Comparison of the performances of copeptin and multiple biomarkers in long-term prognosis of severe traumatic brain injury

Enhanced blood levels of copeptin correlate with poor clinical outcomes after acute critical illness. This study aimed to compare the prognostic performances of plasma concentrations of copeptin and other biomarkers like myelin basic protein, glial fibrillary astrocyte protein, S100B, neuron-specific enolase, phosphorylated axonal neurofilament subunit H, Tau and ubiquitin carboxyl-terminal hydrolase L1 in severe traumatic brain injury. We recruited 102 healthy controls and 102 acute patients with severe traumatic brain injury. Plasma concentrations of these biomarkers were determined using enzyme-linked immunosorbent assay. Their prognostic predictive performances of 6-month mortality and unfavorable outcome (Glasgow Outcome Scale score of 1–3) were compared. Plasma concentrations of these biomarkers were statistically significantly higher in all patients than in healthy controls, in non-survivors than in survivors and in patients with unfavorable outcome than with favorable outcome. Areas under receiver operating characteristic curves of plasma concentrations of these biomarkers were similar to those of Glasgow Coma Scale score for prognostic prediction. Except plasma copeptin concentration, other biomarkers concentrations in plasma did not statistically significantly improve prognostic predictive value of Glasgow Coma Scale score. Copeptin levels may be a useful tool to predict long-term clinical outcomes after severe traumatic brain injury and have a potential to assist clinicians.     

肌苷促进脑损伤后神经功能恢复的实验研究

目的：中枢损伤是目前致残率最高的疾病之一,肌苷对于神经损伤后功能恢复的促进作用已经成为研究热点,本研究拟建立一侧前肢瘫痪的大鼠脑外伤模型,证实肌苷治疗促进中枢损伤后上肢功能恢复的有效性,同时初步探索其机制。方法：建立一侧运动皮层冲击损毁的大鼠模型,通过肢体不对称实验、抓取实验等行为学观察证实其惠侧上肢功能受损,后在实验组进行肌苷药物14天,观察28天内上肢功能的恢复情况,与对照组作对比。证实其行为学上的有效性,同时对损伤侧大脑进行顺行BDA染色,探索其内在机制。结果：通过28天的观察发现经过肌苷治疗的的实验组大鼠肢体不对称实验、抓取实验等行为学评分明显好于隐性对照组,顺行BDA染色证实其有促进损伤周围健存皮层突触再生和代偿的作用。结论：肌苷可以促进中枢损伤后大鼠残存神经元得突触再生,使其大脑能在最大程度上代偿其丧失的功能,该药物可能会成为一种新的中枢损伤治疗的前体药物。     

肌苷促进脑损伤后神经功能恢复的实验研究

目的:中枢损伤是目前致残率最高的疾病之一,肌苷对于神经损伤后功能恢复的促进作用已经成为研究热点,本研究拟建立一侧前肢瘫痪的大鼠脑外伤模型,证实肌苷治疗促进中枢损伤后上肢功能恢复的有效性,同时初步探索其机制。方法:建立一侧运动皮层冲击损毁的大鼠模型,通过肢体不对称实验、抓取实验等行为学观察证实其患侧上肢功能受损,后在实验组进行肌苷药物14天,观察28天内上肢功能的恢复情况,与对照组作对比,证实其行为学上的有效性,同时对损伤侧大脑进行顺行BDA染色,探索其内在机制。结果:通过28天的观察发现经过肌苷治疗的的实验组大鼠肢体不对称实验、抓取实验等行为学评分明显好于隐性对照组,顺行BDA染色证实其有促进损伤周围健存皮层突触再生和代偿的作用。结论:肌苷可以促进中枢损伤后大鼠残存神经元得突触再生,使其大脑能在最大程度上代偿其丧失的功能,该药物可能会成为一种新的中枢损伤治疗的前体药物。     

Relationship between plasma leptin levels and clinical outcomes of pediatric traumatic brain injury

High plasma leptin level has been associated with mortality after adult intracerebral hemorrhage. The present study was undertaken to investigate the plasma leptin concentrations in children with traumatic brain injury and to analyze the correlation of leptin with pediatric traumatic brain injury outcome. Plasma leptin concentration of eighty-nine healthy children and 142 children with acute severe traumatic brain injury was measured by enzyme-linked immunosorbent assay. Twenty-six patients (18.3%) died and 42 patients (29.6%) had an unfavorable outcome (Glasgow outcome scale score of 1-3) at 6 months after traumatic brain injury. Upon admission, plasma leptin level in patients was substantially higher than that in healthy controls. A forward stepwise logistic regression selected plasma leptin level as an independent predictor for 6-month mortality and unfavorable outcome of patients. A receiver operating characteristic curve analysis showed plasma leptin level better predicted 6-month mortality and unfavorable outcome. The prognostic value of leptin was similar to that of Glasgow Coma scale score for 6-month clinical outcomes. Thus, plasma leptin level represents a novel biomarker for predicting 6-month clinical outcome in children with traumatic brain injury.     

创伤性颅脑损伤脑脊液代谢谱改变及临床意义

目的:探讨创伤性颅脑外伤患者脑脊液中代谢谱的改变及其临床意义。方法:用高分辨率质子核磁共振代谢组学检验创伤性颅脑损伤对脑化学物质和代谢的影响。在重型创伤性颅脑损伤组(n=6),损伤后的脑脊液分析脑代谢的变化,并与轻,中型颅脑损伤组(n=6)相比较。结果:与轻型,中型颅脑损伤组相比,发现了乙酰乙酸,尿酸,3-硝基酪氨酸升高的证据。3组脑脊液中乙酰乙酸,尿酸,3-硝基酪氨酸含量有显著性差异(p<0.01)。结论:颅脑创伤后脑脊液中乙酰乙酸,尿酸,3-硝基酪氨酸值均有不同程度升高,且升高越明显则病情越严重。说明乙酰乙酸,尿酸,3-硝基酪氨酸可作为颅脑创伤病情的监测指标。     

Oxidative stress and modification of synaptic proteins in hippocampus after traumatic brain injury

Oxidative stress, an imbalance between oxidants and antioxidants, contributes to the pathogenesis of traumatic brain injury (TBI). Oxidative neurodegeneration is a key mediator of exacerbated morphological responses and deficits in behavioral recoveries. The present study assessed early hippocampal sequential imbalance to possibly enhance antioxidant therapy. Young adult male Sprague-Dawley rats were subjected to a unilateral moderate cortical contusion. At various times post-TBI, animals were killed and the hippocampus was analyzed for antioxidants (GSH, GSSG, glutathione peroxidase, glutathione reductase, glutathione-S-transferase, glucose-6-phosphate dehydrogenase, superoxide dismutase, and catalase) and oxidants (acrolein, 4-hydroxynonenal, protein carbonyl, and 3-nitrotyrosine). Synaptic markers (synapsin I, postsynaptic density protein 95, synapse-associated protein 97, growth-associated protein 43) were also analyzed. All values were compared with those for sham-operated animals. Significant time-dependent changes in antioxidants were observed as early as 3 h posttrauma and paralleled increases in oxidants (4-hydroxynonenal, acrolein, and protein carbonyl), with peak values obtained at 24-48 h. Time-dependent changes in synaptic proteins (synapsin I, postsynaptic density protein 95, and synapse-associated protein 97) occurred well after levels of oxidants peaked. These results indicate that depletion of antioxidant systems following trauma could adversely affect synaptic function and plasticity. Early onset of oxidative stress suggests that the initial therapeutic window following TBI appears to be relatively short, and it may be necessary to stagger selective types of antioxidant therapy to target specific oxidative components.     

The influence of acceleration loading curve characteristics on traumatic brain injury

To prevent brain trauma, understanding the mechanism of injury is essential. Once the mechanism of brain injury has been identified, prevention technologies could then be developed to aid in their prevention. The incidence of brain injury is linked to how the kinematics of a brain injury event affects the internal structures of the brain. As a result it is essential that an attempt be made to describe how the characteristics of the linear and rotational acceleration influence specific traumatic brain injury lesions. As a result, the purpose of this study was to examine the influence of the characteristics of linear and rotational acceleration pulses and how they account for the variance in predicting the outcome of TBI lesions, namely contusion, subdural hematoma (SDH), subarachnoid hemorrhage (SAH), and epidural hematoma (EDH) using a principal components analysis (PCA). Monorail impacts were conducted which simulated falls which caused the TBI lesions. From these reconstructions, the characteristics of the linear and rotational acceleration were determined and used for a PCA analysis. The results indicated that peak resultant acceleration variables did not account for any of the variance in predicting TBI lesions. The majority of the variance was accounted for by duration of the resultant and component linear and rotational acceleration. In addition, the components of linear and rotational acceleration characteristics on the x, y, and z axes accounted for the majority of the remainder of the variance after duration.     

Prognostic value of copeptin: one-year outcome in patients with traumatic brain injury

High plasma copeptin level has been associated with one-month mortality after traumatic brain injury. However, not much is known regarding its relation with long-term outcome. Thus, we investigated the ability of copeptin to predict 1-year outcome in patients with traumatic brain injury. One hundred and six healthy controls and 106 patients with acute severe traumatic brain injury were included. Plasma samples were obtained on admission. Its concentration was measured by enzyme-linked immunosorbent assay. Forty-eight patients (45.3%) suffered from unfavorable outcome (Glasgow Outcome Scale score of 1-3) and 31 patients (29.2%) died in 1 year after traumatic brain injury. Upon admission, plasma copeptin level in patients was substantially higher than that in healthy controls. A forward stepwise logistic regression selected plasma copeptin level as an independent predictor for 1-year unfavorable outcome and mortality of patients. A receiver operating characteristic curve analysis showed plasma copeptin level predicted 1-year unfavorable outcome and mortality obviously. The predictive value of the copeptin concentration was thus similar to that of Glasgow Coma Scale score for the prediction of unfavorable outcome and mortality after 1 year. In a combined logistic-regression model, copeptin improved the area under curve of Glasgow Coma Scale score for the prediction of unfavorable outcome and mortality after 1 year, but the differences were not significant. Thus, copeptin level is a useful, complementary tool to predict functional outcome and mortality 1 year after traumatic brain injury.     

Neurobehavioral sequelae of traumatic brain injury: evaluation and management

Traumatic brain injury (TBI) is a worldwide public health problem. Over the last several decades, improvements in acute care have resulted in higher survival rates. Unfortunately, the majority of survivors of moderate and severe TBI have chronic neurobehavioral sequelae, including cognitive deficits, changes in personality and increased rates of psychiatric illness. These neurobehavioral problems are understandable in the context of the typical profile of regional brain damage associated with trauma. This paper presents an overview of the neurobehavioral sequelae of TBI and outlines issues to consider in the evaluation and management of these challenges.     

Progesterone and vitamin D: Improvement after traumatic brain injury in middle-aged rats

Progesterone (PROG) and vitamin D hormone (VDH) have both shown promise in treating traumatic brain injury (TBI). Both modulate apoptosis, inflammation, oxidative stress, and excitotoxicity. We investigated whether 21 days of VDH deficiency would alter cognitive behavior after TBI and whether combined PROG and VDH would improve behavioral and morphological outcomes more than either hormone alone in VDH-deficient middle-aged rats given bilateral contusions of the medial frontal cortex. PROG (16 mg/kg) and VDH (5 μg/kg) were injected intraperitoneally 1 h post-injury. Eight additional doses of PROG were injected subcutaneously over 7 days post-injury. VDH deficiency itself did not significantly reduce baseline behavioral functions or aggravate impaired cognitive outcomes. Combination therapy showed moderate improvement in preserving spatial and reference memory but was not significantly better than PROG monotherapy. However, combination therapy significantly reduced neuronal loss and the proliferation of reactive astrocytes, and showed better efficacy compared to VDH or PROG alone in preventing MAP-2 degradation. VDH + PROG combination therapy may attenuate some of the potential long-term, subtle, pathophysiological consequences of brain injury in older subjects.     

Addressing the needs of traumatic brain injury with clinical proteomics

Background

Neurotrauma or injuries to the central nervous system (CNS) are a serious public health problem worldwide. Approximately 75% of all traumatic brain injuries (TBIs) are concussions or other mild TBI (mTBI) forms. Evaluation of concussion injury today is limited to an assessment of behavioral symptoms, often with delay and subject to motivation. Hence, there is an urgent need for an accurate chemical measure in biofluids to serve as a diagnostic tool for invisible brain wounds, to monitor severe patient trajectories, and to predict survival chances. Although a number of neurotrauma marker candidates have been reported, the broad spectrum of TBI limits the significance of small cohort studies. Specificity and sensitivity issues compound the development of a conclusive diagnostic assay, especially for concussion patients. Thus, the neurotrauma field currently has no diagnostic biofluid test in clinical use.

Content

We discuss the challenges of discovering new and validating identified neurotrauma marker candidates using proteomics-based strategies, including targeting, selection strategies and the application of mass spectrometry (MS) technologies and their potential impact to the neurotrauma field.

Summary

Many studies use TBI marker candidates based on literature reports, yet progress in genomics and proteomics have started to provide neurotrauma protein profiles. Choosing meaningful marker candidates from such ‘long lists’ is still pending, as only few can be taken through the process of preclinical verification and large scale translational validation. Quantitative mass spectrometry targeting specific molecules rather than random sampling of the whole proteome, e.g., multiple reaction monitoring (MRM), offers an efficient and effective means to multiplex the measurement of several candidates in patient samples, thereby omitting the need for antibodies prior to clinical assay design. Sample preparation challenges specific to TBI are addressed. A tailored selection strategy combined with a multiplex screening approach is helping to arrive at diagnostically suitable candidates for clinical assay development. A surrogate marker test will be instrumental for critical decisions of TBI patient care and protection of concussion victims from repeated exposures that could result in lasting neurological deficits.     

Neuroglobin expression and oxidant/antioxidant balance after graded traumatic brain injury in the rat

Neuroglobin is a neuron-specific hexacoordinated globin capable of binding various ligands, including O₂, NO, and CO, the biological function of which is still uncertain. Various studies seem to indicate that neuroglobin is a neuroprotective agent when overexpressed, acting as a potent inhibitor of oxidative and nitrosative stress. In this study, we evaluated the pathophysiological response of the neuroglobin gene and protein expression in the cerebral tissue of rats sustaining traumatic brain injury of differing severity, while simultaneously measuring the oxidant/antioxidant balance. Two levels of trauma (mild and severe) were induced in anesthetized animals using the weight-drop model of diffuse axonal injury. Rats were then sacrificed at 6, 12, 24, 48, and 120 h after traumatic brain injury, and the gene and protein expression of neuroglobin and the concentrations of malondialdehyde (as a parameter representative of reactive oxygen species-mediated damage), nitrite + nitrate (indicative of NO metabolism), ascorbate, and glutathione (GSH) were determined in the brain tissue. Results indicated that mild traumatic brain injury, although causing a reversible increase in oxidative/nitrosative stress (increase in malondialdehyde and nitrite + nitrate) and an imbalance in antioxidants (decrease in ascorbate and GSH), did not induce any change in neuroglobin. Conversely, severe traumatic brain injury caused an over nine- and a fivefold increase in neuroglobin gene and protein expression, respectively, as well as a remarkable increase in oxidative/nitrosative stress and depletion of antioxidants. The results of this study, showing a lack of effect in mild traumatic brain injury as well as asynchronous time course changes in neuroglobin expression, oxidative/nitrosative stress, and antioxidants in severe traumatic brain injury, do not seem to support the role of neuroglobin as an endogenous neuroprotective antioxidant agent, at least under pathophysiological conditions.     

Extracellular vesicles: pathogenetic,diagnostic and therapeutic value in traumatic brain injury

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Accurate classification according to injury-specific and patient-specific characteristics is critical to help informed clinical decision-making and to the pursuit of precision medicine in TBI. Reliable biomarker signatures for improved TBI diagnostics are required but still an unmet need.

Areas covered: Extracellular vesicles (EVs) represent a new class of biomarker candidates in TBI. These nano-sized vesicles have key roles in cell signaling profoundly impacting pathogenic pathways, progression and long-term sequelae of TBI. As such EVs might provide novel neurobiological insights, enhance our understanding of the molecular mechanisms underlying TBI pathophysiology and recovery, and serve as biomarker signatures and therapeutic targets and delivery systems.

Expert commentary: EVs are fast gaining momentum in TBI research, paving the way for new transformative diagnostic and treatment approaches. Their potential to sort out TBI variability and active involvement in the mechanisms underpinning different clinical phenotypes point out unique opportunities for improved classification, risk-stratification ad intervention, harboring promise of predictive, personalized, and even preemptive therapeutic strategies. Although a great deal of progress has been made, substantial efforts are still required to ensure the needed rigorous validation and reproducibility for clinical implementation of EVs.     

Minocycline improves the functional recovery after traumatic brain injury via inhibition of aquaporin-4

Traumatic brain injury (TBI) is one of the main concerns worldwide as there is still no comprehensive therapeutic intervention. Astrocytic water channel aquaporin-4 (AQP-4) system is closely related to the brain edema, water transport at blood-brain barrier (BBB) and astrocyte function in the central nervous system (CNS). Minocycline, a broad-spectrum semisynthetic tetracycline antibiotic, has shown anti-inflammation, anti-apoptotic, vascular protection and neuroprotective effects on TBI models. Here, we tried to further explore the underlying mechanism of minocycline treatment for TBI, especially the relationship of minocycline and AQP4 during TBI treatment. In present study, we observed that minocycline efficaciously reduces the elevation of AQP4 in TBI mice. Furthermore, minocycline significantly reduced neuronal apoptosis, ameliorated brain edema and BBB disruption after TBI. In addition, the expressions of tight junction protein and astrocyte morphology alteration were optimized by minocycline administration. Similar results were found after treating with TGN-020 (an inhibitor of AQP4) in TBI mice. Moreover, these effects were reversed by cyanamide (CYA) treatment, which notably upregulated AQP4 expression level in vivo. In primary cultured astrocytes, small-interfering RNA (siRNA) AQP4 treatment prevented glutamate-induced astrocyte swelling. To sum up, our study suggests that minocycline improves the functional recovery of TBI through reducing AQP4 level to optimize BBB integrity and astrocyte function, and highlights that the AQP4 may be an important therapeutic target during minocycline treating for TBI.     

清醒小鼠严重颅脑闭合性撞击伤模型的建立

目的-建立一种清醒小鼠严重颅脑闭合性撞击伤模型, 模拟交通事故和战伤中的清醒致伤过程, 为相关研究创造新的动物模型基础。方法-将雄性KM小鼠头戴钢盔后清醒固定, 用BIM III型小型多功能动物撞击机击打, 致伤后2 h、8 h、24 h、48 h、72 h、120 h、1 w、2 w进行神经行为学评分、运动功能评分、死亡小鼠脑组织和肺组织水含量、死亡率、病理切片和电镜观察。结果-致伤后 48 h内致伤组运动功能评分、神经行为学评分明显低于对照组 (P<0 05); 致伤后死亡率高, 各组死亡小鼠脑组织水含量无明显差异, 但致伤组肺组织水含量明显高于对照组 (P <0 05); 病理切片和电镜检查显示, 致伤后脑组织细胞肿胀、坏死。结论-基本成功建立了模拟交通事故和战伤的清醒小鼠严重颅脑闭合性撞击伤模型。     

切断海马伞对大鼠硬性脑挫伤后运动行为恢复的影响

硬性挫伤运动皮层诱发大鼠偏瘫及其随后的行为代偿是研究中枢神经可塑性的一个理想模型。本工作观察了切断海马伞对脑挫伤后行为恢复的影响。结果表明：与对照组相比,(1)切断海马伞—穹隆通路明显延缓了大鼠运动平衡能力的恢复;(2)切断海马伞—穹隆通路后,银杏类黄酮(FGb)失去了促进脑挫伤后运动平衡能力恢复的作用;(3)原位杂交显示,脑损伤后海马DG(齿状回)和CA3区中生长相关蛋白(GAP—43)mRNA的水平明显提高;(4)FGb促进脑损伤后海马DG和CA3区中的GAP—43mRNA水平的上调。这些信息提示,海马参与脑硬性挫伤后的运动代偿,FGb促进脑损伤后的运动行为的恢复可能与海马相关[动物学报49(2)：211-217,2003]。     

在大鼠创伤性脑损伤模型中神经干细胞移植对突触素表达的影响

目的探讨神经干细胞（NSCs）移植对创伤性脑损伤（TBI）模型大鼠感觉运动功能的恢复作用及其对损伤脑组织中突触素（SYP）表达的影响。方法体外培养大鼠胚胎皮质NSCs;采用Feeney法制备TBI模型,于造模后72h,移植组采用PKH26荧光示踪剂标记的NSCs直接移植于脑损伤区,对照组以等量生理盐水代替NSCs;分别于移植后不同时间点,采用Gridwalk和Latency试验检测TBI大鼠的感觉运动功能;荧光显微镜下计数移植细胞的存活数量;采用免疫印迹和RT-PCR技术检测脑损伤区及周围组织中SYP的表达。结果 NSCs移植大鼠前、后肢功能分别在移植后第2w和4w恢复至手术前水平,而直到第8w,对照组大鼠后肢功能和通过平板移动时间与NSCs移植组和基线比较仍有显著性差异（P〈0.05）。移植的NSCs随移植时间延长存活数量减少,移植后第4w和8w的存活数分别为6.3%±1.0%和4.1%±0.9%。在移植后的8w期间,移植组脑损伤区及周围组织中SYP的表达均明显高于对照组（P〈0.05）。结论移植的NSCs在TBI脑内能够存活,并明显改善了TBI大鼠对侧肢体的感觉运动功能;NSCs移植促进了脑损伤区及周围组织中SYP的表达,这可能是NSCs移植促进功能恢复的机理之一。