Speaking of Biomarkers…

How about this information out of Canada, from the Montreal Gazette;

The new study enrolled 295 people – 96 of whom had a mild or moderate concussion. They were compared to two “control” groups: normal adult volunteers without any injuries whatsoever, and “non-head injured” patients treated in emergency after a car crash or with a broken bone, but no head trauma.

Some earlier proteins studied in brain injuries have also been found in bones. “So if a patient has multiple trauma with a broken leg and head injury, we can’t tell if the protein is coming from the broken leg, or the brain,” Papa said.

Her team found two proteins were higher only in the blood of patients with a brain injury. “Patients who walked off the street had almost no levels of marker in their blood – we detected almost nothing,” she said.

They took it to the next level by comparing the blood tests to CT scans. The more severe the brain lesions, the higher the protein levels in blood. Papa said the proteins are detect-able in blood within an hour of injury; up to four hours later, they’re still elevated. The study also found that these protein levels were higher in patients who needed urgent surgery.

“The key is, could these proteins tell us in advance how severe the head injury is, and is this patient going to require some kind of neurosurgery?” “There’s really no approved blood test for the brain as we know it right now,” Papa said. “When people come in with heart attacks, you do a blood test to see if there’s heart dam-age.” There are blood tests for the kidneys, liver and thyroid.

More research is needed to validate the findings. But Papa believes a blood test for concussions will be available in emergency departments within five years.

Perhaps we are closer that we think in finding a sideline test?

One thought on “Speaking of Biomarkers…

  1. Jake Benford June 5, 2012 / 22:16

    I think the idea of having a reliable biomarker for mTBI in 5 years is very optimistic. Right now we are still working out exactly what happens at the cellular level with mTBI. It is not enough to try to extrapolate the data we have for severe TBI. We need hard science for what happens with mTBI, and its hard to study. Why, for one reason we do not have a good animal model. We can create severe TBI in animals, that’s easy to see. How do you create a model that inflicts a consistent injury you can not see on a scan, and how do you verify the injury (hard to do serial 7s on a rat).

    Next is the biomarkers we have. They all measure cell injury and/or death, or the brains scar tissue (tau proteins). Right now we do not know if all mTBI causes enough cell injury to cause a biomarker leak, and if they don’t then we want to make the diagnosis and prevent a second injury that will most surely result in a leak. The more cellular injury/death you have, the more scar tissue builds up (tau protein), leading to CTE.

    Last is the rate of release. Lets use the biomarkers we currently have for heart attack as an example. Even when we can see that someone is having a heart attack on the EKG, often the biomarkers will be normal initially because it takes a while for them to “leak” into the blood. The smaller the injury, the more time it takes. This process can take up to 24hrs. In addition, if someone only has unstable angina (think of a car balancing on a cliff, hasn’t gone over yet but could go at any time), all the biomarkers will be negative. These are the people we most desperately want to catch so we can intervene before they have a heart attack. I think the same might be true for mTBI.

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