. Despite the growing use of blood biomarkers in concussion, inflammatory biomarkers have not been well characterized. Furthermore, it is unclear if the systemic inflammatory response to concussion differs from that of musculoskeletal injury. The purpose of this paper was to characterize systemic inflammation after injury in athletes with sport-related concussion or musculoskeletal injury. Methods A prospective, observational cohort study was conducted employing 175 interuniversity athletes (sport-related concussion, n = 43; musculoskeletal injury, n = 30; healthy, n = 102) from 12 sports at a sports medicine clinic at an academic institution. High-sensitivity immunoassay was used to evaluate 20 inflammatory biomarkers in the peripheral blood of athletes within 7 days of injury (subacute) and at medical clearance. Healthy athletes were sampled prior to the start of their competitive season. Partial least squares regression analyses were used to identify salient biomarker contributions to class separation between injured and healthy athletes, as well as to evaluate the relationship between biomarkers and days to recovery in injured athletes. Results In the subacute period after injury, compared to healthy athletes, athletes with sport-related concussion had higher levels of the chemokines’ monocyte chemoattractant protein-4 (p < 0.001) and macrophage inflammatory protein-1β (p = 0.001); athletes with musculoskeletal injury had higher levels of thymus and activation-regulated chemokine (p = 0.001). No significant differences in biomarker profiles were observed at medical clearance. Furthermore, concentrations of monocyte chemoattractant protein-1 (p = 0.007) and monocyte chemoattractant protein-4 (p < 0.001) at the subacute time point were positively correlated with days to recovery in athletes with sport-related concussion, while thymus and activation-regulated chemokine was (p = 0.001) positively correlated with days to recovery in athletes with musculoskeletal injury. Conclusion Sport-related concussion is associated with perturbations to systemic inflammatory chemokines that differ from those observed in athletes with a musculoskeletal injury. These results support inflammation as an important facet of secondary injury after sport-related concussion that can be measured systemically in a human model of injury. Electronic supplementary material The online version of this article (10.1186/s12974-019-1402-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alex P Di Battista
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada. .,Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada.
| | - Nathan Churchill
- Neuroscience Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Shawn G Rhind
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.,Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Doug Richards
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.,David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| | - Michael G Hutchison
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada.,David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
46
|
Lee S, Hwang H, Yamal JM, Goodman JC, Aisiku IP, Gopinath S, Robertson CS. IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury. J Neurosurg 2019; 131:1931-1937. [PMID: 30641838 DOI: 10.3171/2018.8.jns18676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/14/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Multiple organ dysfunction syndrome (MODS) occurs frequently after TBI and independently worsens outcome. The present study aimed to identify potential admission characteristics associated with post-TBI MODS. METHODS The authors performed a secondary analysis of a recent randomized clinical trial studying the effects of erythropoietin and blood transfusion threshold on neurological recovery after TBI. Admission clinical, demographic, laboratory, and imaging parameters were used in a multivariable Cox regression analysis to identify independent risk factors for MODS following TBI, defined as maximum total Sequential Organ Failure Assessment (SOFA) score > 7 within 10 days of TBI. RESULTS Two hundred patients were initially recruited and 166 were included in the final analysis. Respiratory dysfunction was the most common nonneurological organ system dysfunction, occurring in 62% of the patients. International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) probability of poor outcome at admission was significantly associated with MODS following TBI (odds ratio [OR] 8.88, 95% confidence interval [CI] 1.94-42.68, p < 0.05). However, more commonly used measures of TBI severity, such as the Glasgow Coma Scale, Injury Severity Scale, and Marshall classification, were not associated with post-TBI MODS. In addition, initial plasma concentrations of interleukin (IL)-6, IL-8, and IL-10 were significantly associated with the development of MODS (OR 1.47, 95% CI 1.20-1.80, p < 0.001 for IL-6; OR 1.26, 95% CI 1.01-1.58, p = 0.042 for IL-8; OR 1.77, 95% CI 1.24-2.53, p = 0.002 for IL-10) as well as individual organ dysfunction (SOFA component score ≥ 1). Finally, MODS following TBI was significantly associated with mortality (OR 5.95, 95% CI 2.18-19.14, p = 0.001), and SOFA score was significantly associated with poor outcome at 6 months (Glasgow Outcome Scale score < 4) when analyzed as a continuous variable (OR 1.21, 95% CI 1.06-1.40, p = 0.006). CONCLUSIONS Admission IMPACT probability of poor outcome and initial plasma concentrations of IL-6, IL-8, and IL-10 were associated with MODS following TBI.
Collapse
Affiliation(s)
| | - Hyunsoo Hwang
- 2Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas; and
| | - Jose-Miguel Yamal
- 2Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas; and
| | - J Clay Goodman
- 3Pathology & Immunology, Baylor College of Medicine, Houston
| | - Imoigele P Aisiku
- 4Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
47
|
Jeong SC, Kim HJ, Shin YS, Han JW, Lim JY, Son HS. Influence of cannula positioning on brain injury during extracorporeal membrane oxygenation. J Thorac Dis 2019; 10:6184-6191. [PMID: 30622790 DOI: 10.21037/jtd.2018.10.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In veno-arterial extracorporeal membrane oxygenation (V-A ECMO), a patient is cannulated using either an atrio-aortic technique (central type ECMO; cECMO) or a femoro-femoral technique (peripheral type ECMO; pECMO). The direction of the pump flow at the aortic arch is anterograde from the ascending aorta in cECMO and retrograde from the descending aorta in pECMO. Hemodynamic differences from the position of the cannulas may influence the brain differently. To evaluate the effect of ECMO cannula positioning on the brain, hemodynamic data and plasma biomarkers were collected. Methods Eight pigs were randomly divided into the cECMO group (n=4) or pECMO group (n=4). ECMO was administered for 6 hours at a pump flow rate based on the mean flow of the ascending aorta. Mean arterial pressure (MAP), mean arterial flow (MAF), energy equivalent pressure (EEP), and surplus hemodynamic energy (SHE) were measured in the brachiocephalic artery every 30 minutes. During ECMO treatment, plasma was collected for analysis of interleukin-6 (IL-6), S100B, glial fibrillary acidic protein (GFAP), and neuron-specific enolase. The data were analyzed using the Mann-Whitney U tests, and repeated measures ANOVAs; significance was set at P<0.05. Results MAP and EEP at 1 and at 3 hours, MAF at all measured times, and SHE at 1 hour and 6 hours were significantly higher in the pECMO group. There was no significant difference in the levels of brain injury biomarkers between cECMO and pECMO groups. Conclusions The hemodynamic data showed that pECMO was superior to cECMO. Based on the biomarker data, neither pECMO nor cECMO for 6 hours caused evidence of brain injury.
Collapse
Affiliation(s)
- Seong Cheol Jeong
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do, Korea
| | - Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeon Soo Shin
- Korea Artificial Organ Center, Korea University, Seoul, Korea
| | - Jung Wook Han
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, Gyeonggi-do, Korea
| | - Ju Yong Lim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea
| | - Ho Sung Son
- Korea Artificial Organ Center, Korea University, Seoul, Korea.,Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea
| |
Collapse
|
48
|
Lo Coco V, Lorusso R, Raffa GM, Malvindi PG, Pilato M, Martucci G, Arcadipane A, Zieliński K, Suwalski P, Kowalewski M. Clinical complications during veno-arterial extracorporeal membrane oxigenation in post-cardiotomy and non post-cardiotomy shock: still the achille's heel. J Thorac Dis 2018; 10:6993-7004. [PMID: 30746245 DOI: 10.21037/jtd.2018.11.103] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is life-saving for potentially reversible heart failure and respiratory injuries not responsive to conventional therapies. Technological innovations have produced over the years significant improvements in ECMO devices (pump, cannula design and oxygenator) and have allowed a better risk/benefit profile. Alongside with recognized advantages in the treatment of very sick patients, ECMO remains an invasive procedure for mechanical circulatory support (MCS) and it is associated with complications that strongly influence the prognosis. Current review was designed to provide a comprehensive outline on ECMO complications, analyzing risk factors and strategies of management, focusing on adult population undergoing veno-arterial ECMO (VA-ECMO) therapy.
Collapse
Affiliation(s)
- Valeria Lo Coco
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Giuseppe M Raffa
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | | | - Michele Pilato
- Department of the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Gennaro Martucci
- Department of Anaesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy
| | - Antonio Arcadipane
- Department of Anaesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy
| | | | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.,Clinical Department of Cardiac Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Poland.,Cardiothoracic Research Centre, Innovative Medical Forum, Bydgoszcz, Poland
| |
Collapse
|
49
|
Pro- and anti-inflammatory biomarkers and traumatic brain injury outcomes: A review. Cytokine 2018; 110:248-256. [DOI: 10.1016/j.cyto.2018.01.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/22/2017] [Accepted: 01/10/2018] [Indexed: 02/06/2023]
|
50
|
Gill J, Mustapic M, Diaz-Arrastia R, Lange R, Gulyani S, Diehl T, Motamedi V, Osier N, Stern RA, Kapogiannis D. Higher exosomal tau, amyloid-beta 42 and IL-10 are associated with mild TBIs and chronic symptoms in military personnel. Brain Inj 2018; 32:1277-1284. [PMID: 29913077 DOI: 10.1080/02699052.2018.1471738] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Identify biomarkers in peripheral blood that relate to chronic post-concussive and behavioural symptoms following traumatic brain injuries (TBIs) to ultimately improve clinical management. RESEARCH DESIGN We compared military personnel with mild TBIs (mTBIs) (n = 42) to those without TBIs (n = 22) in concentrations of tau, amyloid-beta (Aβ42) and cytokines (tumour necrosis factor alpha (TNFα, interleukin (IL)-6 and -10) in neuronal-derived exosomes from the peripheral blood. We utilized nanosight technology coupled with ultra-sensitivity immunoassay methods. We also examined the impact of post-concussive and behavioural symptoms including depression and post-traumatic stress disorder (PTSD) on these neuronal-derived markers. RESULTS We report that concentrations of exosomal tau (F1, 62 = 10.50), Aβ42 (F1, 61 = 5.32) and IL-10 (F1, 59 = 4.32) were elevated in the mTBI group compared to the controls. Within the mTBI group, regression models show that post-concussive symptoms were most related to exosomal tau elevations, whereas exosomal IL-10 levels were related to PTSD symptoms. CONCLUSIONS These findings suggest that chronic post-concussive symptoms following an mTBI relate to altered exosomal activity, and that greater tau pathology may underlie chronic post-concussive symptoms that develop following mTBIs. It also suggests that central inflammatory activity contributes to PTSD symptoms following an mTBI, providing necessary insights into the role of inflammation in chronic PTSD symptoms.
Collapse
Affiliation(s)
- Jessica Gill
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Maja Mustapic
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Ramon Diaz-Arrastia
- c Department of Neurology, School of Medicine , University of Pennsylvania , Philadelphia , PA , United States
| | - Rael Lange
- d Defense and Veterans Brain Injury Center , Walter Reed National Military Medical Center , Bethesda , MD , United States
| | - Seema Gulyani
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Tom Diehl
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| | - Vida Motamedi
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Nicole Osier
- a Tissue Injury Branch, National Institutes of Health, National Institute of Nursing Research , Bethesda , MD , United States
| | - Robert A Stern
- e Neurosurgery, and Anatomy & Neurobiology , Boston University, Boston University Alzheimer's Disease and CTE Center , Boston , MA , United States
| | - Dimitrios Kapogiannis
- b Aging, National Institutes of Health, National Institute of Aging , Baltimore , MD , United States
| |
Collapse
|