Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Role of Serum-Based Neuronal and Glial Markers as Potential Predictors for Distinguishing Severity and Related Outcomes in Traumatic Brain Injury

  • Lee, Jae Yoon (Department of Neurosurgery, Konyang University Hospital) ;
  • Lee, Cheol Young (Department of Neurosurgery, Konyang University Hospital) ;
  • Kim, Hong Rye (Department of Neurosurgery, Konyang University Hospital) ;
  • Lee, Chang-Hyun (Department of Neurosurgery, Konyang University Hospital) ;
  • Kim, Hyun Woo (Department of Neurosurgery, Konyang University Hospital) ;
  • Kim, Jong Hyun (Department of Neurosurgery, Konyang University Hospital)
  • Received : 2015.01.27
  • Accepted : 2015.06.10
  • Published : 2015.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Optimal treatment decision and estimation of the prognosis in traumatic brain injury (TBI) is currently based on demographic and clinical predictors. But sometimes, there are limitations in these factors. In this study, we analyzed three central nervous system biomarkers in TBI patients, will discuss the roles and clinical applications of biomarkers in TBI. Methods : From July on 2013 to August on 2014, a total of 45 patients were included. The serum was obtained at the time of hospital admission, and biomarkers were extracted with centrifugal process. It was analyzed for the level of S-100 beta (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1). Results : This study included 33 males and 12 females with a mean age of 58.5 (19-84) years. TBI patients were classified into two groups. Group A was severe TBI with Glasgow Coma Scale (GCS) score 3-5 and Group B was mild TBI with GCS score 13-15. The median serum concentration of S100B, GFAP, and UCH-L1 in severe TBI were raised 5.1 fold, 5.5 fold, and 439.1 fold compared to mild injury, respectively. The serum levels of these markers correlated significantly with the injury severity and clinical outcome (p<0.001). Increased level of markers was strongly predicted poor outcomes. Conclusion : S100B, GFAP, and UCH-L1 serum level of were significantly increased in TBI according to severity and associated clinical outcomes. Biomarkers have potential utility as diagnostic, prognostic, and therapeutic adjuncts in the setting of TBI.

Keywords

References

  1. Alpert JS, Thygesen K, Antman E, Bassand JP : Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36 : 959-969, 2000 https://doi.org/10.1016/S0735-1097(00)00804-4
  2. Anderson RE, Hansson LO, Nilsson O, Dijlai-Merzoug R, Settergren G : High serum S100B levels for trauma patients without head injuries. Neurosurgery 48 : 1255-1258; discussion 1258-1260, 2001
  3. Baker SP, O'Neill B, Haddon W Jr, Long WB : The injury severity score : a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14 : 187-196, 1974 https://doi.org/10.1097/00005373-197403000-00001
  4. Bell MJ, Kochanek PM, Heyes MP, Wisniewski SR, Sinz EH, Clark RS, et al. : Quinolinic acid in the cerebrospinal fluid of children after traumatic brain injury. Crit Care Med 27 : 493-497, 1999 https://doi.org/10.1097/00003246-199903000-00023
  5. Berger RP, Beers SR, Richichi R, Wiesman D, Adelson PD : Serum biomarker concentrations and outcome after pediatric traumatic brain injury. J Neurotrauma 24 : 1793-1801, 2007 https://doi.org/10.1089/neu.2007.0316
  6. Berger RP, Pierce MC, Wisniewski SR, Adelson PD, Clark RS, Ruppel RA, et al. : Neuron-specific enolase and S100B in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatrics 109 : E31, 2002 https://doi.org/10.1542/peds.109.2.e31
  7. Dimopoulou I, Korfias S, Dafni U, Anthi A, Psachoulia C, Jullien G, et al. : Protein S-100b serum levels in trauma-induced brain death. Neurology 60 : 947-951, 2003 https://doi.org/10.1212/01.WNL.0000049931.77887.7F
  8. Eccles MP, Foy R, Sales A, Wensing M, Mittman B : Implementation Science six years on--our evolving scope and common reasons for rejection without review. Implement Sci 7 : 71, 2012 https://doi.org/10.1186/1748-5908-7-71
  9. Hamm CW, Katus HA : New biochemical markers for myocardial cell injury. Curr Opin Cardiol 10 : 355-360, 1995 https://doi.org/10.1097/00001573-199507000-00003
  10. Hammond FM, Grattan KD, Sasser H, Corrigan JD, Bushnik T, Zafonte RD : Long-term recovery course after traumatic brain injury : a comparison of the functional independence measure and disability rating scale. J Head Trauma Rehabil 16 : 318-329, 2001 https://doi.org/10.1097/00001199-200108000-00003
  11. Hans P, Born JD, Albert A : "Extrapolated" creatine kinase-BB isoenzyme activity in assessment of initial brain damage after severe head injury. J Neurosurg 66 : 714-717, 1987 https://doi.org/10.3171/jns.1987.66.5.0714
  12. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA : Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med 358 : 453-463, 2008 https://doi.org/10.1056/NEJMoa072972
  13. Jackson P, Thompson RJ : The demonstration of new human brain-specific proteins by high-resolution two-dimensional polyacrylamide gel electrophoresis. J Neurol Sci 49 : 429-438, 1981 https://doi.org/10.1016/0022-510X(81)90032-0
  14. Kleiman NS, Lakkis N, Cannon CP, Murphy SA, DiBattiste PM, Demopoulos LA, et al. : Prospective analysis of creatine kinase muscle-brain fraction and comparison with troponin T to predict cardiac risk and benefit of an invasive strategy in patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol 40 : 1044-1050, 2002 https://doi.org/10.1016/S0735-1097(02)02119-8
  15. Kruse A, Cesarini KG, Bach FW, Persson L : Increases of neuron-specific enolase, S-100 protein, creatine kinase and creatine kinase BB isoenzyme in CSF following intraventricular catheter implantation. Acta Neurochir (Wien) 110 : 106-109, 1991 https://doi.org/10.1007/BF01400675
  16. Middeldorp J, Hol EM : GFAP in health and disease. Prog Neurobiol 93 : 421-443, 2011 https://doi.org/10.1016/j.pneurobio.2011.01.005
  17. Mishra A, Srivastava C, Singh SK, Chandra A, Ojha BK : Choroid plexus carcinoma : case report and review of literature. J Pediatr Neurosci 7 : 71-73, 2012 https://doi.org/10.4103/1817-1745.97633
  18. Missler U, Wiesmann M, Friedrich C, Kaps M : S-100 protein and neuron-specific enolase concentrations in blood as indicators of infarction volume and prognosis in acute ischemic stroke. Stroke 28 : 1956-1960, 1997 https://doi.org/10.1161/01.STR.28.10.1956
  19. Missler U, Wiesmann M, Wittmann G, Magerkurth O, Hagenstrom H : Measurement of glial fibrillary acidic protein in human blood : analytical method and preliminary clinical results. Clin Chem 45 : 138-141, 1999
  20. Mondello S, Linnet A, Buki A, Robicsek S, Gabrielli A, Tepas J, et al. : Clinical utility of serum levels of ubiquitin C-terminal hydrolase as a biomarker for severe traumatic brain injury. Neurosurgery 70 : 666-675, 2012
  21. Morganti-Kossmann MC, Hans VH, Lenzlinger PM, Dubs R, Ludwig E, Trentz O, et al. : TGF-beta is elevated in the CSF of patients with severe traumatic brain injuries and parallels blood-brain barrier function. J Neurotrauma 16 : 617-628, 1999 https://doi.org/10.1089/neu.1999.16.617
  22. Papa L, Lewis LM, Silvestri S, Falk JL, Giordano P, Brophy GM, et al. : Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention. J Trauma Acute Care Surg 72 : 1335-1344, 2012 https://doi.org/10.1097/TA.0b013e3182491e3d
  23. Park JE, Kim SH, Yoon SH, Cho KG, Kim SH : Risk Factors Predicting Unfavorable Neurological Outcome during the Early Period after Traumatic Brain Injury. J Korean Neurosurg Soc 45 : 90-95, 2009 https://doi.org/10.3340/jkns.2009.45.2.90
  24. Pelinka LE, Kroepfl A, Leixnering M, Buchinger W, Raabe A, Redl H : GFAP versus S100B in serum after traumatic brain injury : relationship to brain damage and outcome. J Neurotrauma 21 : 1553-1561, 2004 https://doi.org/10.1089/neu.2004.21.1553
  25. Pickett W, Ardern C, Brison RJ : A population-based study of potential brain injuries requiring emergency care. CMAJ 165 : 288-292, 2001
  26. Raabe A, Grolms C, Sorge O, Zimmermann M, Seifert V : Serum S-100B protein in severe head injury. Neurosurgery 45 : 477-483, 1999 https://doi.org/10.1097/00006123-199909000-00012
  27. Ross SA, Cunningham RT, Johnston CF, Rowlands BJ : Neuron-specific enolase as an aid to outcome prediction in head injury. Br J Neurosurg 10 : 471-476, 1996 https://doi.org/10.1080/02688699647104
  28. Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT, et al. : Classification of traumatic brain injury for targeted therapies. J Neurotrauma 25 : 719-738, 2008 https://doi.org/10.1089/neu.2008.0586
  29. Schafer BW, Heizmann CW : The S100 family of EF-hand calcium-binding proteins : functions and pathology. Trends Biochem Sci 21 : 134-140, 1996 https://doi.org/10.1016/S0968-0004(96)80167-8
  30. Siman R, Toraskar N, Dang A, McNeil E, McGarvey M, Plaum J, et al. : A panel of neuron-enriched proteins as markers for traumatic brain injury in humans. J Neurotrauma 26 : 1867-1877, 2009 https://doi.org/10.1089/neu.2009.0882
  31. Usui A, Kato K, Abe T, Murase M, Tanaka M, Takeuchi E : S-100ao protein in blood and urine during open-heart surgery. Clin Chem 35 : 1942-1944, 1989
  32. van Geel WJ, de Reus HP, Nijzing H, Verbeek MM, Vos PE, Lamers KJ : Measurement of glial fibrillary acidic protein in blood : an analytical method. Clin Chim Acta 326 : 151-154, 2002 https://doi.org/10.1016/S0009-8981(02)00330-3
  33. Yamazaki Y, Yada K, Morii S, Kitahara T, Ohwada T : Diagnostic significance of serum neuron-specific enolase and myelin basic protein assay in patients with acute head injury. Surg Neurol 43 : 267-270; discussion 270-271, 1995 https://doi.org/10.1016/0090-3019(95)80012-6
  34. Yoon KH, Han KS, Sung MM : Fabrication of a new type of organic-inorganic hybrid superlattice films combined with titanium oxide and polydiacetylene. Nanoscale Res Lett 7 : 71, 2012 https://doi.org/10.1186/1556-276X-7-71
  35. Zimmer DB, Cornwall EH, Landar A, Song W : The S100 protein family : history, function, and expression. Brain Res Bull 37 : 417-429, 1995 https://doi.org/10.1016/0361-9230(95)00040-2
  36. Zoltewicz JS, Scharf D, Yang B, Chawla A, Newsom KJ, Fang L : Characterization of antibodies that detect human GFAP after traumatic brain injury. Biomark Insights 7 : 71-79, 2012

Cited by

  1. Brain damage after general anesthesia vol.146, pp.9, 2015, https://doi.org/10.1016/j.medcle.2016.06.052
  2. Blood Biomarkers for Evaluation of Perinatal Encephalopathy vol.7, pp.None, 2016, https://doi.org/10.3389/fphar.2016.00196
  3. Biomarkers for acute diagnosis and management of stroke in neurointensive care units vol.2, pp.1, 2015, https://doi.org/10.4103/2394-8108.178546
  4. Biomarkers of Traumatic Brain Injury: Temporal Changes in Body Fluids vol.3, pp.6, 2015, https://doi.org/10.1523/eneuro.0294-16.2016
  5. Acute death of astrocytes in blast-exposed rat organotypic hippocampal slice cultures vol.12, pp.3, 2017, https://doi.org/10.1371/journal.pone.0173167
  6. Effects of Quercetin and Mannitol on Erythropoietin Levels in Rats Following Acute Severe Traumatic Brain Injury vol.60, pp.3, 2017, https://doi.org/10.3340/jkns.2016.0505.015
  7. Differential protein expression in exosomal samples taken from trauma patients vol.11, pp.9, 2015, https://doi.org/10.1002/prca.201700095
  8. Variation in Candidate Traumatic Brain Injury Biomarker Genes Are Associated with Gross Neurological Outcomes after Severe Traumatic Brain Injury vol.35, pp.22, 2015, https://doi.org/10.1089/neu.2017.5268
  9. The diagnostic values of UCH-L1 in traumatic brain injury: A meta-analysis vol.32, pp.1, 2015, https://doi.org/10.1080/02699052.2017.1382717
  10. An update on diagnostic and prognostic biomarkers for traumatic brain injury vol.18, pp.2, 2015, https://doi.org/10.1080/14737159.2018.1428089
  11. A novel method for the rapid detection of post-translationally modified visinin-like protein 1 in rat models of brain injury vol.32, pp.3, 2018, https://doi.org/10.1080/02699052.2017.1418907
  12. Effect of Mannitol Infusion on Optic Nerve Injury After Acute Traumatic Subarachnoid Hemorrhage and Brain Injury vol.29, pp.7, 2015, https://doi.org/10.1097/scs.0000000000004827
  13. Novel Mouse Tauopathy Model for Repetitive Mild Traumatic Brain Injury: Evaluation of Long-Term Effects on Cognition and Biomarker Levels After Therapeutic Inhibition of Tau Phosphorylation vol.10, pp.None, 2015, https://doi.org/10.3389/fneur.2019.00124
  14. A Serum Protein Biomarker Panel Improves Outcome Prediction in Human Traumatic Brain Injury vol.36, pp.20, 2015, https://doi.org/10.1089/neu.2019.6375