An update on diagnostic and prognostic biomarkers for traumatic brain injury

ABSTRACT

Introduction: Traumatic brain injury (TBI) is a major worldwide neurological disorder of epidemic proportions. To date, there are still no FDA-approved therapies to treat any forms of TBI. Encouragingly, there are emerging data showing that biofluid-based TBI biomarker tests have the potential to diagnose the presence of TBI of different severities including concussion, and to predict outcome.

Areas covered: The authors provide an update on the current knowledge of TBI biomarkers, including protein biomarkers for neuronal cell body injury (UCH-L1, NSE), astroglial injury (GFAP, S100B), neuronal cell death (αII-spectrin breakdown products), axonal injury (NF proteins), white matter injury (MBP), post-injury neurodegeneration (total Tau and phospho-Tau), post-injury autoimmune response (brain antigen-targeting autoantibodies), and other emerging non-protein biomarkers. The authors discuss biomarker evidence in TBI diagnosis, outcome prognosis and possible identification of post-TBI neurodegernative diseases (e.g. chronic traumatic encephalopathy and Alzheimer’s disease), and as theranostic tools in pre-clinical and clinical settings.

Expert commentary: A spectrum of biomarkers is now at or near the stage of formal clinical validation of their diagnostic and prognostic utilities in the management of TBI of varied severities including concussions. TBI biomarkers could serve as a theranostic tool in facilitating drug development and treatment monitoring.

KEYWORDS:

• Biomarkers
• traumatic brain injury
• diagnostics
• theranostics
• neurotrauma

Declaration of interest

KK Wang is a stockholder of Banyan Biomarkers, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study is supported in part by U.S. DOD TED Seed Project TED1506 (KK Wang), NIH R21NS085455-01 (KK Wang), VA I01 RX001859-02 Merit Award (KK Wang), and Florida State/McKnight Brain Institute BSCIRT Fund (#110587) (KK Wang), NIH RC2 NS069409 (GT Manley), NIH 1U01 NS086090-01 (GT Manley), DOD Grant W81XWH-14-2-0176 (GT Manley), DOD Grant W81XWH-13-1-04 (GT Manley), DOD-Army grant W81XWH-14-2-0166 (R Rubenstein). European Commission Framework Program 7, FP7-HEALTH-2013-INNOVATION-1 grant # 602150-2; (KK Wang; overall PI Andrew Maas, David Menon).