Biomarkers of primary and evolving damage in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms, and therapeutic decision making.
OBJECTIVE
Emerging data suggest that biomarkers of brain injury have potential utility as diagnostic, prognostic, and therapeutic adjuncts in the setting of traumatic and ischemic brain injury. Two approaches are being used, namely, assessing markers of structural damage and quantifying mediators of the cellular, biochemical, or molecular cascades in secondary injury or repair. Novel proteomic, multiplex, and lipidomic methods are also being applied.


RESULTS
Biochemical markers of neuronal, glial, and axonal damage such as neuron-specific enolase, S100B, and myelin basic protein, respectively, are readily detectable in biological samples such as serum or cerebrospinal fluid and are being studied in patients with ischemic and traumatic brain injury. In addition, a number of studies have demonstrated that novel tools to assess simultaneously multiple biomarkers can provide unique insight such as details on specific molecular participants in cell death cascades, inflammation, or oxidative stress.


CONCLUSIONS
Multifaceted cellular, biochemical, and molecular monitoring of proteins and lipids is logical as an adjunct to guiding therapies and improving outcomes in traumatic and ischemic brain injury and we appear to be on the verge of a breakthrough with the use of these markers as diagnostic, prognostic, and monitoring adjuncts, in neurointensive care.
Kochanek
Patrick M
PM
Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260, USA. kochanekpm@ccm.upmc.edu
Berger
Rachel P
RP
Bayir
Hülya
H
Wagner
Amy K
AK
Jenkins
Larry W
LW
Clark
Robert S B
RS
D015415:Biomarkers; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology*; D003657:Decision Making; D006801:Humans; D007249:Inflammation; D004676:Myelin Basic Protein / Q000032:analysis; D009414:Nerve Growth Factors / Q000032:analysis; D018384:Oxidative Stress; D010751:Phosphopyruvate Hydratase / Q000032:analysis; D011379:Prognosis; D040901:Proteomics; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000032:analysis
D015415:Biomarkers; D004676:Myelin Basic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D010751:Phosphopyruvate Hydratase