Polymorphonuclear (PMN) elastase in patients after severe traumatic brain injury

Lukas Kurt Postl,Martijn Van Griensven,Christoph Egginger,Marc Beirer,Viktoria Bogner,Peter Biberthaler,Karl Georg Kanz,Chlodwig Kirchhoff

doi:10.1186/s40001-018-0341-x

Abstract

BackgroundData on PNM elastase levels in cerebrospinal fluid following traumatic brain injury (TBI) in humans are not available in the literature. Therefore, the aim of this prospective study was to evaluate the dynamics of PMN elastase in the cerebrospinal fluid (CSF) of patients after TBI.MethodsPatients suffering from isolated, closed TBI, presenting with an initial Glasgow coma score ≤ 8 and with intracerebral hemorrhage on the initial cranial computed tomography scan (performed within 90 min after TBI) were enrolled. CSF and blood samples were obtained immediately, 12 h, 24 h, 48 h, and 72 h after admission. ELISA testing was used to quantify the PMN elastase levels in CSF. In addition, the ratio of CSF albumin to serum albumin was calculated to evaluate the role of the blood–cerebrospinal fluid barrier (BCSFB). As controls, CSF samples were taken from patients receiving spinal anesthesia for elective orthopedic surgery of the lower extremity.ResultsTwenty-three patients meeting the inclusion criteria and ten control patients were enrolled. The PMN elastase showed a significant elevation at 48 and 72 h after TBI. When comparing the PMN elastase levels of patients with intact BCSFB to patients with defective BCSFB, there was no significant difference for the respective observation points.ConclusionsThis is the first study to demonstrate that the PMN elastase levels in CSF significantly increased in the early posttraumatic phase (48 h and 72 h after TBI) in patients. The function of the BCSFB showed no significant influence on the PMN levels.

Highlights

Data on PNM elastase levels in cerebrospinal fluid following traumatic brain injury (TBI) in humans are not available in the literature
The actual study evaluated for the first time the dynamics of PMN elastase in cerebrospinal fluid of patients suffering from traumatic brain injury in the direct posttraumatic phase
This might indicate that the influx of neutrophilic cells via the blood–cerebrospinal fluid barrier (BCSFB) was regulated in both groups

Summary

Introduction

Data on PNM elastase levels in cerebrospinal fluid following traumatic brain injury (TBI) in humans are not available in the literature. The severity of the primary traumatic injury and the extent of the secondary biomolecular injury cascades determine the outcome [2] Since these secondary injuries might be responsible for the development of neurological deficits, they might serve as a potential target in the development of new therapeutic interventions [3]. Granulocytes or polymorphonuclear (PMN) leukocytes have granules in their cytoplasm which contain elastase that can be secreted. This so-called PMN elastase is involved in the extracellular immune defense of microorganisms. Severe inflammatory conditions can lead to an overload of the human immune system and elastase, especially in combination with oxidants (e.g., H2O2, O2 radicals), which can lead to tissue damage

Objectives

Methods

Results

Discussion

Conclusion