Influence of Blood-Brain Barrier Integrity on Brain Protein Biomarker Clearance in Severe Traumatic Brain Injury: A Longitudinal Prospective Study.
Nelson, David W
Ghatan, Per Hamid
von Horn, Henrik
Agoston, Denes V
Journal of neurotrauma
Mary Ann Liebert
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Lindblad, C., Nelson, D. W., Zeiler, F. A., Ercole, A., Ghatan, P. H., von Horn, H., Risling, M., et al. (2020). Influence of Blood-Brain Barrier Integrity on Brain Protein Biomarker Clearance in Severe Traumatic Brain Injury: A Longitudinal Prospective Study.. Journal of neurotrauma, 37 (12), 1381-1391. https://doi.org/10.1089/neu.2019.6741
Brain protein biomarker clearance to blood in traumatic brain injury (TBI) is not fully understood. The aim of this study was to analyze the effect a disrupted blood-brain barrier (BBB) had on biomarker clearance. Seventeen severe TBI patients admitted to Karolinska University Hospital were prospectively included. Cerebrospinal fluid (CSF) and blood concentrations of S100B and neuron-specific enolase (NSE) were analyzed every 6-12 hours for approximately one week. A). dependent changes in the CSF and blood levels of the two biomarkers were similar but the correlation between the biomarkers and QA was lower for NSE (=0.444) than S100B (=0.668). Since data was longitudinal, we also conducted cross correlation analyses, which indicated a directional flow and lag-time of biomarkers from CSF to blood. For S100B, this lag-time could be ascribed to BBB integrity, whereas for NSE it could not. Upon inferential modelling, using generalized least square estimation (S100B) or linear mixed models (NSE), QA (p=0.045), time from trauma (p<0.001), time from trauma2 (p=0.023) and CSF biomarker levels (p=0.008) were independent predictors of S100B in blood. In contrast, for NSE, only time from trauma was significant (p<0.001). These findings are novel and important, but must be carefully interpreted because of different characteristics between the two proteins. Nonetheless, we present the first data that indicates that S100B and NSE are cleared differently from the central nervous system, and that both the disrupted BBB and additional alternative pathways, such as the recently described glymphatic system, may play a role. This is of importance both for clinicians aiming to utilize these biomarkers and for the pathophysiological understanding of brain protein clearance, but warrants further examination.
External DOI: https://doi.org/10.1089/neu.2019.6741
This record's URL: https://www.repository.cam.ac.uk/handle/1810/301604
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