Aptamer-based proteomics in pediatric patients with severe traumatic brain injury: a pilot study

BACKGROUND: Severe traumatic brain injury (sTBI) in children is a major cause of morbidity and mortality, yet its biology and prognostic indicators remain partially defined. Aptamer-based proteomics enables high-throughput characterization of molecular responses and may reveal biomarkers that improve injury characterization and outcome prediction. METHODS: In this prospective, repeated-measures case-control pilot study, we characterized temporal changes in the plasma proteome after pediatric sTBI and evaluated their relationship to short-term outcomes. Plasma samples from children with sTBI (n = 24) were collected at 24- and 72-hours after injury and compared with healthy controls (n = 4). Samples were analyzed using an aptamer-based assay measuring 1297 proteins. Principal component analysis, differential expression testing, and pathway enrichment were performed. Associations with Glasgow Outcome Scale - Extended, Pediatric Revision (GOS-E Peds) scores at hospital discharge and 3-months were examined. RESULTS: = 0.88). CONCLUSION: Temporally resolved plasma proteomics may identify evolving brain and systemic responses after pediatric sTBI that are associated with short-term outcomes. IMPACT: Temporally resolved aptamer-based plasma proteomics reveal dynamic shifts in brain-specific and systemic signaling after pediatric severe traumatic brain injury (sTBI) and correlate with short-term neurologic outcomes. We identify 634 proteins with significant temporal changes, including both established and novel biomarkers, and show that age is a major determinant of proteomic variability in patients with sTBI. This study demonstrates the feasibility and clinical potential of high-dimensional proteomic profiling for biomarker discovery, molecular phenotyping, and potential for outcome prediction, informing future precision medicine approaches in pediatric neurocritical care.