Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality worldwide. Prevention is a public health priority, but equally essential is research leading to improvement in clinical outcomes for those affected. Biomarkers for TBI currently in development promise to lead to innovations in clinical management in the near future.
Edited by neuroscientists directing brain biomarker laboratories at their respective academic medical centers, Kennesaw State and the University of Florida, along with an industry leader (the founder of Banyan Biomarkers), this book provides a summary of the latest cutting-edge research findings in the field.
A biomarker for TBI would have potential application across the spectrum of TBI diagnosis: from a point of care test in the field to facilitate triage of potentially life-threatening injuries, to a blood test drawn during an outpatient evaluation of mild TBI to inform prognosis or clarify differential diagnosis of cognitive dysfunction when there is a history of closed head injury. Biomarkers, which can inform TBI extent on a neuropathophysiologic basis, have the potential to empirically refine TBI practice guidelines across disciplines, as well as significantly enhance the precision of TBI-related research. The potential value of such an assay as well as the challenges faced in its development are clearly illustrated in this elegant and compact hardcover book.
Beginning with a description of the clinical relevance of biomarkers for TBI, the book is divided into 13 chapters, each arranged around a particular neuropathophysiologic focus. Highlights include magnetic resonance imaging biomarkers for mild TBI (eg, diffusion tensor imaging), immunological mechanisms underlying chronic traumatic encephalopathy, astroglial proteins as markers of intracerebral hemorrhage, an experimental rat model for blast injury simulating combat TBI, and a description of the regulatory process required for a biomarker candidate to come to market.
The biomarker candidates under consideration are many and include proteins, enzymes, receptors, and cytokines, which transiently leak out of cells and cross the blood brain barrier as a consequence of brain injury enabling their detection in peripheral blood or cerebrospinal fluid. A short list includes glial fibrillary acidic protein and S100B, glutamate receptors, AMPA receptors, and N-methyl-D-aspartic acid receptors, inflammatory cytokines released from activated microglia, ubiquitin C-terminal hydrolase L1, cleaved tau, NR2 peptide, alpha II-spectrin breakdown products, light and heavy chain neurofilaments (neurofilament light and neurofilament heavy) among others. Rather than an exhaustive description of the research related to each putative biomarker, this book presents the biomarkers' data in relationship to each particular chapter's focus, making for more conceptually organized, and entertaining, reading.
Challenges to the search for a TBI-specific biomarker are covered to a limited extent, including the choice of tissue to sample, the optimal timing for measurement and the determination of the normal range, as well as determining the severity or stage of TBI for which the biomarker will be most informative. A biomarker for TBI must separate brain injury from multiple-trauma- and from nontrauma-related neurodegenerative processes. Many of the biomarkers discussed in this book are relevant for research into other neurological conditions, particularly overlapping with stroke.
Biomarkers for Traumatic Brain Injury is an essential reference for investigators, graduate and medical students interested in the mechanisms mediating, and detection of trauma-related neuronal injury. It is an inspiration for clinicians to see how the groundwork is being laid toward the development of biomarkers, which could revolutionize the field of TBI.
Amy Aloysi, MD, MPH
Departments of Psychiatry and Neurology
Icahn School of Medicine at Mount Sinai
New York, NY