创伤性脑损伤
生物标志物
生物标志物发现
医学
脑震荡
胶质纤维酸性蛋白
病理
生物信息学
蛋白质组学
内科学
毒物控制
生物
伤害预防
急诊医学
精神科
免疫组织化学
生物化学
基因
作者
Stuart J. McDonald,Sandy R. Shultz,Denes V. Agoston
标识
DOI:10.1089/neu.2021.0011
摘要
Blood-based protein biomarkers have revolutionized several fields of medicine by enabling molecular level diagnosis, as well as monitoring disease progression and treatment efficacy. Traumatic brain injury (TBI) so far has benefitted only moderately from using protein biomarkers to improve injury outcome. Because of its complexity and dynamic nature, TBI, especially its most prevalent mild form (mild TBI; mTBI), presents unique challenges toward protein biomarker discovery and validation given that blood is frequently obtained and processed outside of the clinical laboratory (e.g., athletic fields, battlefield) under variable conditions. As it stands, the field of mTBI blood biomarkers faces a number of outstanding questions. Do elevated blood levels of currently used biomarkers—ubiquitin carboxy-terminal hydrolase L1, glial fibrillary acidic protein, neurofilament light chain, and tau/p-tau—truly mirror the extent of parenchymal damage? Do these different proteins represent distinct injury mechanisms? Is the blood–brain barrier a “brick wall”? What is the relationship between intra- versus extracranial values? Does prolonged elevation of blood levels reflect de novo release or extended protein half-lives? Does biological sex affect the pathobiological responses after mTBI and thus blood levels of protein biomarkers? At the practical level, it is unknown how pre-analytical variables—sample collection, preparation, handling, and stability—affect the quality and reliability of biomarker data. The ever-increasing sensitivity of assay systems and lack of quality control of samples, combined with the almost complete reliance on antibody-based assay platforms, represent important unsolved issues given that false-negative results can lead to false clinical decision making and adverse outcomes. This article serves as a commentary on the state of mTBI biomarkers and the landscape of significant challenges. We highlight and discusses several biological and methodological “known unknowns” and close with some practical recommendations.
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