Abstract
Mild traumatic brain injury (mTBI) causes persisting post-concussion syndrome for many patients without abnormalities on conventional neuroimaging. Currently, there is no method for identifying at-risk cases at an early stage for directing concussion management and treatment. SNTF is a calpain-derived N-terminal proteolytic fragment of spectrin (αII-spectrin1-1176) generated in damaged axons following mTBI. Preliminary human studies suggest that elevated blood SNTF on the day of mTBI correlates with white matter disruption and lasting brain dysfunction. Here, we further evaluated serum SNTF as a prognostic marker for persistent brain dysfunction in uncomplicated mTBI patients treated in a Level I trauma center emergency department. Compared with healthy controls (n = 40), serum SNTF increased by 92% within 24 h of mTBI (n = 95; p < 0.0001), and as a diagnostic marker exhibited 100% specificity and 37% sensitivity (AUC = 0.87). To determine whether the subset of mTBI cases positive for SNTF preferentially developed lasting brain dysfunction, serum levels on the day of mTBI were compared with multiple measures of brain performance at 90 days post-injury. Elevated serum SNTF correlated significantly with persistent impairments in cognition and sensory-motor integration, and predicted worse performance in each test on a case by case basis (AUC = 0.68 and 0.76, respectively). SNTF also predicted poorer recovery of cognitive stress function from 30 to 90 days (AUC = 0.79–0.90). These results suggest that serum SNTF, a surrogate marker for axonal injury after mTBI, may have potential for the rapid prognosis of lasting post-concussion syndrome and impaired functional recovery following CT-negative mTBI. They provide further evidence linking axonal injury to persisting brain dysfunction after uncomplicated mTBI. A SNTF blood test, either alone or combined with other markers of axonal injury, may have important utilities for research, prognosis, management and treatment of concussion.
Highlights
Mild traumatic brain injury, often referred to as concussion, is the most common neurological injury, occurring at an estimated annual incidence in the United States of 1.4– 3.8 million [1]
In order to compare the serum SNTF level between healthy controls and uncomplicated Mild traumatic brain injury (mTBI) cases on the day of injury and assess its prognostic relationship with long-term brain functional impairment, we developed an improved second-generation electrochemiluminescence-based SNTF immunoassay with high analytical validity
The new immunoassay reliably quantified SNTF in sera from uninjured controls, with levels of the marker in 38 of 40 control sera along with all 95 mTBI patients taken within 24 h of injury being above the lower limit of quantification of 0.55 U (58 femtograms recombinant human SNTF (rhSNTF)), and for all 135 study participants above the lower limit of detection of 0.31 U (32 femtograms rhSNTF)
Summary
Mild traumatic brain injury (mTBI), often referred to as concussion, is the most common neurological injury, occurring at an estimated annual incidence in the United States of 1.4– 3.8 million [1]. In a significant subset of these uncomplicated mTBI cases, brain dysfunction is persistent and its effects debilitating, sometimes for years [2,3,4,5,6,7]. Diffuse axonal injury (DAI) has emerged as a likely primary structural correlate for chronic brain functional impairment after mTBI. In a large animal model mimicking the human biomechanics of mTBI, DAI accompanied by localized blood-brain barrier disruption are the only observable histopathologies [9,10,11,12]. A blood biomarker whose levels relate to mTBI-induced chronic brain dysfunction and the DAI underlying it could have major applications related to mTBI
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