Shock/Sepsis/Trauma/Critical Careτ Proteins in Serum Predict Outcome After Severe Traumatic Brain Injury
Introduction
Traumatic brain injury (TBI) is the leading cause of death and disabilities among all traumas 1, 2. The identification of reliable indicators of outcome following TBI is crucial for the determination of appropriate clinical management and for predicting clinical outcome. Reliable prediction of outcome following severe TBI, especially in the early stages, has still not been achieved [3]. Although clinical characteristics such as the Glasgow Coma Scale (GCS) score and imaging studies are well established, there are still some concerns regarding these tools [4]. It would be beneficial to supplement these methods of investigation with some chemical biomarkers for TBI 4, 5, 6, 7, 8, 9, 10, 11.
τ Protein is a microtubule-associated protein that is primarily localized in neuronal cells. τ Binds to axonal microtubules and forms axonal microtubule bundles. These bundles are important structural elements in the axonal cytoskeleton. The level of τ proteins in the serum and cerebrospinal fluid (CSF) can be determined, and it is released from the central nervous system secondarily because of TBI 8, 9, 10, 11. Evidence indicates that τ protein levels are elevated in the CSF 8, 9 and serum following TBI 10, 11. However, data on serum τ protein levels in patients with severe TBI are sparse. The predictive value of serum τ protein levels in determining outcome in cases of severe TBI have not been investigated thoroughly. The aim of the present study is to clarify whether τ protein levels could predict 6-mo outcomes in patients with severe TBI.
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Patients
This study was approved by the local ethics committee of the E-Da Hospital in Taiwan. Prior to enrollment, written informed consent was obtained from each patient's next of kin because all the eligible patients were unconscious. Thirty-four patients, aged 18 y or more, with severe closed head injury who were admitted to the neurosurgical intensive care unit (NICU) at E-Da Hospital, Kaohsiung, Taiwan, within 6 h of injury were enrolled in this study between April 2006 and January 2007. Severe
Results
Figure 1 shows a flow diagram of how patients were included or excluded in the study. The demographic and injury characteristics of patients are shown in Table 1. The τ protein levels (mean ± SD) were 8.1 ± 20.8 pg/mL (range, 0 to 67) in the control group (n = 10), undetectable (< 12 pg/mL) in 9 of the 10 volunteers, and 243.9 ± 387.4 pg/mL (range, 0 to 1882) in the patient group (n = 34). Significant differences were found between the control and patient groups (P < 0.0001). The τ protein
Discussion
The serum τ levels in severe TBI cases (243.9 ± 387.4 pg/mL) were higher than those in healthy volunteers (8.1 ± 20.8 pg/mL) in this study. The findings support the theory that serum τ protein levels could increase after TBI 10, 11. The present study also demonstrated that serum τ levels were significantly higher in the TBI patients with poor outcomes and could be used as an independent prognostic factor for severe TBI. Multivariate analysis revealed that the GCS score and the serum τ protein
Acknowledgment
This work was supported by research grants from the Taiwan National Science Council grant nos. NSC 94-2314-B-214-003 and NSC 95-2314-B-214-006 to PCL.
References (23)
- et al.
The impact of time, legislation, and geography on the epidemiology of traumatic brain injury
J Clin Neurosci
(2007) - et al.
Survey of traumatic intracranial hemorrhage in Taiwan
Surg Neurol
(2006) - et al.
The value of serum τ protein for the diagnosis of intracranial injury in minor head trauma
Am J Emerg Med
(2007) - et al.
Assessment of outcome after severe brain damage
Lancet
(1975) - et al.
Current experiences in the use of the severe head-injury guidelines in Taiwan
Surg Neurol
(2006) - et al.
C-τ biomarker of neuronal damage in severe brain injured patients: Association with elevated intracranial pressure and clinical outcome
Brain Res
(2002) - et al.
Quantification and localization of kainic acid-induced neurotoxicity employing a new biomarker of cell death: Cleaved microtubule-associated protein-τ (C-τ)
Neuroscience
(2003) - et al.
Serum cleaved τ protein levels and clinical outcome in adult patients with closed head injury
Ann Emerg Med
(2002) - et al.
Clinical outcome of severe head injury in different protocol-driven therapies
J Clin Neurosci
(2007) Outcome from severe head injury
Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury
J Trauma
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2020, Brain ResearchCitation Excerpt :In addition, Huber et al have demonstrated that a single blast leads to an increase in phospho and cleaved tau in 24 h post injury and remained elevated for at least 30 days (Huber et al., 2013). Moreover, upregulation of total and phosphorylated tau proteins has been demonstrated in the brain, CSF and blood of patients and also in different animal models of TBI (Goldstein et al., 2012; Liliang et al., 2010; Ost et al., 2006; Zhao et al., 2017), which further indicates the role of tau in TBI. In order to further clarify why Tα1 improves blast induced cognitive dysfunction, we investigated the effect of Tα1 on the expression and phosphorylation of tau protein in the hippocampus by Western Blotting, and we have found for the first time that Tα1 could decrease tau phosphorylation at the Thr205 epitope without affecting phosphorylation of tau protein at the Ser404 and Ser262 epitopes as well as the total tau protein expression in bTBI model.