Novel inflammatory biomarkers could lead to an effective diagnostic test for TBI

Written by Jonathan Wilkinson, Future Science Group

A research group from University of Birmingham (Birmingham, UK) have published a study reporting the identification of inflammatory biomarkers which may indicate whether the brain has suffered injury. The results were published in the journal Scientific Reports, and could lead to the development of a pitch-side or paramedic test to detect brain injury shortly after an incident has occurred.
Lisa Hill (University of Birmingham), lead author of the study, explained the importance of her group’s research: “Early and correct diagnosis of traumatic brain injury is one of the most challenging aspects facing clinicians. Currently, no reliable biomarkers exist to help diagnose the severity of TBI to identify patients who are at risk of developing secondary injuries that impair function, damage other brain structures and promote further cell death. Thus, the discovery of reliable biomarkers for the management of TBI would improve clinical interventions.”

In their study, the researchers collected blood samples from 30 patients who had suffered a head injury; this took place within an hour of the incident occurring, before they reached a hospital. Subsequent blood samples were then collected at intervals of 4, 12 and 72 hours after injury. A screening process then took place to identify inflammatory biomarkers that correlated with the severity of the injury. A panel of 92 inflammation-associated human proteins were used to analyze the blood samples, which were screened simultaneously.

The screening identified the three inflammatory biomarkers CST5, AXIN1 and TRAIL as early indicators for TBI. More specifically, CST5 identified patients with severe TBI and could do so within the first hour of injury. AXIN1 and TRAIL could discriminate between TBI and uninjured patient controls, also within the first hour.

Valentina Di Pietro (University of Birmingham), another of the study authors, commented: “Early and objective pre-hospital detection of TBI would support clinical decision-making and the correct triage of major trauma. Moreover, the correct diagnosis of TBI, which is one of hardest diagnosis to make in medicine, would allow clinicians to implement strategies to reduce secondary brain injury at early stage, for example, by optimising blood and oxygen delivery to the brain and avoiding manoeuvres that could potentially increase intracranial pressure. In addition, this has potential implications for drug development, as novel compounds could be given immediately after injury and potentially commenced at the roadside, if there was sufficient confidence in the diagnosis of TBI.”

Sources: Hill LJ, Di Pietro V, Hazeldine J et al. Cystatin D (CST5): An ultra-early inflammatory biomarker of traumatic brain injury. Sci. Rep. 7, 5002 doi:10.1038/s41598-017-04722-5 (2017); www.birmingham.ac.uk/university/colleges/mds/news/2017/07/biomarkers-brain-injury.aspx