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Biomarkers in the Clinical Diagnosis and Management of Traumatic Brain Injury

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Traumatic brain injury (TBI) is the leading cause of death and disability among young adults. Numerous safety improvements in the workplace, the addition of airbags to vehicles, and the enforcement of speed limits have all helped to reduce the incidence and severity of head trauma. While improvements in emergency response times and acute care have increased TBI survivability, this has heightened the necessity for developing reliable methods to identify patients at risk of developing secondary pathologies. At present, the primary clinical indicators for the presence of brain injury are the Glasgow Coma Scale (GCS), pupil reactivity, and head computed tomography (CT). While these indices have proven useful for stratifying the magnitude and extent of brain damage, they have limited utility for predicting adverse secondary events or detecting subtle damage. Biomarkers, reflecting a biological response to injury or disease, have proven useful for the diagnosis of many pathological conditions including cancer, heart failure, infection, and genetic disorders. For TBI, several proteins synthesized in astroglial cells or neurons have been proposed as potential biomarkers. These proteins include the BB isozyme of creatine kinase (CK-BB, predominant in brain), glial fibrilary acidic protein (GFAP), myelin basic protein (MBP), neuron-specific enolase (NSE), and S100B.

The presence of these biomarkers in the cerebrospinal fluid and serum of patients with moderate-to-severe TBI, and their correlation with outcome, suggest that they may have utility as surrogate markers in clinical trials. In addition, many of these markers have been found to be sensitive indicators of injury, and therefore may have the potential to diagnose persons with mild TBI. In addition to biomarkers that correlate with long-term outcome, a few studies have identified prognostic biomarkers for secondary injury that may be useful in individualizing patient management.

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Acknowledgments

The Vivian L. Smith Center for Neurological Research supported the preparation of this review; research in the authors’ laboratories was supported by The Mission Connect/TIRR Foundation and grants from the National Institutes of Health (grant numbers NS35457, NS049160, and MH072933). The funding organizations had no role in the design, conduct, collection, management, analysis, or interpretation of the review.

The authors have no conflicts of interest to report. All those who made relevant contributions to the work have been included as authors.

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Authors and Affiliations

  1. Vivian L. Smith Center for Neurological Research, The University of Texas Health Science Center at Houston, Houston, Texas, USA

    Georgene W. Hergenroeder, John B. Redell, Anthony N. Moore & Pramod K. Dash

  2. Departments of Neurobiology and Anatomy, Neurosurgery,, The University of Texas Health Science Center at Houston, Houston, Texas, USA

    Georgene W. Hergenroeder, John B. Redell, Anthony N. Moore & Pramod K. Dash

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  1. Georgene W. Hergenroeder
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Correspondence to Georgene W. Hergenroeder.

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Hergenroeder, G.W., Redell, J.B., Moore, A.N. et al. Biomarkers in the Clinical Diagnosis and Management of Traumatic Brain Injury. Mol Diag Ther 12, 345–358 (2008). https://doi.org/10.1007/BF03256301

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