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Bagg MK, Hicks AJ, Hellewell SC, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions. Neurotrauma Rep 2024; 5:424-447. [PMID: 38660461 PMCID: PMC11040195 DOI: 10.1089/neur.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were "roundtable" discussion (n = 30); with facilitation (n = 16); that was iterative (n = 27); and frequently conducted in-person (n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.
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Affiliation(s)
- Matthew K. Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Amelia J. Hicks
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peter A. Cameron
- National Trauma Research Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D. Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
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Fitzgerald M, Ponsford JL, Hill R, Rushworth N, Kendall E, Armstrong E, Gilroy J, Bullen J, Keeves J, Bagg MK, Hellewell SC, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Gabbe BJ. The Australian Traumatic Brain Injury Initiative: Single Data Dictionary to Predict Outcome for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38117144 DOI: 10.1089/neu.2023.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
In this series of eight articles, the Australian Traumatic Brain Injury Initiative (AUS-TBI) consortium describes the Australian approach used to select the common data elements collected acutely that have been shown to predict outcome following moderate-severe traumatic brain injury (TBI) across the lifespan. This article presents the unified single data dictionary, together with additional measures chosen to facilitate comparative effectiveness research and data linkage. Consultations with the AUS-TBI Lived Experience Expert Group provided insights on the merits and considerations regarding data elements for some of the study areas, as well as more general principles to guide the collection of data and the selection of meaningful measures. These are presented as a series of guiding principles and themes. The AUS-TBI Aboriginal and Torres Strait Islander Advisory Group identified a number of key points and considerations for the project approach specific to Aboriginal and Torres Strait Islander peoples, including key issues of data sovereignty and community involvement. These are outlined in the form of principles to guide selection of appropriate methodologies, data management, and governance. Implementation of the AUS-TBI approach aims to maximize ongoing data collection and linkage, to facilitate personalization of care and improved outcomes for people who experience moderate-severe TBI.
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Affiliation(s)
- Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, Victoria, Australia
| | - Nick Rushworth
- Brain Injury Australia, Sydney, New South Wales, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Griffith University, Brisbane, Queensland, Australia
| | - Elizabeth Armstrong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - John Gilroy
- Aboriginal and Torres Strait Islander Research, Faculty of Medicine and Health, The University of Sydney, Sydney New South Wales, Australia
| | - Jonathan Bullen
- Office of DVCA, Curtin University, Bentley, Western Australia, Australia
- Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Jemma Keeves
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew K Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
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Bagg MK, Hellewell SC, Keeves J, Antonic-Baker A, McKimmie A, Hicks AJ, Gadowski A, Newcombe VFJ, Barlow KM, Balogh ZJ, Ross JP, Law M, Caeyenberghs K, Parizel PM, Thorne J, Papini M, Gill G, Jefferson A, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Gabbe BJ, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review of Predictive Value of Biological Markers for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115587 DOI: 10.1089/neu.2023.0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to co-design a data resource to predict outcomes for people with moderate-severe traumatic brain injury (TBI) across Australia. Fundamental to this resource is the data dictionary, which is an ontology of data items. Here, we report the systematic review and consensus process for inclusion of biological markers in the data dictionary. Standardized database searches were implemented from inception through April 2022. English-language studies evaluating association between a fluid, tissue, or imaging marker and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Records were screened using a prioritization algorithm and saturation threshold in Research Screener. Full-length records were then screened in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association, and high-value predictors were discussed in a consensus process. Searches retrieved 106,593 records; 1,417 full-length records were screened, resulting in 546 included records. Two hundred thirty-nine individual markers were extracted, evaluated against 101 outcomes. Forty-one markers were judged to be high-value predictors of 15 outcomes. Fluid markers retained following the consensus process included ubiquitin C-terminal hydrolase L1 (UCH-L1), S100, and glial fibrillary acidic protein (GFAP). Imaging markers included computed tomography (CT) scores (e.g., Marshall scores), pathological observations (e.g., hemorrhage, midline shift), and magnetic resonance imaging (MRI) classification (e.g., diffuse axonal injury). Clinical context and time of sampling of potential predictive indicators are important considerations for utility. This systematic review and consensus process has identified fluid and imaging biomarkers with high predictive value of clinical and long-term outcomes following moderate-severe TBI.
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Affiliation(s)
- Matthew K Bagg
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Medicine, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Jemma Keeves
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Adelle Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Virginia F J Newcombe
- PACE Section, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Karen M Barlow
- Acquired Brain Injury in Children Research Program, Queensland Children's Hospital, Brisbane, QLD, Australia
- Centre for Children's Health Research, University of Queensland, Brisbane, QLD, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Jason P Ross
- Molecular Diagnostic Solutions, Health and Biosecurity, CSIRO, Australia
| | - Meng Law
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Department of Neuroscience and Radiology, Monash University, Alfred Health, Melbourne, VIC, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Paul M Parizel
- University of Antwerp, Edegem, Belgium
- Department of Radiology, Royal Perth Hospital and University of Western Australia, Perth, WA, Australia
- West Australian National Imaging Facility Node, Nedlands, WA, Australia
| | - Jacinta Thorne
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Melissa Papini
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Geena Gill
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Amanda Jefferson
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
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Thorne J, Hellewell SC, Cowen G, Ring A, Jefferson A, Chih H, Gozt AK, Buhagiar F, Thomas E, Papini M, Bynevelt M, Celenza A, Xu D, Honeybul S, Pestell CF, Fatovich D, Fitzgerald M. Symptoms Associated With Exercise Intolerance and Resting Heart Rate Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2024:00001199-990000000-00129. [PMID: 38453632 DOI: 10.1097/htr.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVES People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery. METHODS Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR. RESULTS Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non-sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013). CONCLUSION Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.
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Affiliation(s)
- Jacinta Thorne
- Author Affiliations: School of Allied Health (Ms Thorne and Mr Ring) and Curtin Medical School (Drs Cowen, Jefferson, and Xu), Faculty of Health Sciences, Curtin Health Innovation Research Institute (Mss Thorne and Papini and Drs Hellewell, Cowen, Gozt, Pestell, and Fitzgerald), and School of Population Health (Drs Chih, Thomas, and Xu), Curtin University, Bentley, Western Australia; Perron Institute for Neurological and Translational Science, Nedlands, Western Australia (Mss Thorne and Papini and Drs Hellewell, Gozt, and Fitzgerald); Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia (Mr Ring); School of Psychological Science (Drs Buhagiar and Pestell) and Divisions of Surgery (Dr Thomas) and Emergency Medicine (Dr Celenza), School of Medicine, The University of Western Australia, Nedlands, Western Australia; Neurological Intervention & Imaging Service of Western Australia (Dr Bynevelt) and Emergency Department (Dr Celenza), Sir Charles Gairdner Hospital, Nedlands, Western Australia; The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China (Dr Xu); Sir Charles Gairdner, Royal Perth and Fiona Stanley Hospitals, Perth, Western Australia (Dr Honeybul); Emergency Medicine, Royal Perth Hospital, University of Western Australia (Dr Fatovich); and Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Western Australia (Dr Fatovich)
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Uchakin PN, Hellewell SC, Stowe RP. Editorial: Stress in health and disease: new era and new challenges. Front Physiol 2023; 14:1303345. [PMID: 37900952 PMCID: PMC10613077 DOI: 10.3389/fphys.2023.1303345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Peter N. Uchakin
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA, United States
- Department of Internal Medicine Sciences, Mercer University School of Medicine, Macon, GA, United States
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Crawley, WA, Australia
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Hellewell SC, Granger DA, Cernak I. Blast-Induced Neurotrauma Results in Spatially Distinct Gray Matter Alteration Alongside Hormonal Alteration: A Preliminary Investigation. Int J Mol Sci 2023; 24:ijms24076797. [PMID: 37047768 PMCID: PMC10094760 DOI: 10.3390/ijms24076797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Blast-induced neurotrauma (BINT) frequently occurs during military training and deployment and has been linked to long-term neuropsychological and neurocognitive changes, and changes in brain structure. As military personnel experience frequent exposures to stress, BINT may negatively influence stress coping abilities. This study aimed to determine the effects of BINT on gray matter volume and hormonal alteration. Participants were Canadian Armed Forces personnel and veterans with a history of BINT (n = 12), and first responder controls (n = 8), recruited due to their characteristic occupational stress professions. Whole saliva was collected via passive drool on the morning of testing and analyzed for testosterone (pg/mL), cortisol (μg/dL), and testosterone/cortisol (T/C) ratio. Voxel-based morphometry was performed to compare gray matter (GM) volume, alongside measurement of cortical thickness and subcortical volumes. Saliva analyses revealed distinct alterations following BINT, with significantly elevated testosterone and T/C ratio. Widespread and largely symmetric loci of reduced GM were found specific to BINT, particularly in the temporal gyrus, precuneus, and thalamus. These findings suggest that BINT affects hypothalamic-pituitary-adrenal and -gonadal axis function, and causes anatomically-specific GM loss, which were not observed in a comparator group with similar occupational stressors. These findings support BINT as a unique injury with distinct structural and endocrine consequences.
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Affiliation(s)
- Sarah C Hellewell
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- The Perron Institute for Neurological and Translational Science, Perth, WA 6009, Australia
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA 92697, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ibolja Cernak
- Department of Biomedical Sciences, Mercer University School of Medicine, Columbus, GA 31902, USA
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Lins BR, Anyaegbu CC, Hellewell SC, Papini M, McGonigle T, De Prato L, Shales M, Fitzgerald M. Cannabinoids in traumatic brain injury and related neuropathologies: preclinical and clinical research on endogenous, plant-derived, and synthetic compounds. J Neuroinflammation 2023; 20:77. [PMID: 36935484 PMCID: PMC10026409 DOI: 10.1186/s12974-023-02734-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/13/2023] [Indexed: 03/21/2023] Open
Abstract
Traumatic brain injury is common, and often results in debilitating consequences. Even mild traumatic brain injury leaves approximately 20% of patients with symptoms that persist for months. Despite great clinical need there are currently no approved pharmaceutical interventions that improve outcomes after traumatic brain injury. Increased understanding of the endocannabinoid system in health and disease has accompanied growing evidence for therapeutic benefits of Cannabis sativa. This has driven research of Cannabis' active chemical constituents (phytocannabinoids), alongside endogenous and synthetic counterparts, collectively known as cannabinoids. Also of therapeutic interest are other Cannabis constituents, such as terpenes. Cannabinoids interact with neurons, microglia, and astrocytes, and exert anti-inflammatory and neuroprotective effects which are highly desirable for the management of traumatic brain injury. In this review, we comprehensively appraised the relevant scientific literature, where major and minor phytocannabinoids, terpenes, synthetic cannabinoids, and endogenous cannabinoids were assessed in TBI, or other neurological conditions with pathology and symptomology relevant to TBI, as well as recent studies in preclinical TBI models and clinical TBI populations.
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Affiliation(s)
- Brittney R Lins
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia.
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia.
| | - Chidozie C Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Melissa Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - Terence McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
| | - Luca De Prato
- MediCann Health Aust Pty Ltd, Osborne Park, 6017, Australia
| | - Matthew Shales
- MediCann Health Aust Pty Ltd, Osborne Park, 6017, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, 6102, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
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8
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Lins BR, Anyaegbu CC, McGonigle T, Hellewell SC, Patel P, Reagan H, Rooke-Wiesner C, Warnock A, Archer M, Hemmi JM, Bartlett C, Fitzgerald M. Secondary Degeneration Impairs Myelin Ultrastructural Development in Adulthood following Adolescent Neurotrauma in the Rat Optic Nerve. Int J Mol Sci 2023; 24:ijms24043343. [PMID: 36834755 PMCID: PMC9966883 DOI: 10.3390/ijms24043343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
Adolescence is a critical period of postnatal development characterized by social, emotional, and cognitive changes. These changes are increasingly understood to depend on white matter development. White matter is highly vulnerable to the effects of injury, including secondary degeneration in regions adjacent to the primary injury site which alters the myelin ultrastructure. However, the impact of such alterations on adolescent white matter maturation is yet to be investigated. To address this, female piebald-virol-glaxo rats underwent partial transection of the optic nerve during early adolescence (postnatal day (PND) 56) with tissue collection two weeks (PND 70) or three months later (PND 140). Axons and myelin in the transmission electron micrographs of tissue adjacent to the injury were classified and measured based on the appearance of the myelin laminae. Injury in adolescence impaired the myelin structure in adulthood, resulting in a lower percentage of axons with compact myelin and a higher percentage of axons with severe myelin decompaction. Myelin thickness did not increase as expected into adulthood after injury and the relationship between the axon diameter and myelin thickness in adulthood was altered. Notably, dysmyelination was not observed 2 weeks postinjury. In conclusion, injury in adolescence altered the developmental trajectory, resulting in impaired myelin maturation when assessed at the ultrastructural level in adulthood.
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Affiliation(s)
- Brittney R. Lins
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Chidozie C. Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
- Correspondence:
| | - Terence McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Sarah C. Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Parth Patel
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Harry Reagan
- School of Biological Sciences, The University of Western Australia, Perth, WA 6009, Australia
| | - Cara Rooke-Wiesner
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Andrew Warnock
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Michael Archer
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Jan M. Hemmi
- School of Biological Sciences, The University of Western Australia, Perth, WA 6009, Australia
- Oceans Institute, The University of Western Australia, Perth, WA 6009, Australia
| | - Carole Bartlett
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6845, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA 6009, Australia
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9
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Markovic SJ, Hellewell SC, Doré V, Xia Y, Scott BR, Peiffer JJ, Fitzgerald M, Brown BM. Investigating the Link between Later-Life Brain Volume and Cardiorespiratory Fitness after Mild Traumatic Brain Injury Exposure. Gerontology 2023; 69:201-211. [PMID: 36174542 DOI: 10.1159/000526297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Evidence suggests that maintaining a higher level of cardiorespiratory fitness (CRF) later in life can offer some protection against brain volume loss as we age. By contrast, mild traumatic brain injury (mTBI) could accelerate age-related cortical atrophy. The current study sought to examine whether variations in the CRF level modified the association between mTBI history and brain volumetric measures in a sample of older adults. METHODS Seventy-nine community-dwelling older adults (mean age 68.7 ± 4.3 years, 54.4% female) were assessed for their mTBI history: 25 participants (32%) reported sustaining at least one lifetime mTBI. Participants also underwent a CRF assessment and magnetic resonance imaging (MRI) to obtain global and region-of-interest volumes. RESULTS Analysis of covariance, controlling for age, sex, education, and apolipoprotein (APOE) ε4 allele carriage, revealed that participants with a history of mTBI had a significantly larger total mean grey matter volume (582.21 ± 12.46 cm3) in comparison to participants with no mTBI history (571.08 ± 17.21 cm3, p = 0.01 after correction for multiple comparisons). However, no differences between groups based on mTBI history were found for total white matter volume or in any other cortical or subcortical structures examined. A subsequent moderation analysis found that CRF was predominantly non-influential on the association between mTBI history and the MRI-quantified measures of brain volume. CONCLUSION While unexpected, the findings suggest that a history of mTBI can lead to grey matter alterations in the ageing brain. However, concurrent variations in the CRF level did not influence the differences in brain volume found based on mTBI exposure status.
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Affiliation(s)
- Shaun J Markovic
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Washington, Australia.,Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute, Nedlands, Washington, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Sarich Neuroscience Research Institute Building, Nedlands, Washington, Australia.,Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, Washington, Australia
| | - Vincent Doré
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Queensland, Australia.,Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
| | - Ying Xia
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Queensland, Australia
| | - Brendan R Scott
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Washington, Australia.,Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Washington, Australia
| | - Jeremiah J Peiffer
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Washington, Australia.,Murdoch Applied Sports Science Laboratory, Discipline of Exercise Science, Murdoch University, Perth, Washington, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Sarich Neuroscience Research Institute Building, Nedlands, Washington, Australia.,Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, Washington, Australia
| | - Belinda M Brown
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Perth, Washington, Australia.,Australian Alzheimer's Research Foundation, Sarich Neuroscience Research Institute, Nedlands, Washington, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Washington, Australia
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10
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Toomey LM, Papini M, Lins B, Wright AJ, Warnock A, McGonigle T, Hellewell SC, Bartlett CA, Anyaegbu C, Fitzgerald M. Cuprizone feed formulation influences the extent of demyelinating disease pathology. Sci Rep 2021; 11:22594. [PMID: 34799634 PMCID: PMC8604913 DOI: 10.1038/s41598-021-01963-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/01/2021] [Indexed: 11/09/2022] Open
Abstract
Cuprizone is a copper-chelating agent that induces pathology similar to that within some multiple sclerosis (MS) lesions. The reliability and reproducibility of cuprizone for inducing demyelinating disease pathology depends on the animals ingesting consistent doses of cuprizone. Cuprizone-containing pelleted feed is a convenient way of delivering cuprizone, but the efficacy of these pellets at inducing demyelination has been questioned. This study compared the degree of demyelinating disease pathology between mice fed cuprizone delivered in pellets to mice fed a powdered cuprizone formulation at an early 3 week demyelinating timepoint. Within rostral corpus callosum, cuprizone pellets were more effective than cuprizone powder at increasing astrogliosis, microglial activation, DNA damage, and decreasing the density of mature oligodendrocytes. However, cuprizone powder demonstrated greater protein nitration relative to controls. Furthermore, mice fed control powder had significantly fewer mature oligodendrocytes than those fed control pellets. In caudal corpus callosum, cuprizone pellets performed better than cuprizone powder relative to controls at increasing astrogliosis, microglial activation, protein nitration, DNA damage, tissue swelling, and reducing the density of mature oligodendrocytes. Importantly, only cuprizone pellets induced detectable demyelination compared to controls. The two feeds had similar effects on oligodendrocyte precursor cell (OPC) dynamics. Taken together, these data suggest that demyelinating disease pathology is modelled more effectively with cuprizone pellets than powder at 3 weeks. Combined with the added convenience, cuprizone pellets are a suitable choice for inducing early demyelinating disease pathology.
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Affiliation(s)
- Lillian M Toomey
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia.,Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, WA, 6009, Australia
| | - Melissa Papini
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Brittney Lins
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Alexander J Wright
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Andrew Warnock
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Terence McGonigle
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Sarah C Hellewell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Carole A Bartlett
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Chidozie Anyaegbu
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia. .,Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, 8 Verdun St, Nedlands, WA, 6009, Australia.
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11
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Hellewell SC, Welton T, Pearce AJ, Maller JJ, Grieve SM. Diffusion MRI as a complementary assessment to cognition, emotion, and motor dysfunction after sports-related concussion: a systematic review and critical appraisal of the literature. Brain Imaging Behav 2021; 15:1685-1704. [PMID: 32720180 DOI: 10.1007/s11682-020-00336-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sports-related concussion (SRC) is a complex and heterogeneous injury with psychological, cognitive and functional consequences. Advances in diffusion magnetic resonance imaging (dMRI) allow sensitive measurement of white matter pathology post-SRC and may provide insight into injury and recovery. We systematically reviewed and meta-analyzed the literature examining dMRI alongside cognitive, emotional or motor assessments to determine relationships between these analyses. Sixteen studies examining young athletes (n = 6) or retired professionals (n = 10) met the inclusion criteria, with 12 emotional, 10 cognitive and four motor assessments. Studies had heterogeneous methodology, moderate quality and modest sample sizes. Fractional anisotropy (FA) was the most frequent dMRI metric, with SRC-induced changes described most commonly in the frontal lobe and least in the cerebellum and brainstem. There is an emerging complementary role for dMRI as part of a comprehensive assessment battery for SRC. However, larger-scale studies with broader subject populations (specifically, in females and in the 30-45 year age range) are needed to corroborate findings and determine the true diagnostic utility of dMRI post-SRC.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Alan J Pearce
- School of Allied Health, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jerome J Maller
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia.,General Electric Healthcare, Richmond, VIC, 3181, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2006, Australia. .,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2006, Australia.
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12
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Hellewell SC, Beaton CS, Welton T, Grieve SM. Characterizing the Risk of Depression Following Mild Traumatic Brain Injury: A Meta-Analysis of the Literature Comparing Chronic mTBI to Non-mTBI Populations. Front Neurol 2020; 11:350. [PMID: 32508733 PMCID: PMC7248359 DOI: 10.3389/fneur.2020.00350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. Methods: We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. Results: We included 47 cross-sectional studies (n = 25,103 mTBI and 29,982 control), 26 cohort studies (n = 70,119 mTBI, 262,034 control), four prospective observational studies (n = 1,058 mTBI and 733 control), two prospective longitudinal studies (n = 119 mTBI, 81 control), two case-control studies (n = 56 mTBI, 56 control), and one randomized controlled trial (n = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68–4.03, I2 = 96%). The OR for depression did not change when subjects were assessed at 6–12 months (OR 2.43, 1.45–4.07), years 1–2 (OR 4.12, 2.10–8.07); 2–10 (OR 3.28, 2.42–4.46), or 10+ (OR 3.42, 1.51–7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82–2.81; 25–35: OR 4.67, 3.06–7.14; >35: OR 2.69, 1.42–5.10) and different age at assessment (<40 years: OR 3.14, 2.48–3.99; >40 years: OR 4.57, 2.54–8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39–166.93) compared to male (OR 3.0, 2.33–3.86). mTBI etiology had no impact on depression. Conclusions: Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.
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Affiliation(s)
- Sarah C Hellewell
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Caerwen S Beaton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Thomas Welton
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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13
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Hellewell SC, Conquest A, Little L, Vallance S, Board J, Bellomo R, Cooper DJ, Morganti-Kossmann MC. EPO treatment does not alter acute serum profiles of GFAP and S100B after TBI: A brief report on the Australian EPO-TBI clinical trial. J Clin Neurosci 2020; 76:5-8. [PMID: 32331937 DOI: 10.1016/j.jocn.2020.04.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the diagnostic and prognostic value of glial fibrillary acidic protein (GFAP) and S100B after traumatic brain injury (TBI) in an Erythropoietin (EPO) clinical trial and examine whether EPO therapy reduces biomarker concentrations. MATERIALS AND METHODS Forty-four patients with moderate-to-severe TBI were enrolled to a sub-study of the EPO-TBI trial. Patients were randomized to either Epoetin alfa 40,000 IU or 1 ml sodium chloride 0.9 as subcutaneous injection within 24 h of TBI. RESULTS GFAP and S100B were measured in serum by ELISA from D0 (within 24 h of injury, prior to EPO/vehicle administration) to D5. Biomarker concentrations were compared between injury severities, diffuse vs. focal TBI, 6-month outcome scores (GOS-E) and EPO or placebo treatments. At D0 GFAP was significantly higher than S100B (951 pg/mL vs. 476 pg/mL, p = 0.018). ROC analysis of S100B at 1D post-injury distinguished favorable vs. unfavorable outcomes (area under the curve = 0.73; p = 0.01). EPO did not reduce concentration of either biomarker. CONCLUSIONS Elevated serum concentrations of GFAP and S100B after TBI reflect a robust, acute glial response to injury. Consistent with lack of improved outcome in TBI patients treated with EPO and prior findings on neuronal and axonal markers, glial biomarker concentrations and acute profiles were not affected by EPO.
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Affiliation(s)
- Sarah C Hellewell
- University of Sydney, Sydney, Australia; Department of Surgery, Alfred Hospital, Melbourne, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Alison Conquest
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lorraine Little
- Australian New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Shirley Vallance
- Department of Intensive Care, Alfred Hospital, Melbourne, Australia
| | - Jasmin Board
- Department of Intensive Care, Alfred Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Intensive Care Research, Austin Health, Melbourne, Australia
| | - David J Cooper
- Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Australian New Zealand Intensive Care Research Centre, Melbourne, Australia; Department of Intensive Care, Alfred Hospital, Melbourne, Australia
| | - Maria Cristina Morganti-Kossmann
- Australian New Zealand Intensive Care Research Centre, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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14
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Morganti-Kossmann MC, Semple BD, Hellewell SC, Bye N, Ziebell JM. The complexity of neuroinflammation consequent to traumatic brain injury: from research evidence to potential treatments. Acta Neuropathol 2019; 137:731-755. [PMID: 30535946 DOI: 10.1007/s00401-018-1944-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 12/18/2022]
Abstract
This review recounts the definitions and research evidence supporting the multifaceted roles of neuroinflammation in the injured brain following trauma. We summarise the literature fluctuating from the protective and detrimental properties that cytokines, leukocytes and glial cells play in the acute and chronic stages of TBI, including the intrinsic factors that influence cytokine responses and microglial functions relative to genetics, sex, and age. We elaborate on the pros and cons that cytokines, chemokines, and microglia play in brain repair, specifically neurogenesis, and how such conflicting roles may be harnessed therapeutically to sustain the survival of new neurons. With a brief review of the clinical and experimental findings demonstrating early and chronic inflammation impacts on outcomes, we focus on the clinical conditions that may be amplified by neuroinflammation, ranging from acute seizures to chronic epilepsy, neuroendocrine dysfunction, dementia, depression, post-traumatic stress disorder and chronic traumatic encephalopathy. Finally, we provide an overview of the therapeutic agents that have been tested to reduce inflammation-driven secondary pathological cascades and speculate the future promise of alternative drugs.
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Affiliation(s)
- Maria Cristina Morganti-Kossmann
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Australian New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia.
| | - Bridgette D Semple
- Department of Neuroscience, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC, Australia
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah C Hellewell
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, Heart Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Nicole Bye
- Department of Pharmacy, College of Health and Medicine, University of Tasmania, Sandy Bay, TAS, Australia
| | - Jenna M Ziebell
- Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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15
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Hellewell SC, Cernak I. Measuring Resilience to Operational Stress in Canadian Armed Forces Personnel. J Trauma Stress 2018; 31:89-101. [PMID: 29465774 DOI: 10.1002/jts.22261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/21/2017] [Accepted: 11/23/2017] [Indexed: 11/06/2022]
Abstract
Adaptability to stress is governed by innate resilience, comprised of complex neuroendocrine and immune mechanisms alongside inherited or learned behavioral traits. Based on their capacity to adapt, some people thrive in stressful situations, whereas others experience maladaptation. In our study, we used state-of-the-art tools to assess the resilience level in individuals, as well as their susceptibility to developing military stress-induced behavioral and cognitive deficits. To address this complex question, we tested Canadian Armed Forces (CAF) personnel in three distinct stress environments (baselines): during predeployment training, deployment in Afghanistan, and readjustment upon return to Canada. Our comprehensive outcome measures included psychometric tests, saliva biomarkers, and computerized cognitive tests that used the Cambridge Neuropsychological Automated Test Battery. Participants were categorized based on initial biomarker measurements as being at low-, moderate-, or high stress-maladaptation risk. Biomarkers showed significant changes (ds = 0.56 to 2.44) between baselines, calculated as "delta" changes. Participants at low stress-maladaptation risk demonstrated minimal changes, whereas those at high stress-maladaptation risk showed significant biomarker variations. The psychometric patterns and cognitive functions were likewise affected across baselines, suggesting that the panel of saliva stress biomarkers could be a useful tool for determining the risk of stress maladaptation that can cause psychological and cognitive decline.
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Affiliation(s)
- Sarah C Hellewell
- Canadian Military and Veterans' Clinical Rehabilitation Research Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ibolja Cernak
- Canadian Military and Veterans' Clinical Rehabilitation Research Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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16
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Abstract
The impact acceleration (I/A) model of traumatic brain injury (TBI) was developed to reliably induce diffuse traumatic axonal injury in rats in the absence of skull fractures and parenchymal focal lesions. This model replicates a pathophysiology that is commonly observed in humans with diffuse axonal injury (DAI) caused by acceleration-deceleration forces. Such injuries are typical consequences of motor vehicle accidents and falls, which do not necessarily require a direct impact to the closed skull. There are several desirable characteristics of the I/A model, including the extensive axonal injury produced in the absence of a focal contusion, the suitability for secondary insult modeling, and the adaptability for mild/moderate injury through alteration of height and/or weight. Furthermore, the trauma device is inexpensive and readily manufactured in any laboratory, and the induction of injury is rapid (~45 min per animal from weighing to post-injury recovery) allowing multiple animal experiments per day. In this chapter, we describe in detail the methodology and materials required to produce the rat model of I/A in the laboratory. We also review current adaptations to the model to alter injury severity, discuss frequent complications and technical issues encountered using this model, and provide recommendations to ensure technically sound injury induction.
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Affiliation(s)
- Sarah C Hellewell
- Canadian Military and Veterans' Clinical Rehabilitation Research Program, Faculty of Rehabilitation Medicine, University of Alberta, 3-48, Corbett Hall, Edmonton, AB, Canada, T6G 2G4.
| | - Jenna M Ziebell
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
- Phoenix VA Healthcare System, Phoenix, AZ, USA
- Neuroscience Program, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - M Cristina Morganti-Kossmann
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
- Neuroscience Program, Department of Psychology, Arizona State University, Tempe, AZ, USA
- Department of Epidemiology and Preventive Medicine, Monash University and Australian New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia
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17
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Yan EB, Hellewell SC, Bellander BM, Agyapomaa DA, Morganti-Kossmann MC. Post-traumatic hypoxia exacerbates neurological deficit, neuroinflammation and cerebral metabolism in rats with diffuse traumatic brain injury. J Neuroinflammation 2011; 8:147. [PMID: 22034986 PMCID: PMC3215944 DOI: 10.1186/1742-2094-8-147] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/28/2011] [Indexed: 11/29/2022] Open
Abstract
Background The combination of diffuse brain injury with a hypoxic insult is associated with poor outcomes in patients with traumatic brain injury. In this study, we investigated the impact of post-traumatic hypoxia in amplifying secondary brain damage using a rat model of diffuse traumatic axonal injury (TAI). Rats were examined for behavioral and sensorimotor deficits, increased brain production of inflammatory cytokines, formation of cerebral edema, changes in brain metabolism and enlargement of the lateral ventricles. Methods Adult male Sprague-Dawley rats were subjected to diffuse TAI using the Marmarou impact-acceleration model. Subsequently, rats underwent a 30-minute period of hypoxic (12% O2/88% N2) or normoxic (22% O2/78% N2) ventilation. Hypoxia-only and sham surgery groups (without TAI) received 30 minutes of hypoxic or normoxic ventilation, respectively. The parameters examined included: 1) behavioural and sensorimotor deficit using the Rotarod, beam walk and adhesive tape removal tests, and voluntary open field exploration behavior; 2) formation of cerebral edema by the wet-dry tissue weight ratio method; 3) enlargement of the lateral ventricles; 4) production of inflammatory cytokines; and 5) real-time brain metabolite changes as assessed by microdialysis technique. Results TAI rats showed significant deficits in sensorimotor function, and developed substantial edema and ventricular enlargement when compared to shams. The additional hypoxic insult significantly exacerbated behavioural deficits and the cortical production of the pro-inflammatory cytokines IL-6, IL-1β and TNF but did not further enhance edema. TAI and particularly TAI+Hx rats experienced a substantial metabolic depression with respect to glucose, lactate, and glutamate levels. Conclusion Altogether, aggravated behavioural deficits observed in rats with diffuse TAI combined with hypoxia may be induced by enhanced neuroinflammation, and a prolonged period of metabolic dysfunction.
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Affiliation(s)
- Edwin B Yan
- National Trauma Research Institute, The Alfred Hospital, 89 Commercial Road, Melbourne 3004, Australia
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18
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Hellewell SC, Yan EB, Agyapomaa DA, Bye N, Morganti-Kossmann MC. Post-Traumatic Hypoxia Exacerbates Brain Tissue Damage: Analysis of Axonal Injury and Glial Responses. J Neurotrauma 2010; 27:1997-2010. [DOI: 10.1089/neu.2009.1245] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah C. Hellewell
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Edwin B. Yan
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Doreen A. Agyapomaa
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicole Bye
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - M. Cristina Morganti-Kossmann
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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